SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

EDITED BY

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

TROFESSOR OF STECIAL AND COMPARATIVE ANATOMY IN THE MEDICAL COLLEGE OF GEORGIA

AND

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

DEMONSTRATOR OK AN ATOM T IN TUG MEDICAL COLLEGE OV GEORGIA.

MKDICAL COI.LKGE OF GEORGIA.

Je prcnds Ic bicn on je la trouve.

VOL. XV. 1859. NEW SERIES.

AUGUSTA, GA:

J. MORRIS, PRINTER AND PUBLISHER.

1850.

SOUTHERN

MEDICAL AID SURGICAL JOURNAL.

(NEW SERIES.)

Vol. I?.] AUGUSTA, GEORGIA, JANUARY, 1859. [No. 1.

ORIGINAL AND ECIECTIC.

ARTIC*^ I-

A Case of Hydrophobia from the Bite of a Pole- Cat Tracheotomy*
By R. De Jernett, M. D., of Greeneville, Texas.

[The following well written report presents, in a graphic man-
ner, the details of one of those touching and painful cases,
which too often present themselves as gloomy episodes in
the physician's life. The experiment with the operation of
Tracheotomy, and the Doctor's inquiries in relation to the
nature of the animal poison producing hydrophobia^ are sub-
jects of deep interest to the profession, and render the case one
of much importance, as a record of that mysterious and terrific
affection :]

Called February 24th to see Amanda S , age ten years.

About the 8th of January she was bitten by a Pole-cat, in the
night, while sleeping. Her father hearing her cry, went to her
relief, and had to choke the cat before he could disengage its
hold. He remarked, it was sucking the blood from the wound,
which was inflicted on right side of her mouth, in the lip. It
was thrown out and killed by a dog, which was also bitten, but
did not manifest any symptoms of the disease up to the 2
February, when he was killed, fearing the disease might yet be
developed.

N. S. VOL. XV. NO. I. 1

4 De Jernett. Case of Hydrophobia. [January,

The bite on A. S swelled the face, and was painful for

four days ; then healed as a bite of any kind would, and her
health was good until Sunday, Feb. 21st, when her parents ob-
served she was stupid and inclined to sleep. The patient spoke
of an itching sensation in the cicatrix.

22nd. Patient slept most of the day, and when not sleeping,
rather petulent ; still complains of itching in the cicatrix ; appe-
tite very good.

Vd. Symptoms, so far as could be learned, were very mueh
ai yesterday, with this exception has no appetite to eat.

54th. Patient arose from bed before day, and said she felt
better than she had for three days ; but in the course of an hour
complained of spasms about tW>. fauces, in attempting to swal-
low fluids; yet she tonld swallow aol ids with impunity. The
family became alarmed, a*d Dr. Patterson was called in. The
Doctor told me, when he wa getting the history of the case,
that, lie had some fears it was a case of hydrophobia ; but not
being satisfied, and as the case presented some symptoms of
worms, he gave a dose of calomel, and

The case grew worse very fast, and Dr. P. was r*r\t for again
at 3 o'clock P. M. He found her very restless, with jactitation
of limbs and occasional slight spasms; he requested the parents
to send for me.

When T saw her, 10 o'clock P.M., she was in bed, and very
restless. Her father brought her to the fire, and seated her in a
large rocking-chair, and she assumed an erect position, with her
thrown back, her face flushed; in the countenance
was fearful expression of anxiety. She addressed

me tone of voice: said "I am bitten by a Pole-

cats me?" then seemed to smile with a forced

effort, hi eing very much contorted. 'I was informed by

Dr. P. that her pulse had been low and irregular during the even-
ing, the extremities had been cold and moist. Dr. P. had given
ammonia, quinine, and some of the antispasmodics, with no
other effect than thai ;ng the pulse. I asked her if she

had any pain? She in the forehead, the back of

neck, and at times undei num. "We gave opium, with a

hope of tranquil izing the system and procuring sleep, but in
vain. She said there was a mat of long hair in her right eye.

1859.] De JERNETT. Case of Hydrophobia. 5

I could not see anything, though it was red, and running wa-
ter the left was also discharging tears, but not so much as the
right ; the pupils of both, very much dilated.

1 1 o'clock P. M. Pulse irregular, but frequent ; extremities
cold and moist; stomach irritable, constantly spitting a tenace-
ous mucous, and complained of something rising in her throat
about the size of her little finger, and on trying to get it out, it
would slip down. By pressing forward the tongue with a spoon,
I could see a tenaceous and frothy substance rise up, in a conical
shape, to the posterior nares, which interfered with the free ac-
tion of the epiglottis ; she would become restless, and throw
herself back suddenly, as if badly frightened. Her mouth was
widely opened during the inspection. When bidden, she would
do anything that promised relief. The panic either proceeded
from the difficulty in respiration, caused by this substance rising
in the throat, or from the slipping of the spoon on the tongue,
in her efforts to breathe; the latter is probable, because by titil-
lating the skin on any part of the body, or passing a current of
air on the skin, produced these shuddering tremors.

I had a cup of water brought, and requested her to take some.
She said " I want it, and will try to drink." Violent agita-
tion of the whole body supervened ; finally, rallying sufficient
power, she clutched it with both hands, and with a quick
movement put it to her mouth. It did not more than touch the
mouth, when it was thrown off with violence, and the body
convulsed. She was also tried with milk, and with the same
result. Her eyes were always directed to one side of the fluid
till the moment of seizing it. 12 o'clock. Took about 6 ounces
of blood from the arm, and gave 2 grains opium; sinapisms to
the extremities; but could not be retained, owing to restlessness.
1 o'clock A. M. Gave, by inhalation, two drachms chloroform,
which only exasperated the symptoms. Her symptoms all grew
worse, vomiting came on, and at times delirium, when she
would spring from imaginary evils and halloo at the top of her
voice, and occasionally bite the bed-clothes.

Standing by, only to witness the futility of the means
employed while the disease was clinging on with unrelenting
tenacity we resolved to act upon the suggestion of Dr. Rey-
nolds, of Bellveue Hospital, to open the trachea, and introduce

6 Teent, on the Treatment of Intermittents. [January,

a tube. I proceeded to do so, and she breathed somewhat easier.
In this, our dernier resort, we did not entertain a sanguine hope
of success, for we were expecting death to occur every minute ;
but asphyxia seemed to be the threatening evil. If this had
been done twelve hours sooner, I believe it would have saved
the patient ; but death occurred suddenly, in a hard convulsion,
at 4 o'clock A. M., half hour after the trachea was opened, and
sixteen hours from the time the disease was fully developed.
The cicatrix, after death, was of a livid hue. No post-mortem
examination.

Most writers believe this disease results from the entrance
into the blood of the poison of a rabbid animal. To this opin-
ion, I cannot be reconciled; for this, with five other cases,
within the last six years, have been bitten by these cats, and
only two escaped the disease ; and in one of them an extensive
ulceration was set up in and about the wound. Only one dog
has been known to have the disease during these six years.
These cats are numerous in this country, and our dogs kill them
frequently, and are bitten by the cats, yet the dogs do not have
the disease.

I would like that some writer, able to do this subject justice,
would give his views on the above facts.

AKTICLE II.

Apocynum Cannabinum, as an Antiperiodic in the Treatment of
Inter mittents. By Peteefield Teent, M. D., of Eichmond,
Virginia.

Sometime during the fall of 1856, while conversing with my
friend, Dr. E. S. Cauthorn, of this city, I mentioned how disap-
pointed I had recently been in the treatment of intermittents
with quinia. Dr. C. called my attention to the value of the
Apocynum Cannabinum of the U. S. Dispensatory in the treat-
ment of Intermittents, and related to me his experience of its
use. In the May number of the American Journal of Medical
Sciences, for 1833, Dr. Griscom, of New York, has an interest-
ing and able paper upon the history of this plant, together with
its chemical and medical properties. Dr. Knapp has also given

1859.] Trent, on the Treatment of Inter mittents. 7

his experience of its medicinal virtues in the treatment of Pneu-
monic affections, and Dysentery. Dr. Mott has also used it suc-
cessfully in Dropsy ; and by Dr. Rush it has been styled the
vegetable trocar. In the present instance, I only design to notice
its effects in the treatment of Intermittents, as have occurred in
my own practice.

Case I. Abram, a slave. I received a message from my
overseer, that my servant Abram had been laid up for some
time with chills, having one every day. He had been for
sometime liable to periodical returns of fever and ague. I sent
120 grains of quinine, and directed it to be made into twelve
pills one to be given ever two hours, until three pills were
taken each day before the chill was expected. About a week
after, I received a note, stating that Abram still continued to
have a chill each day, and the overseer feared, unless they were
speedily checked, his health would entirely give way. Dr.
Cauthorn having very kindly given me a specimen of the plant,
I powdered a portion of the root, and after sifting it, I made up
about two dozen pills of 5 grains each. I ordered 12 grains
calomel and 12 grains jalap, to be given the patient at bedtime
next morning to give one of the pills of the Apocynum Canna-
binum every two hours, until four pills had been taken. After
taking some ten or twelve of the pills his chills entirely ceased,
and he has never had one since, to my knowledge.

Case II. Mrs. A. Upon visiting my patient, I found the
chill had just gone off, and the fever rising. Her tongue was
furred, and she complained of pain in her head and back. Up-
on enquiry, I found this was her second chill, having had one
the day previous. I ordered two comp. cath. pills (Tilden's),
to be taken at bedtime at 8 o'clock the next morning to take
one of the following pills every two hours until four had been
taken: $. Apocynum Cannabinum, 3j.

Olei Mg. Pip. gttae. xvj.

Syrup, q. s. M. ft. pil. No. xij.

Second visit to Mrs. A. Found my patient had had that day a
slight return of her chill ; the medicine had produced profuse
perspiration; her tongue was cleaner; her bowels had been

8 Trent, on the Treatment of Inter mittents. [January,

freely opened ; the last pills taken had produced some nausea.
I ordered the pills to be continued as previously ordered.

Third visit. Found Mrs. A. sitting up. No return of her
chill. Ordered her to take one of the remaining pills morning
and night, until she had taken the whole twelve. Her chills
have never returned.

Case III. Called to see Mrs. C, an old patient of mine,
whom I had treated with quinine, for chills, the two previous
falls. Upon enquiry, learned that Mrs. C. had, previous to send-
ing for me, resorted to my former quinine prescription, but
failed in stopping the chills. She had considerable fever, and
complained of her limbs aching; her tongue was but slightly
furred. I directed two comp. cath. pills at bedtime. To com-
mence immediately after breakfast, and take one of the follow-
ing pills, every two hours, until four pills were taken previous
to the expected chill that day.

$. Apocynum Cannabinum, 3j.

Olei Mg. Pip. gttae. xij. M. ft. pil. No. xij.

Second visit. Found Mrs. C. had just had a chill, as severe
as her former one. The medicine had operated freely, aod had
produced profuse perspiration, but no nausea. Ordered the
pills to be continued the next day, as directed the morning of
the day I saw her.

Third visit. Found Mrs. C. in bed thought she had had a
slight return of her chills otherwise she felt better. I ordered
the pills to be continued, as previously directed.

Being called unexpectedly from town, I did not see Mrs. C.
for some month or two. When I did see her, learned her chills
had ceased after taking the twelve pills, and that they had not
returned.

Case IV. I was called to see Miss V. Found her in bed,
with a severe headache, furred tongue and considerable fever.
Upon enquiry, was told by her mother that the chill she had
just had was the fourth one that week. I found Miss Y. had
resided in a district liable to chills, and that she never escaped
an attack of Intermittent fever at least once a year. I ordered
the comp. cath. pills, and pills of 5 grains each of Apocynum

1859.] Trext, on the Treatment of Intermittents. 9

Cannabinum, as directed in the cases previously reported, and
to be taken in the manner there directed.

Second visit. Found Miss V. had not escaped having a chill.
She, however, was free from headache, and freer from fever
than she was the previous day. The last pills taken had pro-
duced considerable nausea, and had produced large watery
evacuations. She had perspired freely. Ordered the pills to
be continued.

Third visit. jSTo return of chill all the other symptoms
abated. Patient thought she felt chilly for a little while that
morning, but did not think she had a chill. Ordered the pills
to be continued.

Fourth visit. No return of chill, nor chilliness. Learned
from her mother, some two weeks since, the chills had not re-
turned.

Case Y. Called to see Miss B. Learned from her mother
that she was liable to attacks of chills and fever every fall. She
had noticed for the past week, her daughter would sometimes,
during the day, while she would be cooking, come close to the
fire, and that she could hear her teeth chatter her lips would
turn purple ; and that headache and fever always followed this
chilliness. I directed the comp. cath. pills and the Apocynum
Cannabinum, to be taken as directed in the cases heretofore
reported.

Second visit. Found Miss B. sitting up the chilliness had
not returned; no unpleasant effect had been produced by the
Apocynum Cannabinum.

Third visit. Still no return of chilliness. Ordered the re-
maining four pills to be given, one each night and morning,
until all were taken.

Case VI. Called to see Mrs. I. (enciente). Upon enquiry,
was told she had a chill about 6 o'clock every morning, and
that headache and fever followed. I directed two comp. cath.
pills (Tilden's), to be taken at once, and one pill of the Apocy-
num Cannabinum, to be given at 8 and 10 o'clock that night.
Commence at 6 o'clock next morning, and give one pill every
two hours, until two pills had been taken.

10 NlSBET, on English Medical Education [January,

Second visit. Some chilliness had been felt that morning
about the usual time that her previous chills had occurred. No
unpleasant effects had been produced by the last pills ordered.
Directed Apocynum Cannabinum pills to be continued as
directed at my first visit.

Third visit. No return of chills, nor chilliness. Ordered the
remaining four pills to be taken, one night and morning, until
all were taken.

The six cases I have reported were patients whom I visited,
with the exception of case 1st, which I did not visit. Cases 7,
8, 9 and 10, prescribed for, but not reported, were cases of pa-
tients who visited my office, and complained of having fever
and ague. These cases I treated precisely like those I have
reported. I have been only able to hear from two or three
they were reported as entirely cured.

In my practice among the indigent, I am really happy to find
so ready a helper, as I have found the Apocynum Cannabinum
in the treatment of Inter mittents. Its cheapness, in comparison
to the Quinia, is not to be lightly overlooked. I would not have
my professional brethren suppose, that I class the Apocynum
Cannabinum among the cure-qjls, or that I would discard the
other valuable antiperiodics of our Materia Medica, to use this
medicine alone. I, however, must say that my limited experi-
ence does justify me in saying that, as an antiperiodic, it de-
serves a higher place in our Materia Medica than has been here-
tofore assigned to it by the Profession.

ARTICLE III.

English Medical Education. By E. H. Nisbet, M. D., of Ma-
con, Georgia.

The last Westminster Eeview contains an able article upon the
subject of English Medical Education. The writer reviews the
history of the Koyal College of Surgeons, the Eoyal College of
Physicians, and the Apothecaries Company of London, from
their earliest organization to the present time. He retraces the
steps they have taken to reach that pre-eminence in position,

1859.] NiSBET, on English Medical Education. 11

which they now occupy in the medical world. What are the
facts of the case ? These chartered companies are in a condi-
tion to dictate terms to the profession, and through the profession
to the people. They are fostered by State aid, and their rights
secured by Eoyal sanction. The result proves that they have
instituted a prominent order of monopoly. They have built up
a system which is grossly selfish, exclusive, and unjust to the
commonality. Their scheme of medical ethics is shrewdly
planned, and its requirements are rigidly exacted. In a word,
the- system is "English" throughout. In a republican sense, its
story is similar to the one of Church and State, and suggestive of
that deep-seated policy so characteristic of parliamentary power.
It is injurious to the profession, because subversive of all efforts
to compete with it outside of its sacred enclosure. It ignores the
professional standing of all licentiates who have not been gradu-
ated by the fixed rules of its own standard. Outsiders are
" non -conformists," unorthodox, aliens from the "grand sys-
tem," and as such they are persecuted. It will not permit its
own licentiates to aspire to a fellowship. The College of Sur-
geons, whose membership embraces the larger portion of the
medical body, has decreed that none but graduates of Oxford
and Cambridge, shall be admitted as candidates for Fellowship.
Even distinguished foreigners must apply with an "adeundem"
degree from these colleges. Now, when it is known that both
Oxford and Cambridge require their alumni to subscribe to the
" thirty-nine articles," it becomes equivolent to enforcing even
a religious test upon candidates for fellowship, in an institution
which is purely scientific. Such men as Sydenham, Hunter,
Copland, Fothergill, Wells, Locock, and a host of others, have
been excluded. Men who are the very pillars of the temple,
must needs stand outside the holy enclosure, when supporting
the whole superstructure, while the Dukes of Eichmond, and
Montague, mere " dabblers in the science," become its privileged
priests. The College of Physicians black-balled Dr. Locock
because, forsooth, he was an accoucheur. He could enter the
bed-chamber of the Dutchess of Eichmond, to deliver her from
the "perils of child-birth," but by doing so, he "degraded" him-
self, and, hence, could not enter into scientific fellowship with
the noble Duke.

12 Nisbet, on English Medical Education. [January,

It is an easy matter to show the selfish, costly, monopolizing
result of a system controlled by those chartered colleges. In
brief it is as follows :

The profession in England is divided into the distinct depart-
ments of Surgeons, Physicians and Apothecaries. Each Col-
lege grants its own diploma, which restricts the licentiate to its
own limited sphere of action. In order to become a " general
practitioner of medicine," it is incumbent upon the student to
pay for a diploma from two of these Colleges. The average cost
of a license, so obtained, is, in round numbers, $3500. It com-
pels the student to set aside five years the most important ones
of his literary life to the exclusive purpose of acquiring a
medical education : two of these are thrown away upon the
miserably conducted system of apprenticeship: the remaining
three are occupied in attending lectures, and hospital service.
Three winter courses, of six months each, and two summer
sessions, of three months each. In all, twenty-four months of
unremitting study. At the end of five years he becomes a
candidate for graduation, and must present himself duly certifi-
ed to, and systematically indoctrinated. A certificate of ap-
prenticeship, paid for! a certificate of hospital service, paid
for ! a certificate of attendance upon lectures, paid for! which
all amounts to an English tax upon time, money, health, and
the privilege of a royal sanction to professional standing. A
diploma so purchased, is not, of necessity, a criterion of merit.
The examination is a farce. The leading questions to the can-
didate are "Have you been duly certified to"? "Have yon
paid the requisite fees " ? An answer in the affirmative (together
with the proof) calls for a diploma paid for ! The operation
of this chartered system is such as to compel English students
to be graduated in the city of London. The city hospitals are
under the controul of the colleges. The medical schools are
but appurtenances to the hospitals, and hence the whole system
belongs to a superanuated set of " Eoyal Fellows."

Such has been the state of things up to the present time. But
it seems that a reformation is about to ensue. The constituent
membership of these corporate colleges is composed of fifteeen
thousand "duly qualified physicians, surgeons, and general
practitioners." This body does not include the army, and navy

1859.] NlSBET, on English Medical Education. 13

medical staff of the regular service, nor the large body in the
employ of the East India Company. In all, it is a noble army
of physicians in league against that universal enemy Disease.
It has been fighting a brave battle at home, in the Crimea, in
the East Indies, and the Colonies. But while battling against
disease, it has maintained the fight against the " powers that be."
It has waged incessant war against the system under which it
has been trained for the fight. It has contended for reform in
the present plan of English medical education. Parliament, the
people, and the profession, have all been petitioned for a substi-
tute, in lieu of the present system. The object is to consolidate
the existing colleges into one Medical Council, whose business
it shall be to regulate the standard of Education for the United
Kingdom. The advantages gained will be a minimum price,
as the cost of professional education less time in acquiring it
in a word, a more perfect system.

It will be needless to add, that the scheme is but little better
than the old system. It is the first step toward reformation
the last of which will not be taken until any plan proposed
shall require no aid from the State. Our professional cousins
must inaugurate the same republican principles which govern
medical education in America, before they can satisfy the wants
of the people, and please the great body of their physicians.
We are pleased to see that there are Doctors who are doing for
the profession what D'Isreali is doing for the people. The pro-
gress of republicanism is slow, but sure; still we are glad to see
that our noble science is becoming the "head and front of the
offending." We trust that the time is not far distant when it
shall be wholly released from the shackles of arbitrary enact-
ment.

14 Treatment of Dysentery. [January,

On the Treatment of Dysentery by the Administration of Large
Doses of Ipecacuanha. By E. S. Docker, Esq., Surgeon of
the 2d Battalion of the 7th Koyal- Fusiliers.

In no part of the world, probably, does dysentery prevail
more extensively, or with greater severity, than in the island
of Mauritius, and nowhere is it more fatal. As surgeon of the
5th Fusiliers, I was stationed there nearly six years, and had
therefore ample opportunity of becoming acquainted with this
hitherto intractable and fatal disease. I say " hitherto," as it
is my firm belief that, henceforward, dysentery may be as much
under control and as expeditiously cured as simple diarrhoea.

For the greater part of the above period viz., from 1851 to
1857 I have availed myself of the remedies in general use.
At last, disheartened with my ill success in several bad cases,
wherein I had perseveringly but ineffectually employed the
secundum artem treatment, and remembering to have somewhere
seen it mentioned that the powdered root of ipecacuanha, in large
doses, had been given with great effect in the complaint, I be-
came anxious to make trial of an agent declared to be of such
extraordinary efficacy.

I have tested this medicine in cases of every kind and degree.
Out of upwards of fifty cases of dysentery I lost but one (in for-
mer years the mortality ranged from ten to eighteen per cent.) ;
and in the instance in question death was caused by abscess in
the liver : the primary disease had been not only cured, but
very thoroughly cured, as I shall hereafter show. I must ob-
serve that I had at one time been in the habit of prescribing
ipecacuan in the the small doses recommended by Mr. Twining ;
but so ineffective was it when thus administered excepting in
cases of no great severity, wherein other medicines answered as
well, without the inconvenience of nauseating, that I had long
ceased to employ it. On resuming the use of ipecacuan, I gave
it in doses ranging from ten to ninety grains; rarely less than
twenty grains. The largest quantity was given in urgent cases
only, the ordinary dose being a scruple or half a drachm. The
action of these large doses is certain, speedy and complete ; and
truly surprising are sometimes their effects. In no single in-
stance has failure attended this medicine, thus employed. I am
not, of course, sufficiently sanguine to expect that it will invari-
ably succeed ; but of this I am convinced, that it will effect a
complete cure in an immense majority of instances.

In all constitutions, robust as well as delicate, under all cir-
cumstances, the result is the same. In the very worst cases,
when the strength of the patient is almost exhausted, after the
whole range of remedies has been tried in vain, the disease run-

1859.] Treatment of Dysentery. 15

ning its course swiftly and surely to a fatal issue, ninety grains
ofipecacuan have been given, and forthwith the character of the
disease, or, I should rather say, the character of the symptoms
has been entirely changed; for the disease itself is literally
cured, put a summary stop to, driven out. The evacuations,
from being of the worst kind seen in dysentery, have, not grad-
ually, not by any degrees, however rapid, changed for the
better; they have ceased at once, completely. There has been
no inclination even to stool for twenty-four or thirty-six hours,
the patient all the time in a state of delightful ease and freedom
from pain ; then at last, without aid of any kind, a perfectly
natural, healthy evacuation, all irritation, pain, and tenesmus
having at the same time entirely ceased.

Nor is there the disposition to relapse so common in acute
dysentery. I have not observed what may be termed a true
relapse in any instance. If the patient contracts dysentery
again, he does so cle novo. All that remains the medicine
having cut short the disease is for the patient to recover
strength; and this quickly follows, without any extraordinary
care as regards diet and regimen, so indispensible and requiring
such nicety of management in convalescence from dysentery
generally. The usual necessity, moreover, for after treatment,
in the shape of a long course of astringents, &c, is in most cases
entirely obviated, a few doses of some vegetable tonic being all
that is needed.

It may be asked by what means the stomach is enabled to
retain such large doses of an emetic substance. The course I
have generally adopted is as follows : In the first place, a sinap-
ism is applied over the region of the stomach, and simultane-
ously a draught given containing a drachm of laudanum. Half
an hour after, when the sensibility of the stomach has been, by
the action of the opium and counter-irritant, as much as possi-
ble diminished, and the patient's attention is occupied with the
sinapism or by conversation, the ipecacuan is administered
generally in a draught, sometimes in the form of pill or bolus
and the semi-recumbent posture steadily maintained. In a
considerable proportion of cases, the medicine is not rejected,
or it is at least retained long enough to enable it to do its work.
If necessary, I repeat it till the stomach does retain it. I never
yet have been obliged to give it in the form of enema. "Where
so considerable a dose as sixty or ninety grains has been ad-
ministered, I in general wait ten or twelve hours before giving
another. Should the bowels, however, not meanwhile have
acted, a repetition is not generally required. I ought here
to mention that I begin the treatment of dysentery, in most
cases, with an emetic always with a thorough clearance of the
bowels.

16 Treatment of Dysentery. [January,

To those acquainted with tropical dysentery, the facts I have
stated relative to the action of large doses of ipecacuan may ap-
pear almost incredible; the following cases, however, all of
which were under my own immediate care, will, I trust, prove
that I have not exaggerated :

Private J. H , aged twenty-six, admitted April 1, 1855.

This man's symptoms were decidedly dysenteric (I do not
transcribe the case verbatim, as it would occupy too much space);
"stools scanty, containing blood and mucus, accompanied with
severe tenesmus, and tenderness on presure over the descending
colon." An emetic and purge were given at the outset, then
turpentine in ten-minim doses, with a grain of opium every four
hours. This answered very well at first, for on April 2nd, the
report was " stools entirely feculent, semi-fluid, homogeneous,
and of dark colour." And the motions continued feculent,
though action' of the bowels was frequent.

On the morning of the 7th (small doses of turpentine, with
laudanum and astringents, had been continued up to that time),
the report was " seven or eight natural semi- consistent stools
during the last twenty -four hours." Ordered, powdered col um-
bo, one scruple three times a day. This, however, proved to
have been premature, for on the evening of the same day, an
unfavorable change had taken place. "Bowels moved five
times since morning; small quantities of feculent matter, with
much blood and mucus." Ordered, sinapism to the epigastrium,
and three grains of opium ; half an hour after, ninety grains of
ipecacuan in the form of draught. On the following morning
the report was, "Bowels moved three times, very copiously,
during the night; stools watery and feculent, and containing
no trace of dysenteric matters. He retained the ipecacuan four
hours, then vomited. Is quite free from pain." There was no
occasion to repeat the ipecacuan, for not a drop of blood nor
mucus was afterwards seen, and he was discharged, completely
cured, on the tenth day from admission.

Private A. C , aged nineteen, an exceedingly delicate,

weakly lad, admitted on the 26th of December, 1855, " with
frequent purging of scanty stools, consisting of a little feculent
matter, mingled with sanious mucus; tenesmus severe. Ill two
days prior to admission." In this case, ipecacuan was employed
at the outset; scruple doses with twenty drops of laudanum
in a draught every four hours. Sinapism to the entire abdo-
men.

27th. Action of bowels very frequent since admission up-
wards of twenty times ; stools of natural appearance, but copi-
ous and wattery ; tenesmus less severe. (It ought to be mention-
ed that, arriving from England with a batch of recruits in the
month of September previously, he had since landed in the

1859.] Treatment of Dysentery. 17

island, scarcely ever been free from diarrhoea). Draughts and
sinapisms repeated.

2bth. Bowels moved eight times yesterday evacuations less
watery, and five times in the night, when the stools were semi-
consistent; no blood nor mucus. Ordered compound soap pill,
five grains every six hours.

29th. One very scanty, semi-fluid stool only since last report.
Infusion of gentian three times a day.

30th. No motion since yesterday. Gentian continued.

On the 31st, the bowels being still confined, they were gently
moved with castor oil.

The patient was discharged quite well on the 6th of January.
Eight days after, it was necessary to re-admit him on account
of diarrhoea. Ordered, mercury with chalk, quinine, and Do-
ver's powder every four hours. Next da}* he was better. On
the 16th, however, there was a trace of blood in the stools. Ten
grains of ipecacuan were added to each powder (every four
hours).

Jan. 17th. The blood had disappeared; stools were semi-
consistent. He went on very well, gradually gaining strength,
till the 24th, when diarrhoea returned.

25th. Stools now contain blood nnd mucus, and are attend-
ed with straining. Ipecacuanha renewed in ten-grain doses,
every four hours.

26th. Bowels not moved once since yesterday ; three times
during the night; stools semi-consistent, feculent, and intimate-
ly mingled with tenacious mucus. Ipecacuan draughts contin-
ued.

27th. Stools of much better appearance.

On the 28th they were " perfectly natural," and so continued,
with occasional relaxation, but free from the least trace of dys-
enteric matters for eleven days; then, on the evening of the
8th of February, the report was, " Bowels moved twenty times
since morning ; evacuations scanty, and consisting wholly of
sanious mucus." Ordered, sinapism over the stomach, and
draught containing twenty minims of laudanum ; half an hour
afterwards, sixty grains of ipecacuan.

Feb. 9th. Up very liitle during the night, passing, although,
not quite half a teacupful of sanious mucus ; tenesmus, but no
pain in the abdomen. Ordered castor oil, twenty minims ; mu-
cilage, one ounce ; ipecacuan powder, one scruple ; tincture of
opium, ten minims ; peppermint water, one ounce, eveiy four
hours.

On the 10th the only change observable was, that very little
blood was passed. Ipecacuan powder, ten grains ; tincture of
opium, twenty minims ; camphor mixture, one ounce ; liquor
acetate of ammonia, half an ounce, to be taken every four hours.

18 Treatment of Dysentery. [January,

Under this treatment he daily improved, and on the 13th the
stools were " few and perfectly natural."

After a second complete intermission of fourteen days, during
which he was only kept in hospital for the recovery of his
strength, he again had a return of dysenteric symptoms, " seven-
teen or eighteen stools, feculent at first, but latterly tinged with
blood ; tenesmus, with tenderness on pressure over the abdomen
generally." Once more recourse was had to the ipecacuan
draughts, as on the 10th, which had answered so well. Evening:
A few drops only of sanious mucus passed since morning.
Ordered, castor oil, two drachms.

28th. Purged seventeen or eighteen times during the night,
and has passed a quantity of healthy feculent matter. Draughts
repeated ; also on the 29th of March.

April 1st. The report was " stools perfectly natural," and
his bowels continued composed till the 7th, when the stools
again contained a little mucus and blood. Ordered the follow-
ing draught every six hours : Oil of turpentine, ten minims ;
mucilage, half an ounce; tincture of opium, twenty minims;
powdered ipecacuanha ten grains; peppermint water, one ounce.

On the 8th and 9th (the draughts being continued) the action
of the bowels was frequent.

10th. No change having been made in the treatment, the
motions were "natural and/ormec?."

After this he had no return whatever of dysenteric symptoms,
but was so excessively weak that I could not safely discharge
him before the 29th of April. He has since continued well, and
perfectly free from his besetting ailment diarrhoea.

The above case is a very good exemplar of the powers of
ipecacuan in dysentery. Without so powerfully controlling
an agent, I look upon it as, morally certain that this boy would
have died ; for never, in the whole course of my service, had I
to deal with a case in which the disposition to morbid action in
the bowels was so marked. It will be observed that though
there were returns of dysenteric symptoms, yet during the inter-
vals their cessation was complete. I think that chills or checked
perspiration conditions it is impossible entirely to guard against
in the Mauritius, especially at night and in the early morning
were the cause of the repeated attacks in this case.

Private S. M , aged twenty-five ; admitted with dysentery

on the 11th of February, 1856. The symptoms were at first
slight, and the treatment simple (chiefly purgatives and Dover's
powder), and he went on very well till the 17th, when the report
was " four stools since yesterday, scanty, and consisting entire-
ly of blood and mucus." Ordered powdered ipecacuanha, one
scruple ; Dover's powder, half a scruple : to be taken every four
hours.

1859.] Treatment of Dysentery. 19

Feb. 18th. "Four stools since last report, feculent and
formed, with a trace only of sanious mucus ; patient quite free
from pain and tenesmus." Powders continued, with the addition
of one grain of opium to each.

19th. "Stools entirely feculent and consistent." He was
discharged fit for duty on the 1st of March, having had not the
slightest return of dysenteric symptoms after the 19th of Feb-
ruary.

Private W. B , aged thirty-six ; a very weakly phthisical

subject, with a marked disposition to atonic diarrhoea. Admit-
ted with dysenteric symptoms on the 18th of March, 1856.
"Purging frequent, with severe tenesmus; stools watery, and
contain both blood and mucus." He was ordered an emetic
immediately, followed by an ounce of castor oil, and a grain of
opium. Evening: "Purged nine times since admission; eva-
cuations copious and watery, with a large admixture of fluid
blood." Ordered forthwith the sinapism and drachm of lauda-
num, and half an hour after, sixty grains of powdered ipecacuan
in form of pill.

19th. " Feels much better ; bowels moved seven times during
the night ; stools liquid, feculent, and containing very little
blood and mucus ; tenesmus considerably diminished." The
ipecacuanha was retained." Ordered a draught, every four
hours, composed as follows: Oil of turpentine, twenty minims ;
mucilage half an ounce; peppermint water, one ounce; pow-
dered ipecacuan, one scruple; tincture of opium, twenty minims.

20th. "Four stools yesterday of better appearance, two
during the night; a few drops of pus-like (the most harmless)
mucus only perceptible ; feels much better; tenesmus entirely
gone. Draughts of ipecacuan and turpentine continued, with
the addition of twenty drops of castor oil to each.

21st. "No motion yesterday; three during the night, natu-
ral and semi-consistent." Draughts discontinued.

22nd. "Two perfectly natural stools since last report." Or-
dered a scruple of powder of Colombo, three times a day.

23rd. "Improvement maintained;" and he was discharged
quite well on the 28th.

There could not well be a more satisfactory case than the
above. A debilitated, delicate subject, attacked with dysente-
ry and while the attack lasted it was severe is cured in ten
days, and so radically cured as to have had no return whatever
of bowel complaint, though previous^ much disposed thereto.

I now come to one of the worst cases that occurred in the 5th
Fusiliers during the time I was in medical charge. This case
exhibits the specific action of large doses in dysentery in a strik-
ing manner. At that time I was not so fully conversant with
this medicine, and as the man was extremely ill at the time of

N.S. VOL. XV. NO. I. 2

20 Treatment of Dysentery. [January,

admission, I deemed it advisable at first to employ calomel ; and
this medicine, which by many is looked upon as a specific in
dysentery, had a fair trial so fair, indeed, as to place the life
of the patient in considerable jeopardy. At this juncture it will
be observed by those practically conversant with dysentery,
that the man's symptoms were indicative of extremest danger.
Fortunately, recourse was had to ipecacuan ; and this medicine
was given in full (drachm-and-a-half) doses three times. But
I must not anticipate. As this case is so interesting, I make no
apology for transcribing it nearly in full :

Private J. T , aged twenty-eight, admitted March 18th,

1855 ; a slight, narrow-chested, delicate man. Has frequent pur-
ging of copious stools, consisting mostly of fluid-feculent matter,
with some admixture of mucus and much blood. Says " he has
no pain in the belly, no tenderness on pressure." (This was
taken cum grano salts, for there was an evident disposition to
make as light as possible of his complaint : he knew that he had
been guilty of disobedience of orders in not coming to hospital
sooner. Closely questioned, he at last confessed that he had
been ill for several days before reporting himself sick). Admits
having tenesmus. He was under treatment for acute dysentery
in April, 1852. Ordered an emetic immediately, and every four
hours a draught consisting of oil of turpentine, ten minims;
acacia mucilage, half an ounce ; tincture of opium, twenty mi-
nims; peppermint-water, one ounce. In the evening the report
was: " Has passed since morning two scanty dysenteric stools."
Ordered half an ounce of caster oil and twenty drops of lauda-
num.

March 19th. Eight motions during the night, copious, fecu-
lent, and semi-fluid, with some froth tinged with blood on the
surface; pulse 92, soft; tongue coated in the centre. To con-
tinue draughts of turpentine, &c. Evening : Bowels have acted
three times since morning ; stools scanty, and of a highly dys-
enteric appearance. Ordered ten grains of calomel and one of
opium immediately ; the same to be repeated at four o'clock in
the morning.

20th. Has had during the night eight or nine motions, fluid,
dark-coloured, feculent, with a little mucus, and more blood on
the top ; straining very severe, and there is much tenderness on
pressure over the caecum ; pulse 132, soft and rather full ;
tongue furred. Ordered calomel, two grains and a half; tartar
emetic, one-eighth of a grain; hydrochlorate of morphia, one-
sixth of a grain ; every four hours. Evening : Bowels moved
eleven times since morning; stools more dysenteric in appear-
ance, with less of feculent matter. A sinapism was ordered to
be applied immediately over the stomach; internally, sixty mi-
nims of laudanum, and half an hour after, a draught consisting

2859.] Treatment of Dysentery. 21

of a drachm and a half of ipecacuanha to an ounce and a half of
water. Ten P. M. : The report was that he retained the ipecac-
uan draught two or three minutes only; has been moved twice
since six P. M.; stools very bad indeed, quite liquid, with hardly
a trace of feculence, consisting chiefly of a little mucus, and a
very large proportion of fluid blood ; he is excessively weak ;
pulse rapid and thready, intermittent; surface cold, and bathed
in perspiration ; tenesmus severe. The opiate draught was now
repeated, but this time with twenty minims only of laudanum;
half an hour after, ninety grains of ipecacuan, as at six o'clock.

21st. Has passed a tolerable night, and feels better, bowels
not having been once moved since the administration of the
last dose of ipecacuan, which he retained an hour and a half,
then vomiting three times. He feels nausea at present. Is per-
fectly composed, and free from pain or irritability. Pulse 120
full and soft ; tongue furred, but moist. Evening : No action of
the bowels since morning ; the draught was retained three hours;
he then vomited once. To have at bed-time, a draught com-
posed of liquor acetate of morphia, thirty minims; tincture of
matico, and compound tincture of lavender, of each one drachm ;
peppermint water, one ounce.

22nd. Marked improvement in every respect. After an in-
terval of thirty-four hours his bowels have at last acted, during
the night, once only ; stool scanty, semi-consistent, feculent, and
homogeneous, without a trace of blood or mucus. He is entire-
ly free from pain or tenesmus, and perfectly comfortable in every
way. Draught last ordered to be continued every six hours.

23rd. Improvement continues. No motion since last report.
Pulse 100, jerking ; tongue coated. Ordered, camphor mixture,
one ounce; liquor acetate of ammonia, half an ounce; disulphate
of cinchona, two grains; tincture of lavender, one drachm: to
be taken every four hours. Chicken broth ; brandy, half a gill.

24th. One scanty, consistent, entirely feculent stool : pulse
90, soft; tongue cleaning. Ordered, infusion of gentian, two
ounces; disulphate of cinchona, two grains; three times a day.
Brandy, one gill.

25th. Improvement maintained. No motion. Gentian
draughts repeated.

26th. Continues to get better ; one natural evacuation. Tonic
draughts continued. Broiled chicken.

27th.- Same report. He is very weak. Draughts continued.
Ordinary diet, and brandy.

29th. Convalescent. Gentian and cinchona draughts con-
tinued.

April 1st. Same report. Draughts continued.

3rd. He is still rather weak.

4th. A trace of mucus in the stools (three since last report),

22 Treatment of Dysentery, [January,

and there is slight tenesmus. Ordered, castor oil, two drs.;
gentian and cinchona draughts continued.

5th. No motion since last report, nor has he any inclination
to stool. Ordered, castor oil, half an ounce; tonic draughts con-
tinued.

6th. Bowels moved three times after last dose of oil ; stools
natural. Draughts continued.

7th. Some thick, yellow mucus only passed since last report.
Castor oil, two drachms, immediately ; a scruple of powder of
Colombo three times a day.

8th. Has passed three feculent stools, entirely free from mu-
cus, since taking the oil. Colombo continued.

9th. No motion since last report ; has nearly recovered his
strength. Castor oil, one drachm; Colombo powders continued.

11th. Discharged cured.

A more remarkable case than the above could hardly be. It is
an unquestionable fact that this man's life was saved by ipecacu-
an, given in the doses it was, and by ipecacuan alone, for the opium
only aids in enabling the ipecacuan to be retained. Moreover, I
am convinced that, in the condition he was on the evening of
the 20th March, by no other known means could he thus, as it
were, have been snatched from the brink of the grave. Instead
of dying, however, this soldier was at his duty completely cured,
in little more than three weeks from his admission, desparately
ill, into hospital. It will, I think, be conceded, that this last
case, if not those preceding it, ought to secure for the ipecacuan -
in-large-doses treatment at least a fair trial.

To render this record complete, I will now give particulars
of the only case (alreadj^ alluded to) in which dysentery, in
spite of this treatment, terminated in the death of the patient.
This case is specially interesting as showing the condition of the
large intestines, and the action of the remedy upon their tissues,
six days after the primary disorder had been subdued. The sub-
ject, in this instance, was a young sergeant, who, being married,
of course did not report himself sick till he could hardly walk or
stand. (His widow subsequently informed me that he had been
ill three weeks previous to coming into hospital.) I never saw
worse symptoms. The evacuations, which were excessively
frequent, consisted entirely of sanies, and large coagula of pure
blood, without a particle of feculent matter. The man, in short,
appeared to be in a dying state. In this case the action of the
ipecacuan, from the long time the disease had existed uncontrol-
led, was not so speedily manifested as it usually is. Not till the
fourth day from the time the first ninety -grain dose was admin-
istered, did the stools assume a perfectly natural appearance.
Having once done so, however, not a trace of blood or mucus
was afterwards seen. I may here mention that in the course of

1859.] Treatment of Dysentery. 23

these four days he took in all two ounces of ipecucuan. During
the next four days the fearful drain of the pabulum vitas, and
hardly less wearing irritation, having ceased, he had rallied con-
siderably. But on the fifth day an unfavorable change took
place, and it then became evident that abscess had formed in
the liver. His pulse, which on cessation of the dysenteric symp-
toms, had risen in a marked degree, became again depress
and in spite of sedulous support, he sank rapidly, and died the
following day. Post-mortem examination demonstrated how
prompt had been the action of the medicine in the complete ces-
sation of ulcerative, and substitution of reparative, action.' The
lining membrane of the large intestine in its entire course was
covered with recent ulcers of enormous size in some places,
indeed, so large as to occupy the circumference of the gut. The
whole had begun to cicatrize ; their edges were even, surfaces
smooth, and covered with a fine epithelium ; all thickening of
the coats had disappeared ! The bowels contained natural,
semi-fluid faeces ; no vestige of mucus, pus, or blood ! To those
familiar with the usual pathological phenomena resulting from
dysentery the universal thickening and softening; extensive
ragged ulcers, and masses of sloughy debris, mingled with co-
agula ; the state of things I have described in this case will
appear not a little remarkable. But still more extraordinary,
perhaps, is the fact, that any reparative process should have
taken place under the adverse circumstances of great impair-
ment of the vital powers a condition resulting as well from the
primary disorder as from the organic disease then hastening
this poor fellow to his grave. On opening the abdomen, ab-
scesses were seen to occupy nearly the whole of the liver. It
will suggest itself that the fatal event might have been averted
if ipecacuan had been given at an earlier period. From the
promptitude with which it arrested the bowel complaint, pus
might not have been allowed time to form.

I do not think the above case invalidates the presumption that
this treatment, if resorted to in time, will at least greatly dimin-
ish the chance of absorption of pus, and this simply from the
wonderful celerity with which it acts, not only in at once quel-
ling the disease, but also repairing the mischief which that disease
has caused; at least I think the appearance above described
warrant belief that having, by its antiphlogistic power, subdued
the inflammation of the large intestines, and by its powerfully
constringent property stopped the flow of blood from their capil-
laries, the action of this medicine may not end here. If this
conjecture is well founded, it indicates an advantage consequent
upon the large-dose treatment, the importance of which cannot
be over-rated.

Another and more certain benefit resulting from this treat-

24 Diseases of the Prostate Gland. [January,

merit is the apparently entire obviation of chronic dysentery,
with its many and protracted miseries. Who that has to con-
tend with a wearisome and disheartening case of this kind will
not hail with delight a remedy which enables him to effect a
cure in the same number of days that formerly would have oc-
cupied weeks or months ; a cure, moreover, so complete as to send
his patient out with a new lease of life, actually better after his
illness than he was before !

As regards the rationale of the action of ipecacuana in large
doses, I will not venture on so debatable a point to express an
opinion. That it is a very energetic tonic is sufficiently evident ;
especially certain that it is a most powerful styptic, (this being
the effect of its tonic property,) and as such likely to be of great
use in some active and in most passive haemorrhages, especially
in those occasioned by exudation from mucous surfaces. In
dysentery, at all events, the value of this medicine is incontesti-
ble. I believe the time may come when it will be considered
as much a specific in this case as bark is in ague and sulphur in
itch.

That ipecacuan in large doses has been before given in dys-
entery, I have already stated ; I do not, however, think its ines-
timable properties in this form are generally known. My object
in desiring to make known to the profession facts which have
come under my own observation is, if possible, to obtain for this
mode of treatment a more extended trial, as by its universal or
even general employment I have no doubt that the mortality
from a fatal and hitherto unmanageable disease may be very
greatly diminished. [London Lancet.

Extract from an Address before the New York Academy of Medi-
cine, on the Prostate Gland. Delivered by Prof. Valentine
Mott.

diseases of the prostate gland.

The morbid anatomy of the prostate gland is exceedingly in-
teresting, because it involves so many terrible and afflicting
affections, and, as such, it is deserving of the closest attention
on the part of the surgeon.

It is a very singular fact, one that deserves to be mentioned,
although we read about it, and pass it over without thinking of
it as it deserves, that this body will frequently enlarge, when
other parts of the body are diminishing and shriveling in the
decline of age. This is, indeed, a formidable disease, which, in
too many cases, is out of our power to relieve. The pathology
of this gland becomes peculiarly interesting, because it ought to
have associated with it other diseases besides mere enlargement.

1859.] Diseases of the Prostate Gland. 25

This is considered, by gentlemen of the profession who do not
read much, to be the only disease of the prostate. There nre
affections of it that are very formidable besides the mere hyper-
trophy.

But, first, I will call the attention of the academy, for a few
moments, to what is termed atrophy of this gland.

This gland, then, has been found diminished in it natural si
The proper capsule has been found to be filled with an aqueous
fluid. The gland, then, can be atrophied, as well as hypertro-
phied. This gland has been described in this state by several
pathologists, and by two particularly, Sir B. Brodie and Mr.
Cooper, who found it as I have stated. This disease is not ne-
cessarily confined to old age, neither to youth ; it seems to follow
no stated law, but occurs at almost any period.

Inflammation of this gland occurs more frequently than, per-
haps, many of us are aware. I am perfectly well satisfied, that
inflammation of this gland is of very frequent occurrence
whether it be the secretory portion, whether it be the filamen-
tous or areolar tissue of the gland, I shall not stop here to dis-
cuss. My impression is that it is an inflammation of the entire
tissue of the gland.

The prominent symptom is, remarkable tenderness on intro-
ducing the finger into the rectum. When this extreme sensi-
tiveness exists, with difficulty of passing water, it is evidence to
my mind that the gland is very much inflamed.

We know perfectly well, also, that suppuration occurs in this
gland, and produces a great deal of mischief. Lallemand,
among others of distinction, states that the whole gland is in-
flamed. And he goes so far as to state that the openings of the
glands into the urethra pours out the pftis. This shows, conclu-
sively, that the gland is inflamed. Sir Benjamin Brodie cites a
case in which more than a pint of pus was discharged, from
time to time, from the urethra.

This inflammation may be caused by the violent use of in-
struments. I say violent; this is too frequently the case.
There never was a better axiom in surgery, u Make haste slow-
ly," particularly in introducing instruments into the bladder.
The violent use of these instruments, intense sexual indulgence,
as well as urethritis, are capable, then, of producing deep sup-
puration in the gland itself. I have a specimen in my museum
in which there is an abscess in one lobe, which caused retention
of urine, in which the practitioner was unable to pass an instru-
ment, and making use of violence instead of knowledge, forced
the catheter through the membranous portion of the urethra, a
little above the apex of the prostate, and into the side of the
neck of the bladder. The retention was relieved but the in-
flammation that followed was fatal.

26 Diseases of the Prostate Gland. [January,

In suppuration in this gland, the pus general!}' takes the route
into the urethra. Hence, Lallemand states that he has seen the
openings from the prostate large enough to admit the end of a
catheter, from which openings pus escaped into the urethra.
The matter will sometimes make its way through the rectum,
sometimes into the perineum, instances of which I have seen.
I have also seen an opening through the urethra, just at the
apex of the prostate. In one case I found an opening into both
rectum and perineum. Both fistulas were opened to the apex of
the prostate. The cure was complete. A catheter was con-
stantly used.

I now remember seeing two very formidable cases, about a
year since, of this sort, which are not yet entirely cured. Upon
both these I operated with a view to close the recto -urethral
opening. In one instance, there was an opening into the peri-
neum and urethra of some years' standing. I laid open the
urethra from the fistula that was in the perineum, completely
into the rectum and a little above this fistula that entered the
rectum; the urethra was so sound, and he was so desirous of
not being annoyed by the catheter, that I indulged him. I
thought he might- get along, as the urethra was so perfectly
good that a few drops of urine only occasionally came down
from the rectum. Upon close examination there was found an
opening into the rectum which has not yet entirely healed. He
has now returned from the South, and, in a few days, will put
himself under my care again. During the winter he has been
cauterized, but with no good result. He has a full knowledge
of his case, and is willing to risk another trial.

I recall another instance, with which I know a gentleman
before me is also acquainted. The case to which I refer is a
medical man.

He has no disease of the prostate. There is an opening into
the urethra, and also into the rectum. We attempted an oper-
ation, and it failed. I laid open the fistula upwards and down-
wards, above the apex of the prostate, and so down into the
membranous portion of the urethra, hoping that it might close.
He was unwilling to wear a catheter.

The doctor was, as all doctors are, exceedingly restless and
irritable. He thought he could get along by care and at-
tention ; but, unfortunately, it has not healed. His greatest
suffering arises from the passage of some of the faeces by the
urethra.

These remarks are not extraneous to the subject, inasmuch as

they are all connected with snppuration of the prostate gland.

Since we had this gentleman under care, he has been subjected

to the division of all the fistulous openings, and an attempt was

made to effect union by means of the silver wire suture, but it

1859.] Diseases of the Prostate Gland. 27

failed. He is now in a melancholy state, being constantly an-
noyed by faeces passing into the urethra and mixing with the
urine, causing him to be an object of disgust to himself. These,
then, are instances of the effects of suppuration about the pros-
tate.

In one instance that is fresh before me, I fortunately relieved
a gentleman who was of some consideration, by opening the
abscess that was directly between the rectum and prostate
gland, so that he was no longer annoyed by difficulty of mictu-
rition. When I first saw him, no instrument could be intro-
duced. I took my prostatic catheter, which is two inches over
the common length (the noble idea of the immortal Sabatier),
and it passed without the least difficulty, and drew off the urine.
Evacuating the bladder of water, I then examined per rectum,
and found a large fluctuating tumor directly over the prostate
and the membranous portion of the urethra. I felt the tumor
very distinctly in that situation, and by separating the anus suf-
ficiently, I was enabled to look in and see the bulging that was
caused by the presence of this fluctuating mass. I introduced a
bistoury, when a large quantity of pus escaped, and he had no
more trouble. The inflammation of the prostate may be follow-
ed by the deposit of a large quantity of matter. Brodie says,
that as much as a pint was discharged from a case that he saw ;
not, however, at one time.

The prostate is not generally the seat of ulceration. This is
a process in it that is not common. It has occurred from the
introduction of instruments into the urethra, which has first
caused inflammation, the accumulation of pus, then pressure up-
on the gland, and ulceration. This ulcerative process follows.
Excessive onanism and intense sexual indulgence will give rise
to this inflammation.

I have known this to follow such indulgence where death has
been the result of the suppuration that has thus been induced.
Intense sexual indulgence, then, will produce this form of diffi-
culty. This is attended with a great deal of pain and tenderness
in the perineum, a fact which is denoted strikingly by the intro-
duction of the finger intra rectum.

These abscesses in and about the prostrate, will open, not
only into the urethra, as probably was the case in the patient
whom Brodie describes where a pint of matter was, from time
to time, discharged, but they will open into the rectum, as in
the two instances of gentlemen, both of whom were patients of
mine.

Tubercles are occasionally met with in the prostate. These

tubercles go on from softening to progressive ulceration. We

have an instance recorded by Lallemand, where thirty of these

abscesses were found, and as many tubercles. It must have

n. s. VOL. xv. no. i. 3

28 Diseases of the Prostate Gland. [January,

been considerably hypertrophied. Therefore the prostate gland
is liable to have the same condition of things existing as we find
in the testis, mesenteric glands, vesiculae seminales, or where it
is most frequently met, and where you are all acquainted with
its existence, in the lungs.

Dr. Gross, well known to the gentlemen present, if not per-
sonally, by reputation, related a case where tubercles existed in
this gland. He states that they follow the law of tubercles in
other parts of the body.

' Again the prostate is said by some to be affected with cancer.
If we adopt the language of Mr. Walsh, that all forms of diseases
that are heterologous are cancerors, we may consequently have
it in the prostate gland. I prefer the old arrangement of cancer
and malignant disease or what does very well, hard and soft
cancer. I am very well aware that they both have the micro-
scopic characters of cancer.

These malignant forms of disease occur within and about the
prostate. The body of the prostate is not so apt to be involv-
ed as in other forms of hypertrophy. There are three instances
on record, one by Sir Astley Cooper, another by Mr. Stanley of
London, and another by Langstaff. These three instances of
malignant disease connected with the gland were in children.
Therefore, malignant and serious disease of the prostate is not
necessarily confined to old people.

In Stanley's case there was a tumor about the size of an orange
connected with the third lobe ; this tumor was soft, and was the
product of a malignant formation. One of these cases was in a
child 8 or 9 years of age, and the other two were during early
boyhood. The great Dr. Fothergill of London died of malig-
nant disease of the prostate. Great he was in every sense of
the word. His name is known to most of those who read, but
he is better known to some of us who have known his pupils
and friends. Such was the character of the disease that as it
grew upon him, it completely closed up the urethra, and his
water had to be drawn off. He was one of the most remarkable
men that ever lived, not only as a sound and noble physician,
but one of the most extraordinarily virtuous men that we have
any record of. He was attended by his friend and contempora-
ry the illustrious Percival Pott who would joke with him in
relation to his bachelor life. On one occasion he said to him,
" well, sir, considering you have always lived in London, you
have a remarkably good urethra." "Percival," said he, calling
him by his first name, "this instrument," referring to his penis,
has never been used for any other purpose than to draw off my
water."

I had a case a few miles from the city, some years ago, which
was evidently a fungous growth about the prostate. It was, as

1859.] Diseases of the Prostate Gland. 29

in Dr. Fothergiirs case of a malignant form, or soft cancer. I
chose to give it that phraseology. Whenever an instrument
was passed, it would plainly enter the fungous mass, which
would bleed freely. He ultimately died.

I have seen another instance where the tumor was not of the
prostate, but a polypous growth, which acted as a valve, and
gave rise to the most marked symptoms of stone in the bladder.
This ought to teach us that nothing but a sound, grating against
another hard substance, should justify the operation for stone in
the bladder.

Under the head of cancer, I will mention a case that I had
in conjunction with my friend Dr. O'Reilly, who is probably
not known to most of you, but who is an excellent Irish surgeon.
In this case, I thought that there could be no doubt of the ex-
istence of this disease. The patient died, but no post-mortem
examination could be had to verify the diagnosis.

Senile hypertrophy. Most persons who have read a little are
led to believe that this is the only difficulty of the prostate
gland. This is the last affection that I shall name. The occur-
rence of this affection in old age is afflicting in the extreme, in-
ducing a melancholy existance, and embittering the last hours
of life with agony almost insupportable. I do not mean to say
any thing of its pathology, but simply speak of it as an enlarge-
ment of the gland. It is curious that it should occur in advan-
ced life and be confined to the gland itself. A dissolute life is
not necessary to produce it. We may instance the case of Dr.
Fothergill. A bishop, a pleasant old Catholic gentleman, had
this affection. I told him, I thought, considering he had lived
in Rome for 33 years, he had a remarkably good urethra.

There are different phases to this enlargement. The most
tormenting part of this enlargement is the third lobe of Sir Eve-
rard Home the pathological lobe of Velpeau. Before the time
of Amussat, the surgeons were in the habit of speaking of the
gland as being divided into two lobes.

Most of the cases occur in advanced life, and hence the name
senile. It is remarkably hard in its texture. Brodie speaks of
it as having a stony hardness; Rokitansky, as a fibrous enlarge-
ment ; others denominate it cystic hypertrophy, on account of the
cysts found in it. Travers speaks of it as of scirrhous hardness.

This enlargement comes on very gradually, and is not accom-
panied at first with a great deal of pain. The first symptoms is
difficulty in evacuating the last drops of water that are in the
bas-fond of the bladder. Change of position has to be fre-
quently resorted to. All persons with this difficulty make water
better standing up. Some are obliged to get down on their
elbows, so as to give the bladder a better opportunity to force
the urine over the third lobe.

30 Diseases of the Prostate Gland. [January,

The treatment of this affection, as it respects remedial means,
puts us at defiance. With all our resources we can make very
little impression upon the prostate affected by senile hypertro-
phy.

If you will allow me, I will state some few facts connected
with the difficulty of passing water, and the treatment, more
particularly.

It is of great importance, in a difficulty of this kind, that a
person should not have his bladder over- distended. I know a
gentleman, a merchant, who carried a catheter in his side pocket
for the purpose of relieving himself. Every thing that removes
irritation is of the greatest importance, therefore it is often requi-
site to relieve the bladder by means of the catheter.

I know of no treatment other than palliative. We had some
reason to hope, when iodine was discovered, that this great
alterative would be productive of a vast amount of good ; but
this disease seems to baffle every thing.

I have seen more good derived from a seton in perineo, at the
same time keeping the bladder empty and the bowels soluble,
than anything else. In that way, the poor subjects of this
malady linger on a little longer.

Can this third lobe, the pathological lobe of Yelpeau, upon
which nothing can seemingly act with any benefit can this
lobe, I say, be removed ? This is a great question to ask, and
a very difficult one to answer. I have some instruments here,
which, with your permission, Mr. President, I will show the
academy. They are calculated to get hold of this third lobe and
remove it that is, if the difficulty be in that third lobe. The
main difficulty is in this lobe, which has been the isthmus that
has been formed to constitute the gland one entire mass after
foetal life.

Lastly, and not I hope to be tedious, let me call your atten-
tion to another matter, which I have left purposely to the last,
from the fact that it is a very puzzling thing. It is very analo-
gous in appearance to what old Father Pelletan called " engorge-
ment chronique de la membrane du larynx" a most admirable
simile. I mean the uvula vesical of some the luette vesicale of
others. Dr. Baillie first described it as a membranous fold, in
the form of a bar across the vesical orifice of the urethra, and has
given a plate of it in his morbid anatomy. Guthrie revived our
knowledge of it among the English surgeons. Some give him
the credit of originality. Mercier calls it the urethro- vesical
valve. Amussat denominates it valvula pylorica. Le Koy
d'Etiolle styles these folds bourrelets.

Immediately at the neck of the bladder there will be an en-
largement of the mucous membrane, sometimes from above
downwards, but more generally laterally. This gives rise to

1859.] Pulmonary Consumption. 31

a good deal of difficulty in passing the urine. The catheter
passes readily sometimes. It is very difficult to form a diagno-
sis between it and enlarged prostate. In the uvula vesicae, the
catheter passes very readily. In prostatic enlargement there is
frequently great difficulty.

This state of things exists sometimes without any hypertro-
phy of the gland, in which case the catheter will pass in more
easily. Any instrument passed into the bladder will generally
be followed by a small discharge of blood, which alarms the
patient, who thinks it arises from want of skill on the part of the
operator, whereas it is desirable and beneficial. In the opinion
of Guthrie, this is a curable affection. Le Roy d'Etiolle has
great confidence in scarifications. I have seen him make them
These, with the application of caustic, constitute the principal
means of treatment.

I have endeavored, Mr. President, to sum this up in as small
a space as possible ; as it is, I give it as a mere epitome a mere
resume of my knowledge concerning that interesting subject
the pathology of the prostate gland. [ Virginia Med. Journal.

The Diagnosis of Pulmonary Consumption at its Commencement

Dr. Scott Alison reac^ a paper recently on this subject before
the Western Medical and Surgical Society. The importance of
diagnosis at an early period was shown by reference to facts
arranged under three heads 1st, the vast mortality in advanced
stages; 2d, the great destruction of the lining structure almost
invariably found when the disease has long existed, in a great
proportion of cases excluding all reasonable hope of remedy;
and 3d, the material benefit afforded in a very large proportion
of cases easily diagnosticated and treated. The number of
patients under the care of the author at the Hospital for Con-
sumption at Brompton, who here formed the grounds for cal-
culation, is nearly 2000. The mortality in advanced cases has
been very great, and very few have presented signs of perma-
nent restoration to health ; whilst the mortality in early cases
has been comparatively trifling, even when long" observed.
About one-half of these latter cases have been greatly improved
and have presented satisfactory evidences of the disease being
arrested. Numbers have returned to their employment, or ap-
plied themselves to less laborious and exposed* occupations.
Muscle and fat have greatly increased, cough has been removed'
and the respiration has been deprived of much of its shortness!
About three-fourths of these patients presented grave symptoms
and the usual physical signs; while the remainder presented
either well-marked physical signs without material symptoms,

32 Pulmonary Consumption. [January,

or very marked symptoms with physical signs rather beneath
the average weight of evidence ordinarily deemed proof of
phthisis. The 'author regards the results as due to the early
period at which disease was diagnosticated, and not to any par-
ticular method of medical treatment. Early diagnosis would
be secured by a complete inquiry into the history of each case,
by regarding the entire series of symptoms, and by a complete
physical examination instituted at once, the chest being freely
exposed back and front. The present state of medical knowl-
edge was such and so widely diffused, that it was not likely we
should be able to find any new symptoms of the disease, one
which had been carefully observed for ages ; but it was not un-
likely that we should increase our knowledge of the physical
signs. In the particulars of sound, form, and motion, additions
would probably be made ; but it was with respect to sound that
most advance would be effected. Simple observation by the
present means of auscultation would probably suffice to do
much, but it was not unlikely that improvements in our instru-
ments for auscultation would render assistance. Dr. Alison
referred to certain sounds which he had frequently heard in
phthisis at its commencement, and before dulness of percussion
had manifested itself, or was materially pronounced. The
sounds were an " arrowroot-powder" sound, very fine, and ac-
companying expiration ; buzzing, humming, and" kettle-boiling
or kettle-singing sounds. He was as yet uncertain as to the
mechanism of the kettle-singing sound, but was inclined to think
the evidence pointed to slight pressure on the veins of the lung
causing oscillations of the blood and vessels, such conditions as
are produced in the neck by gentle pressure with a stethoscope
or by tightened integument. This sound is continuous, and
several of the patients who presented it had suffered from
haemoptysis. Crumbling sounds had been frequently heard.
A great means of discovering phthisis was afforded in the dif-
ferences in the character and amount of respiration ; and he (Dr.
Alison) believed that the instrument which he had made, which
gave a stethoscope for each ear, and which he designated the
Differential Stethoscope, would prove available in rendering
very slight differences in respiration appreciable, which could
scarcely be discovered by the ordinary stethoscope. The or-
dinary stethoscope necessitated removal of the instrument from
one part to another, and a certain loss of time, though slight in
itself, important when comparing two sensations nearly alike,
was incurred. For the diagnosis of pulmonary consumption at
its commencement, we should look for the signs of that disease
at that period, and not for those of later periods. The acoustic
properties of the lung with small points or spots of tubercle were,
and must be, different from those of that lung which is so stud-

1859.] Ophthalmology. 33

ded with tubercles, or so infiltrated with that material, that
nearly all the lung tissue proper is pressed upon or obliterated,
or when the lung is broken down and has little cohesion, and
presents numerous cavities. (The Differential Stethoscope was
exhibited to the Society.) In many examples of pulmonary
consumption no dulness on percussion whatever is found ; and
not one of the recognized signs is present in all cases, or even at
all times in the same case. We must be content with a certain
amount of evidence, and that will not be the same in all cases,
or in the same case at different times. Deviations from the
natural configuration of the chest occurred in pulmonary con-
sumption at an early period. These were made out by their
history and by comparing one side with another. The author's
Chest Goniometer would serve in discovering the deviations
from the natural angles and curves, and in measuring them.
The measurement at one period might be compared with the
measurement at another. (The instrument was exhibited.)

Specimens of tuberculated lung, both in the early and later
stages of the disease, were exhibited ; and they served to prove
that the physical signs in the different conditions of lung must
greatly vary, and that the lung dotted with solitary tubercles
the size of mustard-seeds, would afford few if any of the ordina-
ry signs, and chiefly produce deviations in quality from the
natural respiratory sounds, and some such delicate new sounds
as had been referred to. The author was not prepared to say
that these delicate sounds would not be found in other mor-
bid states besides phthisis, but the same limitation held in
respect of all other sounds.

The examination of the sputum, and the discovery by means
of the microscope of tubercle and lung tissue, were referred to.
[London Lancet, and American Jour, of Med. Sciences.

On the Influence of the Cervical Portions of the Sympathetic Nerve
and Spinal Cord upon the Eye and its Appendages.

Dr. John "W. Ogle read a paper on this subject before the Eoyal
Medical and Chirurg. Society, June 22nd.

The main object of this paper was the application to clinical
medicine of the various experiments which have from time to
time been performed, as showing the influence possessed by the
sympathetic in the neck and the upper part of the spinal cord
upon the iris and upper eyelid. Experiments and dissection as
regards the lower animals have shown that the curtain of the iris,
containing as it does two sets of muscular fibres, a circular set
by which the pupil is contracted, and a radiating set by which
it is enlarged, is under the domination of two separate and

34 Ophthalmology. [January,

distinct sources of innervation. The third cranial nerve is found
to control the circular or contracting fibres, and the sympathetic,
by virtue of communication with the lenticular ganglion, is
found to control the dilator or radiating fibres. Hence if the
influence of the third pair be destroyed, the pupil becomes dila-
ted, inasmuch as the dilator fibres, those presided over by the
sympathetic, are unopposed ; again, if the influence of the third
cranial pair be left unimpaired, and that of the sympathetic be
destroyed by section or extreme pressure, then the pupil becomes
contracted. The author dwelt upon the history of the various
experiments upon which the above statements are made, and also
upon those from which it is concluded that in certain parts of
the spinal cord resides the power or influence which acts upon
the dilator fibres of the iris passing to that structure through the
sympathetic via the roots of certain cervical and dorsal nerves.
From these latter it is apparent that the same paralysis of the
dilator fibres of the iris which follows section of the sympathetic
in the neck follows also the severance of such fibres as connect
the sympathetic with the spinal cord, as also the section or des-
truction of the spinal cord itself in certain parts. Accordingly it
might naturally be expected that any cause of extreme pressure
acting upon the various portions of the nervous system before
alluded to would, as in the various experiments before adduced,
cause a contracted state of the pupil on the side corresponding
to that on which the extreme pressure existed. And thus it was
that Dr. Gairdner, of Edinburgh, first sought to explain those
cases in which, along with an intra thoracic aneurism, a con-
tracted state of the pupil coincided. These cases of his were
detailed, several of them not having been hitherto recorded,
and to these others were added of his own observation, as well
as some from other sources. Cases were next given in which
pressure from aneurism upon the sympathetic in the neck had
produced contraction of the pupil. In the third place, instances
were adduced in which extreme pressure from other causes than
aneurisms had produced a like effect upon the pupil, as in the
case of enlarged glands, carcinomatous deposit, etc. In the
fourth place, bearing in view the intimate connection between
the sympathetic main branches in the neck and the cervical part
of the spinal cord, he drew attention to several cases in which a
contracted pupil had been observed in injuries of the spinal
cord itself. But in addition to a contraction of the pupil as
brought about by section of the sympathetic, spinal cord, etc.,
as before spoken of, experimenters have also found that irritation
or galvanism of the same parts of the nervous system will bring
about a dilatation of the pupil, and that this dilatation may be
effected even when section or extreme pressure has already
given origin to contraction of the pupil. Accordingly in these

1859.] Epidemic Sore Throat. 35

physiological facts an explanation was sought of certain cases
in which pressure from aneurism, diseased products, etc., ap-
peared to produce, not a contraction but a dilatation of the pupil
in man ; and he instanced, in the 5th place, several cases in
which the pressure from various sources was inestimably
much in extreme as to be, in fact, a source of irritation or stimu-
lus, acting in the same way as it was found in animals, that any
stimulus, mechanical, chemical, or galvanic would act upon the
sympathetic. In no other way could he explain the dilated
state of the pupil which existed. But besides the above-des-
cribed effect upon the pupil of the eyes, in enumerating the
various experiments in which the sympathetic, etc., was divided,
special attention was drawn to a dropping of the upper eyelid,
or ptosis, which on several occasions was observed. This phe-
nomenon was explained on the supposition that along with the
sympathetic fibres to the iris, those to the third cranial pair are
also paralyzed, and hence the levator of the upper eyelid, which
is supplied from the third pair, is deprived of power to a greater
or less degree. One or two cases were also adduced in which
ptosis of the upper eyelid was observed in connection with
pressure about the neck, from aneurism of other sources. He
offered the same explanation of the convergent strabismus which,
in the hands of certain experimenters, was, along with other
results, found to depend upon a division of the sympathetic cord
in the neck. He supposes it to have existed by reason of par-
alysis of such fibres (in several animals, five or six in number)
as pass up to join the sixth cranial pair of nerves, by which the
power of this muscle becomes weakened, and its action counter-
balanced by the internal adductor muscle. [Medical Times and
Gazette, from American Jour, of Med. Sciences.

Notice of Epidemic Sore Throat, (Diphtherite,) as prevalent in
Albany, X. Y. By S. D. TVillaed, M.D.

For four months past there has been a strong predisposition to
affections of the throat in this community. These affections
produced, doubtless, by the same epidemical influences, have
existed under well defined and distinct varieties.

The first, and by far the most common form of the disease is
Pharyngitis. It is a diffused inflammation covering the palate,
uvula and tonsils, which become highly vascular, and give rise
to a sensation of dryness and roughness in the fauces. The
general health and appetite is undisturbed, and the only treat-
ment required, is one or two applications of nitrate of silver, or
an astringent gargle. There have been hundreds of cases of
this mild form, which, in severity, has been scarcely sufficient to
style disease.

36 Epidemic Sore Throat. [January,

The next variety is Sloughing Tonsillitis. It exists more par-
ticularly among children and young persons those under 20
years of age. Upon looking into the fauces, it is at once ob-
servable, that the tonsils are swollen, in some cases so as to
nearly touch each other, and on their surface are white spots, in
size varying from a shot to a half dime. This high, degree of
inflammation and suppurative process, comes on suddenly, and
its progress is through in eight or ten days. These white ulcers
have thick edges, and look deep seated. They become more
extensive, involving the whole of the tonsils; but in most in-
stances, the slough is thrown off, and resolution ensues. In a
few cases, the tonsils have been of a dark mahogany color, and
the ulcers assume a greenish cast, and have been followed by
gangrene, mortification, and consequently death. In some of
these cases of sloughing tonsillitis, there has been a pseudo-
membrane upon the roof of the mouth, the palate, uvula and
tonsils, which by the process of suppuration, has been detached
and thrown off.

The third and most fatal variety is Diphtherite. This has
prevailed mostly among children under seven years of age. Its
onset is sudden and insidious. The false membrane usually
having been formed when the first symptoms of illness attracted
the attention, and occasionally, when the attention was directed
only by the alarming condition of other children of the family.
The membrane rapidly extends upon the palate, tonsils, the
rima glottis, and into the larynx, producing mechanical obstruc-
tion to respiration, as in croup, and the patient dies in precisely
the same manner.

There is yet a fourth, which if not a distinct variety, is at
least a modification of all of them. It is styled by a medical
friend of mine, in expressive language, "the horse-distemper va-
riety." In this, there seems to be a blood poison, and the mucous
membrane of the nose, fauces and bronchi, throw off a thick,
offensive, acrid secretion, and there follows before death incipi-
ent mortification and decomposition. The congestion extends
to the cellular tissue and skin about the throat and chest. As
in many of the cases of sloughing tonsillitis, the parotid glands
become affected and swollen. In this variety there is no false
membrane. It cannot therefore be diphtherite ; yet it is a mala-
dy co-existent with it. From this form of the disease, nearly all
die. Of the three last forms, within three months, about fifty
have died. It is difficult to estimate, accurately, the number of
cases that have occurred. Of the first and mild form of the dis-
ease, doubtless there have been a thousand cases, most of which,
under less apprehensive circumstances, would never have come
under the eye of the physician. The similarity of sloughing
tonsillitis, and the sore throat of scarlatina maligna, is worthy

1859.] Condition of the Cervix Uteri during Pregnancy. 37

of notice. The almost entire absence of scarlatina, for the three
past months, and its prevalence the three months preceding, is
a fact that should not escape observation. Aside from the local
treatment in severe cases, the strongly marked tendency to de-
bility, and prostration, calls early for invigorating and strength-
ening remedies. In several families, two to lour children have
died of one form or another of the disease. My attention has
been called to the greater prevalence of the diphtherite form, in
the southern part of the city.

The disease Diphtherite has been accurately described by that
eminent French pathologist, Mr. Brettonneau, as it prevailed at
Tours-, and by him recognized as a distinct disease, and embra-
ces that form of malady here spoken of under the third variety.
A full, clear and vigorous article on this subject, from the pen of
R. J. Fourgeaud, M. I)., is published in the Pacific Medical and
SurgicalJoumal, (San Francisco, California,) for October, 1858.
The disease known as diphtherite, or membranous sore throat,
having prevailed in the valley of Sonoma, California, in 1856.
The epidemic in Albany is subsiding. [Medical and Surgical
Reporter.

On the Condition of the Cervix Uteri during the latter half of Preg-
nancy. By M. Caseaux.

Des. Costilhes, Boys de Loury, and Bexxett, maintain that
during the early months of pregnancy ulcerations of the cervix
uteri are of great frequency, and exert a powerful influence in
the induction of various pathological conditions. M. Caseaux
believes these statements to be greatly exaggerated ; and at all
events in the latter half of pregnancy, to which his own observa-
tions apply, they are not borne out. Examined by the specu-
lum, the mucous membrane of the vulva, the vagina, and the
free surface of the os itself, is found of a dark colour, which be-
comes deeper and deeper, until towards the end of pregnancy it
has attained a dark violet. A person unaccustomed to this ex-
amination, and especially if he has not previously ascertained
the position of the cervix by means of the finger, may have
considerable difficulty in engaging this part within the extremi-
ty of the instrument this arising from the anteversion of the
body throwing the vaginal extremity backwards.

" As the toucher would lead one to expect, the modifications
presented to the eye by the vaginal portion of the cervix, are
very different in primiparous and in multiparous women. In
both, the cervix is of a deep violaceous, wine-lees colour; but
in the primipary, this is pretty uniform throughout its whole
extent. The external orifice, the lips of which are much softened,
is in general more or less rounded ; but although it is larger

38 Condition of 'the Cervix Uteri during Pregnancy. [January,

than in the unimpregnated state, it admits of the penetration of
the eye with difficulty, even when the valves of the speculum
are considerably expanded. The circumference of the os, and
the free portion of the cervix, rarely exhibit any traces of ulcer-
ation ; but it is common enough to observe series of cherry -red
granulations, true fleshy vegetations, varying in size from a
pin's head to a large pea, which bleed on the slightest contact.
In the woman who has borne a certain number of children, the
cervix is in general much more voluminous, so that there is some
difficulty in completely embracing it by the speculum. The lips
of the os seem divided into several fragments, this segmentation,
the result of lacerations that have occurred during former de-
liveries, rendering it very irregular. In consequence of these
numerous solutions of continuity, the orifice is much larger and
much more easily dilatable, so that the eye is enabled with ease
to explore all the cavity of the cervix. The walls of this cavity
are very unequal, and present irregular series of fungous pro-
jections, separated by more or less deep depressions. Some of
these prominences are transparent, being probably due to hy-
pertrophied follicies, but others resemble true flabby {mollasses)
vegetations. Sometimes these are covered by a protective epi-
thelium, but it is not unusual for them to be deprived of this,
and then to bleed upon the slightest touch. It is especially
within the furrows which separate them, that more or less deep
linear ulcerations are often observed. These ulcerations some-
times so increase in size as to occupy a pretty considerable sur-
face, and then they are easily seen ; but generally they are hid-
den in the depths of the anfractuosities, and in order to perceive
them, after well cleansing the surface, we must put the cervix on
the stretch by opening the instrument widely. 1 have very
often met with these ulcers in multiparous women, and I believe
that I am within the truth when I say that I have observed
them in seven-eighths of the cases, confining this statement to
the last third of pregnancy. Supposing that a singular chance
has not favoured my researches for a long time past, it is proba-
ble that what I describe here is the normal condition, and should
not be considered as a pathological state, but simply as a conse-
quence of the progress of gestation. Kesembling in this respect
the deep colour, the tumefaction, the ramollissement, and the
almost fungous condition of the walls of the cervix, which are
proper to pregnancy, and in nowise influence its progress, these
ulcerations have the same origin, and should be considered as
the result of excessive congestion. I believe that they are of no
more importance. I am especially convinced of their innocence,
and believe that all treatment of them is much more mischievous
than useful If I am not mistaken, then, and if the pecu-
liarities I have been describing belong to pregnancy, and are

1859.] Condition of the Cervix Uteri during Pregnancy. 39

only an exaggeration of the modifications of the structure and the
vascularity of the parietes of the uterus, this condition should
disappear with the cause that gave rise to it. Like vomiting,
varices, haemorrhoids, and all the sympathetic disturbances of
pregnancy, it should cease with this. And that is precisely
what takes place, and we may lay down as a rule, that uo tn
remain five or six weeks after delivery; the ulcerations which
we sometimes meet with in women recently delivered, do not,
in fact, present the same appearances, and generally are refera-
ble to another origin. '? (pp. 453 i56.)

The statements made by Boys de Loury, Bennett, and others,
as to the frequency with which abortion and various puerperal
diseases are produced by ulcerations occurring at an early period
of pregnancy, are so discordant with the observations the author
himself has made, that he cannot but tax them with exageration.
It is of importance to distinguish between ulcerations that have
preceded pregnancy, and have persisted and increased since its
occurrence, from those which have only become developed sub-
sequently to the formation of the germ. The former, becoming
irritated under the influence of exertion, and especially by ex-
cessive coition, may easily induce the contractility of the body
of the uterus, and bring about premature expulsion. But the
latter, in the author's opinion, rarely exercise a similar influence;
so that however proper treatment may be in the one case, it
does not seem called for in the other. He also doubts the jus-
tice of Bennett's statement, that these ulcers are a frequent cause
of obstinate vomiting in pregnancy; and since he has been in
the habit of treating this affection by the application of bella-
donna to the cervix, he has had the opportunity of examining
four primiparae, reduced by it to the last stage of marasmus, in
whom the cervix remained perfectly healthy.

M. Laborie, in his report upon this paper, observes that M,
Coffin, drawing his materials from the practice of M. Richet,
describes precisely the same fungous ulcerations as those treated
by M. Caseaux ; but that he attaches much more importance to
their presence, at the same time that he admits that no kind of
treatment has been applied with success. Of seven women ex-
amined by M. Laborie himself in M. Cullerier's wards at the
Lourcine, there was but one who did not exhibit ulcerations.
She was a primipara, and had reached the fifth month. Two
other primiparae, exhibiting the ulcers markedly, were three
months gone ; and the four multiparae had respectively attained
the periods of five, seven and a half, and nine months. In these
cases no special means of treatment were adopted, nor is it pro-
bable that the ulcerations would ever have been discovered
without the use of the speculum. [British and For. Med. Chir,
Review, from Memoires de la Societe de Chirurgie de Paris,

40 Haemoptysis Treated with Tincture of Iron. [January,

A Severe Case of Haemoptysis successfully treated with Tincture of
Iron. By Isaac Remington, M. D., of Philadelphia.

J. W. C, aged about thirty-six years, married, of scrofulous
habit and consumptive tendencies, having had occasional hemor-
rhage from the lungs during the past fifteen years of his life, was
attacked with Haemoptysis, on the 3rd of March, 1857. On ap-
plying for advice, I prescribed tannin, combined with ipecac,
and opium, in form of pill, and directed one every two hours,
recommending a state of rest and inaction, both of the lungs and
body, by carefully abstaining from loud speaking and all bodily
exercise. From over exertion in going up and down stairs,
and continuing at his occupation of superintending a number of
sewing machines, the hemorrhage rapidly increased, so that it
became necessary to employ other remedies to enjoin a state
of absolute rest in a recumbent posture rigidly to enforce a
refrigerant regimen, with cooling drinks, potas. nit. v.s., &c;
and with a view to divert action from the affected organs, we
directed a warm, stimulating foot-bath, with warm applications
to the extremities.

Notwithstanding the observance of the above treatment, the
returns of hemorrhage, which were of a bright arterial hue, be-
came more frequent, abundant and alarming in their character.
The ruptured vessels pouring out their contents into the air
passages, would excite irritation and cough by the presence of
the effused blood, which of course was expelled with force, caus-
ing a recurrence of the hemorrhage at irregular intervals of half
an hour or one hour.

Homoeopathy was now had recourse to, and after four or five
days consumed in the unavailing employment of its non entities,
I was again solicited to take charge of the case (the patient and
his friends fully expecting it would terminate fatally), on condi-
tion that there was to be no further interference on the part of
friends, and that my prescriptions and advice should be impli-
citly followed, I reluctantly resumed attendance.

March 10. Visit 9 o'clock, A.M. I ordered tr. ferri mur.
gtt. x, every hour in sweetened water, and to suck a raw egg
every two hours. At my visit at 6 o'clock, P.M., the hemorrh-
age recurring very profusely, I administered gtt. xl at one dose.
No discharge took place till 5 o'clock next morning, at which
time I was called up for advice.

11th. At 12 o'clock, M., my friend Dr. Gilbert saw the case
with me, in consultation. Our patient continued to experience
occasional returns of hemorrhage during the day, although the
dose of the iron was augmented to xx gtt. every two hours.

12th. Visit 9 o'clock, A.M. Some improvement apparent.
Had a return of hemorrhage at 11 A.M. Met Dr. G. at 12.

1859.] Abdominal Typhus. 41

Agreed to continue tinct. ferri mur., suck raw eggs, to give the
iron in gum water as a vehicle, to give ice-cream, and occasion-
ally ice. At 4 P.M., there was a slight return of hemorrhage.

13th. A slight return of hemorrhage at 4 A.M. Visit in
consultation at 12 o'clock, M. Agreed to give gtt xx tr. ferri
mur., every hour. Visit 5 P.M., continues to improve; visit 10
P.M., no return of hemorrhage, pulse much improved. The
longest interruption of the hemorrhage now occurred, affording
an encouraging prognosis.

14th Visit 9 o'clock, A. M. A slight return of haemoptysis
at 4 A.M., which is but once in 24 hours. Visit 5 P.M.; takes
gtt. xxx. of the iron every two hours in gum water, takes raw
eggs, oysters, ice-cream, farina, ice, etc., as diet. Improvement
progressive pulse fuller, slower and stronger, respiration easier
and more profound. Patient is able now to lie on his right side,
after maintaining a sitting, upright posture for ten days. Bow-
els moved once in 4 or 5 days by enemata.

16th. No return of hemorrhage to report; and from this
date forward he continued to convalesce rapidly and perfectly.

19th. Pills of ferri, ext. quas. and rhei were substituted for
tinct. ferri mur.

March 24th, our patient left his bed, and, in a few days, was
able to walk out for the benefit of exercise in the open air.

The amount of blood discharged during this attack of haemop-
tysis, lasting about ten days, could not have been estimated at
less than one gallon.

So profuse a hemorrhage occurring in a constitution impaired
by frequent previous attacks, associated with a strong and well-
marked hereditary predisposition to phthisis, and to eventuate
in recovery by the use of tr. ferri mur., affords us a high degree
of satisfaction ; and with the hope that its details might prove
not altogether devoid of interest, we submit it for publication.

[Med. and Surgical Reporter.

Abdominal Typhus.

From 100 dissections, from upwards of 1000 cases, Dr. Lebert,
of Zurich, deduces the following results :

Intestinal affection is not always present, and bears no relation
to the intensity of the disease appearing rather to be a co-effect
of the fever than sufficient for its explanation. In fatal cases,
the intestinal affection has not only formed a slough or sore,
but has even frequently ended in resolution ; and it is not always
easy to discover whether the intestinal affection has entirely
failed, or whether it has only been completely resolved. The
intestinal affection of typhus bears a very strong resemblance

42 Abdominal Typhus. [January,

to that of cholera, only in the latter there is usually more serous
infiltration ; it consists entirely in an increased formation of the
normal cell-elements, and there is no such thing, as far as our
author has seen, as a specific typhus exudation ; while so many
other diseases which have a typhoid condition, as pyaemia, se-
vere icterus, meningitis cerebro-spinalis, and the grave cases of
acute exanthemata, are accompanied by swelling of the intes-
tinal glands and the spleen, that we are involuntarily led to the
conclusion, that there is in many infectious diseases a peculiar
connection between the pathological poisoning and those glands
whose office it is to prepare the blood elements ; and therefore
the intestinal alterations in typhus have a much deeper and
more general signification than is usually believed. From the
eighth to the eleventh day, the cellular infiltration of the mes-
enteric glands, also that of the isolated and agminated glands, is
very distinct; they are soft and swollen, as are also the glands
of the large intestine. Yery soon, erosions, ulcerations, and
other anatomical alterations attendant on intestinal catarrh occur,
which are most frequently observed from the eleventh to the
fifteenth day ; and in this very period, also the phenomena of
resolution are often observed. But the intestinal alterations of
typhus are very far from being bound down to typical phases ;
and there is even an occasional disproportion between the ex-
tent of the disease in the isolated and agminated glands, the lat-
ter being peculiarly its seat, while it is often entirely wanting
in the former. In the course of the third week the intestinal
alterations are at their height; in one case only, pus was found
in the mesenteric glands, partly infiltrated, partly in the fluid
state (as an abscess). In the fourth week the ulceration gen-
erally continues, the catarrh of the colon and ileum already re-
trogressive ; the marrow-like infiltration of the mesenteric glands
at its height, and partly retrograde. One man, however, dead
on the twenty-fourth day, had only a few agminated glands
slightly swollen, and the seat of superficial ulceration. Another
case, dead after the twenty-eight day, showed undeniable symp-
toms of resolution without ulceration ; the mesenteric glands
were partly swollen, partly retrograde; Peyer's patches of a
slaty hue, firm and granular, partly shrivelled, and only one
small ulcer in the processus vermiformis. Tendency to cicatri-
zation was only once observed on the twenty-fourth day. This
stage occurs generally much later than authors have supposed.
In the fifth week we have for the first time a greyish coloration
of the edges of the ulcers, which now begin to fine down, but
show only exceptionally a tendency to reparation. In this week
the author observed three cases of resolution without ulceration,
in only one of which was there trifling ulceration. In one case,
dead after the thirtieth day, Peyer's patches were still slightly

1859.] Abdominal Typhis, 45

swollen, grayish yellow, covered with a few small brown ecchy-
motic spots; the neighboring mucous membrane hyperaemic ; the
spleen large and soft ; the mesenteric glands enlarged. Another
case died on the thirty-fifth day ; the spleen was still large and
soft^ most of Peyer's patches had a slaty-gray appearance ; and
only a few isolated glands showed traces of cicatrized ulcers.
During this week the mesenteric glands are generally partly
diminished in size, partly soft and swollen, and also of a slaty
hue, particularly on the surface, whilst the interior is of a dull-
yellow, cheesy aspect, as of shrivelled nuclei, already undergo-
ing molecular disintegration ; these disintegrated elements are
probably subsequently absorbed, and the glands return* to their
normal state. During the sixth week, reparation proper com-
mences; the edges of the ulcerations long retain their slaty hue,
and the different portions of the intestinal, canal are unequally
advanced ; the mesenteric glands are by this time restored to
their normal state. In this week also the author found a case
of undeniable resolution without trace of ulceration ; Peyer's
glands being slaty in hue, partly reticulated, partly granular and
shrivelled. In the seventh week complete resolution is the
normal condition ; yet our author found three cases in which,
although the edges of the ulcers were slate-coloured, their basis
showed no trace of healing. Such are the cases in which tardy
perforation occurs, and those also in which the patients some-
times die in the third month from sequelae. Once in the eleventh
week, and another time after three and a half months, our
author found cicatrization uncommenced ; in both cases a diph-
theritic diarrhoea, accompanied by numerous ulcerations in the
colon, was present ; our author supposes that fatty degeneration
of the textural elements of the ulceration is the cause of its not
healing. He mentions as very remarkable two cases, one dead
in the ninth week, the other in the eleventh, in both of which
distinct villous granulations (Zotten) were produced on the sur-
face of the sore, while in every other case the cicatrix had a
striped fibroid appearance, with scattered gray pigment granules
and corpuscles; such cicatrices were also distinctly vascular.
As one-fifth of our author's recorded observations comprised
cases in which the intestinal alteration failed entirely, were very
trifling, or ended in resolution, bearing no relation to the se-
verity of the disease, which severity bore also no relative con-
nection to the typhoid diarrhoea, so he concludes that the dis-
tinction between abdominal typhus and exanthematic typhus
without intestinal alteration cannot be strictly defined; much
must still be left for future observers. With respect to the other
textures and organs, our author found, 1st, an important relative
frequency of peritonitis in ileo-typhus; nine cases of perforative,
and seven of simple peritonitis, in 100 deaths; besides numerous

k. s. VOL. XV. NO. i. 4

44 Abdominal Typhus. [January,

unmistakable recoveries from similar accidents, extending in
time from the seventh day to the fourth month, berng most fre-
quent in the second month. The splenic enlargement, more or
less constantly present, bore no relation to the intensity of the
typhous process. Splenic softening, depending on hyperemia
and increased cell-formation, was a much more regular concom-
itant. The liver, in more than one-fifth of all cases observed,
was more or less fatty ; and in every case analyzed by Professor
Stadeler, leucin and tyrosin were found, while, so far as known
to our author, sugar has not been found in a typhous liver; so
he considers it extremely probable that alterations of the liver
not only exist during the typhous process, but probably have an
intimate relation to it. The kidneys in the first two weeks were
somewhat swollen and hyperaemic; later in the disease the kid-
neys were twelve times found to present more serious alteration ;
the size normal, or but slightly increased ; the cortical substance
decolourized, with here and there vascular points and stripes,
the decolorization intruded partly on the pyramids ; and here
there was found, first, on the fourteenth day, generally about
the fourth week, increased cell -formation in the convoluted
ducts, mixed with a fine granular, albuminous infiltration, which
subsequently seemed to undergo fatty degeneration ; in most of
these cases no albumen had been detected in the urine during
life. A few cases of ileo- typhus complicated with Bright's disease
recovered. The heart in the later stages of typhus becomes flab-
by, thin and pale, and frequently fatty, proving thus a proba-
ble source of death in protracted cases. Ulceration of the lar-
ynx, observed by Rokitansky, Vogel, and Rheiner, were never
seen at Zurich ; pleurisy was present eight times ; once the
typhus commenced with pleurisy, which at death, on the forty-
sixth day, was so far healed that only adhesions and increased
injection remained. Occurring at an early period, it generally
terminated favorably; and even as sequela, which it most fre-
quently was, it was only then very serious when double, or the
patient much reduced. The most frequent alteration of the
lung was hyperaemia, with dark red, violet, or a more brownish
colour, compact appearance, and a smooth cut surface, with dis-
tinct collapse of the lung-cells. This condition has been termed
carnification or splenization when extensive, and atalektasis
when more circumscribed. The author observed this condition
twenty-one times diffuse and lobar, and six times scattered and
lobular. The diffuse form is much more common, if to it we
add those numerous cases in which hypostases showed a tenden-
cy to pass into carnification. The lobular atalektasis had a
direct relation to the bronchitic affection, and was more frequent
when that was severe.

Recent emphysema is also by no means an infrequent con-

1859.] Primary Syphilitic Ulcer. 45

comitant of typhus. Lebert observed it thirteen times, and con-
nects it with intense capillary bronchitis. Pneumonia was a
rare complication, occurring but five times twice lobular, and
three times general and lobar; apoplexy of the lung occurred
eight times. Catarrh and bronchitis, with their sequelae hypos-
tasis and carnification, seem to belong to the typhous process ;
while laryngitis, pleurisy, pneumonia, etc., are only accidental
complications or sequela?, and tuberculosis and typhus seem to
a certain extent to antagonize one another. The nervous cen-
tres afford no anatomical explanation of the serious cerebral
symptoms so often occurring in ileo-typhus. Meningeal
hyperemia, and cedema under the arachnoid, are very frequent.
Lebert found, however, only thrice increase of the ventricular
fluid, and also three times effusion of blood in the membranes,
and twice effusion of blood in the brain substance itself; once
there was meningitis with sero-purulent exudation on the sur-
face of the brain. [Edinhurg Med. Jour., from Prager Yierteljahr-
schrift,/. d. Prak. Heilk.

Communication from the Clinical Department for Syphilitic Pa-
tients at the Clwrite in Berlin. By Prof. Y. Baerexspruxg,
(Annalen der Berliner Charite, torn. vi. 1.) Translated for
the Lancet and Observer. By W. Krause, M.D., Cincinnati.

THE PRIMARY SYPHILITIC ULCER.

The peculiarities ascribed to the primary syphilitic ulcer, its
round form, sharp edge, lardaceous bottom, etc., are neither al-
ways well marked, nor sufficient at all to distinguish it from
other similar affections. As a diagnostical means, however, in-
oculation as introduced by Ricord, has gained a wide reputation,
so as to mark even an important epoch in the history of syphi-
litic diseases, by proving the specific and unique nature of the
syphilitic virus as well as its actual difference from the gonor-
rhoic to a certainty, while it rendered the non-contagion of the
secondary affection at least probable. The inoculation of the
syphilitic virus, however, is by no means an insignificant oper-
ation. The pustule rising at the point of inoculation, shows
nothing characteristic of its nature; this can be known only by
the ulcer, developing itself from the pustule. It is, therefore, in
order to obtain a positive result, necessary to leave the pustule
alone for several days, before destroying. The longer, however,
this is deferred, the greater is the danger of infection of the sys-
tem. The destruction, to be successful, must be accomplished
by means of an active cautery, such as the caustic potash or the
Vienna paste, which operation is not at all insignificant to the
patient. Finally, the inoculated chancre may assume, before or

46 Primary Syphilitic Ulcer. [January,.

after its destruction by the cautery, a gangrenous character, it
may spread so as to require a much longer period for its curer
than the ulcers, from which the inoculating matter was taken.
Apart, however, from these possible disadvantages of inocula-
tion, some other circumstances, diminishing its diagnostical val-
ue, urge themselves upon our consideration. For, the chancre,
secreting an inoculable matter only during its first stage, we are
not justified in inferring the non-syphilitic nature of a doubtful
ulcer from an unsuccessful attempt at inoculation. The inocu-
lation of other pathological secretions, moreover, gives rise some-
times to products, more or less similar to an inoculated chancre.
In order to prove the latter assertion, Dr. Y. Baeren sprung
made a series of experiments, by inoculating the chancrous mat-
ter and other morbid secretions, the results of which he conden-
ses into the two following propositions :

1. Kecent laudable pus, inoculated in the common manner,
causes no reaction whatever. Stagnant pus, or other patholo-
gical secretions, in which decomposition has commenced pro-
duces a superficial inflammation of the skin, presenting itself
under the form of an impetigo or ecthyma-like pustule at the
point of inoculation, which dries up after a few days, without
leaving any trace of itself, rarely it leads to superficial inflam-
mation ; ichorous matter, however, and other rotting animal
substances, if inoculated, give rise to a pustule, tending from its
beginning to ulceration, which spreading on the surface and
eating slowly into the tissues, heals by leaving a radiated cica-
trix. Yery similar is the effect of the inoculated syphilitic pus,
only with this difference ; the primitive pustule is larger and
the ulcer following it spreads with greater rapidity.

2. A pustule rising at the point of inoculation, is no pToof
whatever, for the syphilitic nature of the inoculating matter.
Even when the pustule transforms into an ulcer, its syphilitic
character still remains doubtful. Should, however, this ulcer
spread rapidly, while putrid decomposition of the inoculating
matter can be excluded, then, no sooner, a sufficiently certain
criterion for the syphilitic nature of the ulcer has been found.

To obtain farther revelations, the author took pains to eluci-
date the process of syphilitic ulcerations by microscopical exam-
ination. On the first day after the inoculation a vesicle appears
filled by a serous fluid, and under the vesicle, corresponding to
the inoculated point, a little whitish core. The membrane of
the vesicle is formed by the epidermis elevated from the cutis,,
while its contents are a serous matter exuded, in which corpus-
cles of pus of the ordinary form, and numerous swollen cells,
from the rete Malpyghii, are to be found. Thus far, therefore,
this vesicle does not differ from any other, caused by a superfi-
cial dermatitis. Peculiar, however, is that whitish core imbed-

1859.] Primary Syphilitic Ulcer. 47

ded in the coriura. It contains cellular fibres, surrounded by a
number of corpuscles of pus, so as to become distinctly visible
only after an ablution by water. The object gets still clearer
by an addition of acetic acid, which leaves the nuclei of the cells
solely perceptible, cellular fibres disappear, and in their places
bundles of numerous, sharply contoured elastic fibres are seen,
exactly of the same qualities as normally found in the thick cel-
lular substance of the corium. That little core, therefore, is
nothing else but a portion of necrotic tissue, soaked by pus and
surrounding the point of inoculation. This core is thrown out
the next day. In its place a little funnel-shaped ulcer is found,
increasing in size during the next days, and showing the same
character as a chancre produced by natural contagion. It is
always covered with that dirty white or yellowish layer, com-
monly called the lardaceous bottom of the chancre. It consists
of a soft pulpy mass, which can not be pulled or wiped off, in
the form of a membrane, which, however, admits of removal by
abrasion, and shows the same microscopical properties as the
above core, to-wit: cellular and elastic fibres, with a great many
cells of pus. Presently under this layer lies the intact, but hy-
perdermic tissue of the cutis, bleeding after the slightest touch.
The lardaceous bottom of the chancre is, accordingly, the most
superficial portion of the corium, mortified and infiltrated with
pus. As often as removed by scratching it re-forms, while the
ulcer at the same time spreads in circumference and depth.
Hence we infer, that the spreading of a chancre is owing to the
mortification of tissue, progressing by layers. This process, be-
ginning at the point of inoculation, it is, furthermore, apt to
presume, that the ulceration is started by the immediate contact
with the syphilitic virus, which, reproducing itself, like all con-
tagia, exercises the same effect in circles, widening more and
more. The formation of pus, accompanying the process of ul-
ceration, appears as the product of inflammation, kept up by the
adjacent tissues, which have yet escaped destruction .

The necrotic exfoliated elements mingle with the pus, thus
forming the contagious matter of the chancre. When collected
on a watch glass, in large quantities, it appears as a turbid fluid,
in which whitish flakes are suspended. This fluid consists of
serum and corpuscles of pus, while the flakes are the mortified
fibrous elements of the skin with many cells of pus attached to
them. Besides these and other accidentally admixed epidermic
cells, molecular and fatty granules, no other elements are to be
found. The vibrions found and described by Yonni, never
came under observation.

The destroyed elements of tissue are found in the matter se-
creted by the ulcer a^ long as the progressive period of the
chancre lasts, if this is brought to a close either by cauterization

48 Primary Syphilitic Ulcer. [January,

or some other anti-syphilitic treatment, the properties of the ulcer
and its secretion change. The ulcer cleans itself, the necrotic
tissue, covering its bottom disappears. Sometimes, not always,
however, its place is filled by another white layer, differing very
materially from the former by allowing its removal, in form of
a membrane. This latter membrane. consists of fibrine exuded
by the inflamed bottom of the ulcer. It sometimes forms again
and again after being pulled off, until it gives room to the for-
mation of vascular and cellular tissue, which goes on under it
gradually filling the loss of substance, occasioned by the ulcer
and finally consolidating itself into a solid cicatrix. In other
cases such exudation of fibrine is not observed, the bottom of
the ulcer begins to granulate directly. In this, its stage of re-
production the chancrous ulcer does not differ the least from
any other granulating ulcer. Its pus becomes thicker, no other
elements, but the common cells can be detected in it. If trans-
ferred by inoculation it manifests no more virulent qualities.

It is known that a series of chancres have been distinguished
from the common one. Several of them after Eicord's example
have been comprised under the generic term of phagedenic.
Now, strictly speaking, every chancre possesses some of the
phagedenic character. If, therefore, a certain kind is thus par-
ticularly denominated, no qualitative, but a merely quantitative
difference can be meant by it. Let us look first at Eicord's
chancre phagedenique diphtheritique ou pultacee. This owes
its name to a pulpy layer, covering its bottom, which layer does
not only bear external resemblance to the diphtheritic masses
observed on mucous-membrane. Diphtheritic characterizes
itself everywhere by the decay of the matter infiltrating the
morbid tissue and the diphtheritic chancre with its pulpy bottom
shows no marked difference from the lardaceous bottom of the
common chancre. Both consists of mortified tissue with corpus-
cles of pus, with this difference only, that the latter forms a thick-
er layer, because its process of destruction goes on quicker.
The diphtheritic chancre is observed mainly on persons whose
system is in a debilitated or dyskratic condition, before conta-
gion took place. The want of reactive power in such individu-
als is, therefore, to be assigned as a reason for the violent
spreading of the ulcer. On the same ground the other charac-
ters peculiar to this chancre, explain themselves, for instance,
its less regular form, the more oedematous, than inflammatory
condition of the surrounding parts, the slight degree or utter
want of sensitivness, which singularly contrasts with the extent
of the ulceration. The doctrine, that all exulcerating chancres
are not followed by constitutional syphilis is certainly false in
its application to the diphtheritic chancre. The general infec-
tion here, as always, announces itself by the induration of the

1859.] Primary Syphilitic Ulcer. 49

bottom of the ulcer, corresponding in extent to the periphery
and depth of the ulcer. This kind of hardly indurated diphthe-
ritic chancres have been promoted by Ricord to the degree of a
proper species under the name of chancre phagedenique par
exces d'induration.

The same cause, which with invalid constitutions promotes
the enlargement of the chancre, retards also its healing. The
restitution of the destroyed tissue proceeds slowly, nor does it
ever become complete. More or less extensive defects of the
prepuce glands or labia remain forever, and the surrounding
hardness does not disappear, until after a long time. If, moreo-
ver, neglect on the side of the patient makes its influence felt,
such ulcers may be stationary for months, until they finally
become incurable.

The direct contrast to this form is the inflammatory chancre.
Eicord's chancre inflammatoire a tendence gangreneuse franche,
to which must be ranked the chancre phagedenique gangreneux,
for both differ only by this, that the latter has actually termina-
ted in gangrene, which is to be dreaded with the former. The
inflammatory chancre is usually met with on robust, plethoric
individuals, characterizing itself by violent pain and a highly
inflamed halo around the ulcer. If this inflammation is increas-
ed by the irritation from the clothes in active exercise, stimula-
ting diet, spirituous liquors or pressure, caused by a narrow or
swollen prepuce, the result is gangrene, spreading far beyond
the original boundaries of the infection, mortifying with great
rapidity the organic substance and leaving indelible defects.
On microscopical examination of the bottom of and matter secre-
ted by the inflamed chancre, nothing can be detected, which
might distinguish it from the simple or diphtheritic ones, with
the sole exception of a larger number of corpuseles of pus, closer
enveloping the destroyed elements of tissue. The masses des-
troyed by the gangreneous chancre consists likewise of tissues,
which, however, appear yet in their natural connection, having
been thrown off together; the cutis with her papillary body,
the meshy sub-mucous cellular tissue, composed of riddle bun-
dles of fibres, the vessels even, and glandules of the skin are
found almost in their natural form and aggregation, the whole
object appearing the clearer, the less the number of interspersed
corpuscles of pus. The substances, however, found on the bot-
tom and in the matter secreted of chancres non-gangrenous, are
always dissolved in*o their elementary parts, no complex struc-
ture is any more discernible. The essential difference between
the two large classes of chancres consists, therefore, in this: In
gangrene the parts mortify en mass, and far beyond the primary
limits of infection ; in the nou-oangrenous chancre, only an ex-
foliation of tissue, progressing by layers, takes place. In this

50 Primary Syphilitic Ulcer. [January,

circumstance another peculiarity of the gangrenous chancre finds
its explanation, to-wit : the dark color originating from blood
extravasated and metamorphosed, as also the putrid odor, which
is developed by the decay of the mortified substances. Gan-
grene is accordingly a process entirely different from syphilitic
ulceration, on which it may supervene as the result of much
increased local inflammation. Advancing beyond the bounda-
ries of the infection, it is attended by the most important loss of
substance, which, however, prevents the absorption of the
syphilitic virus in the same manner, as cauteries, artistically
employed. It is peculiar only to the gangrenous chancre,
never to be followed by secondary syphilis. The healing of
the ulcer progresses with great rapidity after the demarkation
and detachment of the destroyed masses, there is never left a
specific induration nor a chronic intumescence of the correspond-
ing lymphatic glands. Also the imflammatory chancre seldom
has secondary syphilis in attendance, because the violent pain,
by which it is accompanied, compels the patient to seek
medical counsel in time, perhaps also for this reason, that a
violent inflammatory reaction eliminates by supuration the in-
fected part.

The Hunterian chancre, sufficiently known by its specific in-
duration always supervenes at a later period, never before the
fifth day of the appearance of the primitive chancre. It is
always found accompanied by a moderate indolent swelling of
the inguinal glands, and invariably followed by secondary sy-
philis, not unfrequently, even where a thorough anti-syphilitic
treatment has been instituted. These facts, per se, seem to
indicate that the indurated chancre is not solely a local affection.
The induration on the contrary is the first manifestation of the
general infection of the system, which has already taken place,
and is soon to show itself on a more extensive scale. This theory
is confirmed by the examination of the indurated bottom of the
ulcer. An incision carried through the indurated part, shows
a homogenous lard-like surface. On pressure a turbid and gran-
ular jelly protrudes, which, put under the microscope, appears
to consist of drops of oil and a number of irregularly formed
flakes and granules of very different size and transparency, in
addition, a small number of nuclei and spindle-shaped cells.
Ether, superadded, does not dissolve much, acetic acid, however,
renders the whole object somewhat more transparent. A solu-
tion of iodine gives to a portion of the amorphous granular
masses that red color, proving according to Meckel, the presence
of lardaceous matter. Hence, it will follow, that the exudation,
which forms the specific induration of the chancre, differs from
matter exuded by common inflammation. The presence of
nuclei and cells seems to favor the organization of the matter

1859.] Primary Syphilitic Ulcer.

exuded into cellular tissue, an assumption, proven to be correct
by the observation, that every specific induration, if persist-
ing during some time, is transformed into a fibrous cicatrix.
There seems, however, to be a want of tendency to purulent
metamorphosis, as we are taught by experience, that the ap-
pearance of the specific induration retards or arrests the process
of ulceration. If these observations plead on the one side, for
the specific nature of the induration, they render it probable on
the other, that its anatomical character is identical to other
exudations, formed under the influence of constitutional syphilis
in various other organs. The author had repeatedly the oppor-
tunity of examining into the contents of gummata, which, as is
generally known, sometimes develop themselves by syphilitic
inflammation in the cellular tissue, more frequently under the
periostium. Their microscopical and chemical properties were
always the same as those of the indurated chancre. We are led
therefore, to the conclusion, that the specific induration is a man-
ifestation of constitutional syphilis, that it is unjustifiable, to
class the indurated chancre among the primary ulcers. Indu-
ration often supersedes the simple and diphtheritic chancre, rare-
ly the inflammatory or gangrenous ones. It is not the messen-
ger of Lues coming, but Lues herself present.

Eicord's chancres phagedeniques serpigineux and terebrant
are not sufficiently marked to be classed as different forms. The
former fell under observation only as a secondary affection,
while the latter is nothing but a common serpiginous chancre,
spreading more into depth, than circumference, in consequence
of its accidental implantation on the lax and cedematous cellular
tissue of the margin of the prepuce.

According to V. Baerensprung, the presence of mortified tis-
sue in the matter secreted by the chancre during its progressive
stage may be used as a valuable diagnostical means. For, though
the separation of necrotic substance and the intermixture with
the different secretions is no process peculiar to syphilis, yet it
is not frequently met with in affections apt to be confounded
with chancre. These are herpes vulvae and preputic, the catarr-
hal erosions and inflammatory ulcers of the genitals.

Herpes does not seldom form on the male prepuce, most fre-
quently, however on the female organs of generation. True on
the external surface of the prepuce and labia majora it appears
under the form of vesicles, grouped on a reddened ground, form-
ing eschars after some days, and being speedily cured. On
the inner surface of the prepuce, however, on the mucous lining
of the inner labia and vestibule of the vagina no such vesicles
are formed, because their tender epithelial covering is not resist-
ant enough to be separated as an unbroken membrane from its
corium. In these places, therefore, herpes shows itself as a group

52 Sugar in the Diseases of Infants, etc. [January,

of little round, whitish, aphthse-like erosions, which sometimes
becoming confluent, cover a large extent of surface, assume an
irregular form so as to simulate the existence of a chancre, es-
pecially when the neighboring parts get inflamed and turgid.
On minute examination, however, the corium is found entirely
intact, being deprived only of its epidermic covering. The su-
perficial white layer is composed exclusively of corpuscles of
pus, which adhere to the denuded papillary body.

The large and quite irregular landscape-like erosions, so fre-
quently attending blennorrhoic secretion and balanitis, present
the same anatomical character. Those portions of the mucous
membrane, stripped of their epithelial covering, become the
source of a more or less abundant secretion of pus. The cells of
pus, next to the corium, are supplanted again and again, by
others, until epthelial cells at last begin to form in their place.

From these frequent affections of a catarrhal nature others
are to be distinguished, being the product of plastic inflamma-
tion. Little ulcers of oval form on a highly inflamed base, their
bottom covered by a closely adhering white membrane, which
can be detached as a whole, fall not unfrequently under obser-
vation near the posterior commissure and on the caruncles at the
entrance of the vagina. If left alone, these ulcers do not increase
in size, but heal in a few days without leaving a specific indura-
tion. They arise from trifling mechanical injuries of the mucous
membrane, rents, etc., if these get inflamed by irritating influen-
ces, such as blennorrhoic secretions or frequently repeated
coition. That firmly adhering membrane consists of plastic
matter exuded, which on microscopical examination shows that
granular and fibrous structure, peculiar to coagulated fibrine,
interspersed by many corpuscles of pus, without the presence,
however, of necrotic elements of tissue. [Qlncinnatti Lancet.

Employment of Sugar in the Diseases of Infants, and its utility in
Intestinal Catarrh. By Drs. Behrend and Sieber, of Berlin.

In the Presse Medical Beige is an interesting paper on the use of
sugar in the diseases of infants, a portion of which we abstract.
The authors refer to the writings of Sala, Pellatier, Hoffman,
and many others, in support of the utility of the remedy.

The ordinary cane sugar is employed with our general diet-
etics in consequence of its agreeable taste. During the last
century many of the older authors spoke in high terms of the
therapeutic action of sugar, and recognized in it many proper-
ties of utility in the treatment of divers maladies. In later times
and after the prosecution of many philosophical researches, and
the presentation of their results, we are now taught that the
opinions of the old physicians were well founded and rational.

1859.] Sugar in the Diseases of Infants, etc. 63

We now know that, by the reactions of this agent with the li-
quids of the stomach and intestines, it is transformed into lactie
and butyric acids direct. To the researches oi'Lchmann we are
mainly indebted for the information we now possess, and are
made cognizant of interesting and remarkable changes and ef-
fects on the animal economy from its agency and its mutative
action on medicaments.

Without further prelude we will now cite two cases which
came under our treatment some six years since, and which will
serve to show what may rationally be expected from it as a
therapeutic agent.

During the epidemic which prevailed in this country in 1851,
and which manifested so much activity in the derangement of
the intestinal functions, both in adult and in infant life and
attended with high febrile action we had many opportunities
for observing the salutary effects of the remedy.

A child three years of age, of a scrofulous habit, was seriously
attacked with the prevailing disease. An intense fuver declared
itself at the outset, which was soon followed by copious diar-
rhoea, attended with violent colic pains, and soon afterwards by
excessive abdominal tenderness. An acute inflammation was
manifest, which was combated with an antiphlogistic course, to
which it soon yielded. The diarrhoea persisted, with great irri-
tability of the stomach, and the expulsion of a light flocculent
matter; a nutrient treatment was adopted to support the sinking-
patient, but all ingesta was rejected instantly, and it was easy
to foresee that all the usual remedies in such cases would be
applied in vain. The efforts at vomiting continued; the stools
were mixed with mucous filaments slightly colored with bile,
and at times streaked with blood ; their odour was acid, but not
strong.

The child was now put upon sugar and water, which it ate
with a raven ousness and voracity most remarkable. This pecu-
liarity, and the apparent assurance it gave of adaptability in
this case of intestinal catarrh, determined us, for the first time,
to employ this method of treatment. To effect its exhibition in a
convenient manner it was given in the form of pulv. blanc. sac,
one half oz. slightly moistened with water, each hour. This
treatment was continued four hours, and was tolerated. At
night the same treatment was continued, the patient to have
sweetened water whenever disposed to drink. No other medi-
cation was employed. On the fifth day the abdominal pains had
ceased most completely ; the diarrhoea still continued, but the
stools were less copious and freqnent, and contained fecal mat-
ters. The treatment was continued, with the addition of light
nutrient fluids, which we now found feasible, and, as the patient
recovered, beef tea was given. The treatment, for nine days,

54 Secede Cornutum in Asthenopia. [January,

consisted of sugar in a humid slate, and to its effects we are
disposed to consider the cure attributable, and not to other medi-
cation.

Soon following the above case, another child, aged four years,
was presented with the same disease. It had become very ema-
ciated by the wasting diarrhoea, and, when first presented, was
writhing with the violent colic pains attendant on the disease.
The patient was placed upon the same treatment in all respects
as the former, and at the end of five days the stomach would
tolerate other light nutriment, followed by beef tea, as in the
first case. In three weeks the cure was perfect. During the
last two weeks the quantity of sugar administered was 'dimin-
ished daily.

These two cases go far to establish the value of the remedy
as a therapeutic agent, and when we regard the opinions of the
older writers upon this subject, it seems evident that it has long
been a useful but neglected adjunct in the treatment of peculiar
diseased conditions. [Pacific Med. and Surg. Journal.

Sccale Cornutum in Asthenopia.

Prof. Yon. Willebrand states that he has employed " secale
cornutum in several diseases of the eye in which I believe the
evil to be removable by recalling a brisk contractility in the walls
of the bloodvessels, or in other structures furnished with unstrip-
ed muscular fibres. This remedy has proven of the greatest ad-
vantage in disorders of the adjusting power of the eye . . .

" A woman, aged 28, of a fine, healthy appearance, who had
always enjoyed good health, and who had gone through two
favorable confinements, the last of them four years before, com-
plained of great deterioration of sight, so that she could not oc-
cupy herself for longer than some five minutes at a time in sew-
ing or reading, when the letters seemed to mix together and pain
arose in the eyes, spreading to the brow and temples. Were
they, on the contrary, wholly unemployed, she felt no pain in
the eyes, and found her power of vision pretty much as it had
always been. The patient thought she had remarked this irrita-
bility of the eyes to have come gradually on for two years, con-
temporaneous with diminished menstruation. No morbid
change could be detected about the eyes. The pupils were some-
what contracted, but quite movable. The patient could distin-
guish near and distinct objects as formerly. Her visual distance
was normal. The eyeballs felt something firmer than common.
There was no doubt that the disease consisted in a disturbance
of the adjusting power ; it appeared tome certain also that a
chronic congestive state of the eyes was present, and that this
was probably the cause of the disturbance in the adjusting power

1859.] Treatment of Neuralgia ly Electricity. 55

of the eye. The cause presented nothing further worthy of note,
except that the bowels were slow.

"I ordered ten grains of secale cornutum with carbonate of
magnesia, four times a day. I saw the patient again in four
days; she was overjoyed at the improvement which had taken
place. She could now read and sew with ease. This state lasted
four months, after which the patient observed that the disease
returned. The same means was again employed, and with equal
benefit. Since then she has seldom required to have recourse
to it, so long as she follows the advice given her, to use her eyes
sparingly in reading and sewing.

"More recently, I have in cases of disturbance of the adjust-
ing power, always used the same means, and with constant good
effect. The complaint returns, indeed, readily in those cases,
where the cause (for example, straining of the sight upon minute
objects, especial!}- in a bad light) cannot be avoided, yet it is
removed by the same means. The young people of the ladies'
school of this place, who, in consequence of strained occupation
in a bent position, and of ill-arrranged illumination, are expos-
ed to the above-mentioned unfavorable circumstances for sight,
have afforded me several examples of considerable derangement
of the adjusting power, which all, at least for a time, have yield-
ed to this means. I am thereby firmly convinced, that in dis-
turbed power of adjustment the treatment by means of convex
glasses is greatly aided by internal medicine. The dose of the
secale cornutum is to be varied according to the age of the patient.
Lately, I have ordered only five grains for a dose to an adult,
mostly in combination with carbonate of magnesia, sometimes
in chlorotic cases with iron." [Archiv. fur Ophthalmologic, and
Med. Times and Gaz.

On the Treatment of Neuralgia by Electricity. By J. ALTHAUSr
M.D.

From the time when Sarlandiere and Magendie first made
known their observations on the therapeutical use of electro-
puncture, galvanism has been frequently and in various ways
administered to relieve such neuralgic pains as defy other
therapeutical proceedings. The practice of electro-puncture
being connected with more or less annoying inconveniences,
viz., in many instances very violent pain during the operation,
and afterwards inflammation and supuration in those tissues
into which the needles have been thrust, other modes of apply-
ing galvanism have been naturally resorted to. Duchenne re-
commended to produce a strong revulsion by practicing fara-
disation of the skin, by means of metallic brushes conveying a
very powerful electro-magnetic current to the painful points ;

56 The Vital Point. [January,

but the pain produced by this proceeding is, according to Duch-
enne himself, atrocious, and in a certain number of cases the
operation has not been accompanied with any success. Another,
and in my opinion, the better way, is to send an induced cur-
rent, of middling intensity, for a certain time through the affect-
ed nerve, by means of moistened conductors ; one pole being
placed at a point where the trunk of the nerve may be reached
nearest to the nervous centres, the other one on any of the ter-
minal branches of the nerve. This mode of electro-magnetic
treatment, which is derived from the physiological fact that by
such a proceeding any nerve in its normal state may be made
more or less insensible, I have found the least inconvenient
and the most efficacious for some forms of neuralgia. In fact,
the pain produced by it is very insignificant, and hardly worth
mentioning, when compared to the often excrutiating neuralgic
pain against which the proceeding is instituted. On the other
hand, I have seen the method alluded to answering in cases
where both electro-puncture and faradisation of the skin had
been resorted to with little or no success. [Med. Times and Oaz.

The Vital Point

It is well known that M. Flourens has long since designated a
particular point in the cerebral mass as the seat of that power
which presides over the respiratory and circulatory systems.
According to his statement, the destruction of this point invaria-
bly occasions an instantaneous suspension both of cardiac and
pulmonary movement, and the immediate death of the animal
without pain or convulsions. This has been esteemed by many
as the most positive evidence of the truth of those doctrines,
which, since the days of Hippocrates himself, have found a mul-
titude of champions assuming the name of vitalists, and asserting
the existence of a specific force essential to life, presiding over
the various component organs, and preserving the animal me-
chanism in its normal state of equilibrium. Believing that the
arguments of their more material opponents, who made the scal-
pel the test of everything, were fully answered by the researches
of Flourens, they exhumed the memories of Von Helmont,
Hoffman and Stahl, honored them with orations, and proclaimed
them the only lights which had illuminated the medical world.
Though affecting for years a sovereign contempt for that system
of vivisection, which has really accomplished so much of practi-
cal importance both -for Physiology and Therapeutics, they be-
came at once its warmest friends and most zealous advocates.
Though bound only by a sort of traditional regard to the ab-
stractions of an effete theory, one stroke of the knife awakened
them to new life and energy ; and though ridiculed as laggards

1859.] On the Use of Soluble Glass. 57

in the great march of professional improvement, the}' suddenly
found themselves transformed, as they supposed, into pioneers
and prophets.

More recent and accurate researches, however, are about to
effect another revolution in Medicine, for Sequard, following the
lead of the learned and laborious Bernard, has overturned the
whole theory of Flourens, and demonstrated that the "Vital
Point" is no vital point at all. The following are his conclu-
sions, as first published in the Journal de la Physiolo^ie.

1. Death is not always the immediate result of ablation of the
vital point.

2. When death takes place suddenly after this ablation, it is
due in a great measure to the sudden arrest of the movements of
the heart resulting from irritation of the spinal marrowr.

3. Irritation of the surrounding parts produces sometimes the
arrest or enfeeblement of the heart's action, just as ablation of
the point itself.

4. After dividing the pneumogastric nerve, the destruction of
the vital point never occasions a sudden suspension of cardiac
movement.

5. It is not because of the ablation of the vital point that res-
piration sometimes ceases, but rather on account of the irritation
of the spinal marrow.

6. Irritation of the adjacent parts sometimes arrests respira-
tion even when the " vital point" is not wounded.

7. Respiration and circulation can be performed with force
and regularity for a number of days after ablation of the " vital
point," from which it is evident that this part of the cerebral
mass is neither the source of vital power, nor the main spring of
the respiratory apparatus.

8. Voluntary movements, and the sensorial functions, are of-
ten uninterrupted, even after the destruction of the "vital
point."

9. The " vital point" appears not to be essential to life.

[Medical Journal of North Carolina.

On the Use of Soluble Glass.

Soluble Glass is prepared by fusing a mixture of 15 parts of
quartz, ten of potash or 9 of sodaT and 1 of charcoal. In its dry
state it is clear, colorless, hard, and not easily fusible. Gradual-
ly added, in the form of fine powder, to boiling water, it is dis-
solved, after some time, in 5 or 6 times its weight of water, to a
syrupy liquid. The same solution has been obtained by dissolv-
ing quartz directly in a strong solution of caustic soda under a
pressure of 7 or 8 atmospheres.

58 On the Use of Soluble Glass. [January,

Common chalk, previously soaked in water, and afterwards
allowed to remain in the solution for a few days, has acquired
such a hardness that it cannot be scratched with the ringer nail,
and may be readily polished. This increase of .hardness pene-
trates into the interior of the piece in proportion with the time
allowed for reaction, and a mass is thus obtained quite unsus-
ceptible to the influence of either water or carbonic acid. This
quality of the soluble glass will secure it a vast application for
the hardening and preservation of porous and decaying build-
ing stones, and walls erected from such material. The great
painter, Kaulbach, has the merit to have called forth a new pe-
riod in fresco painting, by the use of the soluble glass for the
fastening of his paintings upon the plaster walls. He paints
with ordinary water colors, or mixes them with a weak solution
of the glass, and the wall, after the finishing of the painting, is
saturated with the glass solution by means of a fine syringe.

Soluble glass may be used for the painting and preservation
of metals, stone, wood, paper, and a number of fabrics. Wood-
en floors are thus made not only very hard and durable, but
their absorption of oil, ink, etc., is effectually prevented, and
they are preserved against all attacks of the wood-worm. Wood,
paper, etc., are rendered uninflamable, particularly if the glass
solution has been mixed with chalk, in which case the glass coat
is, externally, hardly altered, while underneath a kind of des-
tructive distillation is going on; but if the coating has been of
pure, soluble glass, this is apt to become fused by the heat and
run off, thus exposing the wood or paper partly to the fire.
Articles made of iron, clay, and many other metals and earth,
may be painted and glossed ; they are first painted with the
glass, and after this coating has been allowed to dry, a second
coating, consisting of the paint with a weak solution, is applied,
and afterwards coatings of a concentrated warm solution are
laid on, until the articles have attained the desired gloss.

For druggists, it is important to know that soluble glass with
zinc, white or with blanc fix (precipitated sulphate of baryta), is
very available for labelling glass bottles, and that such labels
;are indestructible, either by spirits, oils or acids. Varnished
labels cannot be covered with this glass, as it renders them lia-
ble to crack. But paper boxes soaked in a warm solution of
soluble glass, and after complete drying, painted with a suitable
color ground in the solution, are admirably adapted for the pre-
servation of herbs, roots, and most substances requiring to be
kept excluded from the changes of the air.

A "glass paper" has also been proposed as a substitute for
waxed paper, for the purpose of covering ointments and cerates
and wrapping up plasters ; it is more elegant and much cheaper
than waxed paper. Professor Artus uses moderately heavy

1859.] On the Value of Iodide of Iron. 59

writing paper, and puts the solution of soluble glass of 1.12 or
1.15 spec. grav. on with a brush, reuewing the application after
the first one has become perfectly dry. A stronger solution
produces a more glass-like covering, but such paper cannot be
rolled without cracking.

For domestic use, soluble glass has been recommended as a
substitute for soap; and woolen, silk, cotton, linen and leather
fabrics (kid gloves, &c), are cleansed by it much better than by
soap; it is cheaper and goes further than the latter. On wash-
ing with the glass, hard or soft water may be used, cold or luke-
warm. Only very dirty and starched cotton or linen clothes
must afterwards be rinsed in hot water. Soluble glass lessens
the work and saves fuel, it preserves all colors, with probably
the single exception of bleu de France, which is likewise destroy-
ed by soap. For 100 lbs. of water, but 1 lb. of soluble glass is
necessary in all cases, save for the washing of raw wool, which
may sometimes require as much as 4 lbs. It has been intro-
duced in a number of the largest factories in Europe.

[Druggists' Circular.

On the Value of Iodide of Iron.

The iodide of iron is comparatively a new preparation, as it
was oly in 1834 that Dupasquier, of Lyons, distinguished no
less as a chemist than as a physician, made some very interesting
trials of this preparation in the treatment of pulmonary phthisis,
and proposed a new method of preparing it. He then showed
that he had performed several cures upon patients affected with
crude pulmonary tubercles, and had considerably relieved others
whose tubercles had begun to soften. In the hands of others,
however, the use of iodine of iron has not been attended with
uniformly good results probably in consequence of the uncer-
tain nature of the preparation ; sometimes too much of the iron
was received into the stomach and besides this, there was occa-
sionally an excess of iodine present, which was converted in
the system into hydriodic acid. In recent times, M. Gille has
proposed to administer the iodine in the form of sugar-plums,
and in the formula recommended, it is said that the proportions
of the iron and the iodine are preserved unaltered. M. Boinet
records two cases of abscess of a very aggravated character cured
by the internal use of iodide of iron, together with ioduretted
injections into the sac of the abscess. The first case was that
of a child, nine years old, in whom there was caries of the fourth,
fifth, and sixth dorsal vertebrae; and there were two abscesses,
one in the back, on a level with the diseased vertebrae, and the
other, also on the right side, in the iliac region. The disease

K. S, VOL. XV. NO. I. 5

60 On the Value of Iodide of Iron. [January,

had continued for several months without any amelioration,
when, on the 8th of January, 1857, the abscess in the iliac fossa
was punctured and injected with tincture of iodine; the patient
was put upon good diet, and cod-liver oil was given internally,
together with sugar-plums (dragees) of the iodide of iron. On
the 17th of January both the abscesses were punctured and in-
jected at the same time. This operation was subsequently
repeated on several occasions, and under this treatment the fis-
tulous openings caused by the punctures gradually dried up, and
at last became completely cicatrized. The child improved in all
respects, and under the use of the iodide of iron in sugar-plums,
and the influence of strengthening food, became strong and well.
The second case was that of a man aged sixty-three, under the
care of M. Malgaigne, at the Hopital St. Louis, who had a large
abscess below the crural ligament. M. Boinet punctured this
abscess, which discharged more than three pints of a grumous
pus. The opening was then injected with tinctnre of iodine ;
the abscess remained fistulous for some time, and allowed a
small quantity of pus to flow out every day, but it soon closed.
The iodide of iron was administered internally, and the patient
was put upon a strengthening diet; and six weeks after the
operation and the internal use of the iodide, the patient left the
hospital quite well.

In a lecture on chlorosis by M. Grendrin, the lecturer recom-
mends iron and manganese as the best remedies in this disease,
and passes in review the different preparations of iron which
are employed in medicine. One of the most useful preparations
in cases of chlorosis complicated with scrofula, or only with a
lymphatic temperament, is the iodide of iron. But, unfortunate-
ly, this salt is very easily decomposed, and in order to employ
the syrup with advantage, it should be prepared at the very
time when it is to be taken. The invention of M. Grille fulfils
the object of practitioners in recommending this medicine, . for
he envelops the iodide with a layer of sugar, which altogether
prevents the access of air. These sugar-plums have been preser-
ved more than two years without any alteration of the iodide,
M. Gendrin speaks strongly in favour of this preparation, the
value of which consists not only in the indefinite preservation
of the ferruginous salt, but also because it renders its adminis-
tration easy and agreeable. The iodide of iron has the advan-
tage over other preparations, of being well borne by the patient,
an advantage which it undoubtedly owes to its great solubility.

M. Bostan, in a lecture on chlorosis, says that the iodide of
iron possesses, in the promptitude of its curative action, a very
manifest advantage over the other ferruginous compounds; the
syrup of the iodide has not been used in medicine so much as it
would have been if h had more stability ; but the preparation of

1859.] Different Formula, dfe. 61

M. Gille renders the administration of this salt as easy as that of
the oxide or the carbonate.

In phthisis, the iodide of iron has been found to act very
beneficially, and its importance in this disease will be increased
when it is preserved chemically pure, and given in suitable doses.
Louis, Andral, and Bricheteau, have all used with success, the
syrup of the iodide of iron in pulmonary tubercle; and more
lately Dr. Belouino has published some cures of this disease
effected by the administration of the sugar-plums of M. Gille.
"Recent observations," says Dr. Belouino, "have assigned to
iodide of iron an important place among therapeutic agents, and
it may be boldly placed among the best medicines which we
possess. Formerly it was unworthy of confidence, because it
was badly preserved and was easily decomposed, and conse-
quently did not give always identical results. Physicians, in
consequence, decline to make use of it. At present the iodide
of iron thanks to the laborious researches of M. Gille is pre-
served in a state of perfect purity. I have had occasion to
employ very often the preparations of this gentleman, and I
have attained experimentally the conviction that the iodide of
iron is an excellent medicine in cases of anaemia, scrofula, rachi-
tis, chlorosis, and often in certain cases of pulmonary phthisis in
which the organism requires to be strongly fortified." Dr. Bel-
ouino records two cases of phthisis which- were cured by the
administration of iodide of iron ; one was the case of a lady,
aged twenty-four ; the other that of a child, aged five ; in both,
the existence of tubercular disease was ascertained, but it disap
peared under the use of the iodide. [Journal des Cliniques des
Hopitaux de Paris^ and Brit, and Foreign Med. Chir. Rev,

Different Formula adopted in the Practice of the Medical Profession
in Lyons.

The 'Gazette1 of Lyons has published a series of preparations re-
commended by physicians of repute in that city, and which are
said to have succeeded in certain well-marked cases. The fol-
lowing are some of these preparations :

Powder for the Convulsive Attacks of Hooping- Cough. Bicar-
bonate of soda, seventy-five centigrammes; cochineal powder,
seventy-five centigrammes ; belladonna powder, fifteen centi-
grammes; and sugar in powder, eight grammes. Mix and di-
vide into fifteen doses ; two or three to be taken every day
during the whole duration of the hooping-cough.

Doses for Intermittent or Remittent Spring Fevers. Seignette
salt, sixteen grammes; quina in powder, sixteen grammes; to
be taken in a glass of warm water every morning, for three days

62 Experiments with Atropia and Epilepsy. [January,

consecutively. It is remarkable that, in this formula, the pur-
gative does not interfere with the antiperiodic effect.

Pills for Palpitation of the Heart, with Hypertrophy in an Early
Stage. Sugar of lead, two grammes ; extract of digitalis, one
gramme. Mix, and divide into twenty pills; one to be taken
morning and evening, and the dose may be afterwards doubled.

Sedative Liniment for Eczema. Oil of sweet almonds, ten
grammes; glycerine, ten grammes; oxide of zinc, five grammes.
To be employed in frictions when the acuteness of the eruption
is over, or after the inflammation is calmed down, and the scales
have been removed by meal poultices. In chronic eczema, two
to four grammes of sublimed sulphur may be added to the pre-
ceding liniment. This formula is particularly adapted for the
eczema of the anus and the chaps of the breast.

Remedy for Habitual Headache. Dr. Teissier, of Lyons, re-
commends fifty centigrammes of menyanthes to be infused for
half an hour in a cup of boiling water, adding a tablespoonful
of syrup of valerian. This quantity to be taken two or three
times a-day. Dr. Teissier has often ascertained the good effects
of this very simple remedy, which had already been recommend-
ed by Tissot and Sainte- Marie, and which has improperly fal-
len completely into oblivion.

Pills for Acute Articular Rheumatism. Dr. Bouchet gives the
following pills, in conjunction with drinks containing nitre:
Extract of guaiacum. one gramme; extract of aconite, fifty cen-
tigrammes; sublimed calomel, ten centigrammes. Mix, and
divide into ten pills, to be taken during the day, one every two
hours. Dr. Bouchet has almost always seen the symptoms mend
under this treatment from the fourth to the sixht day, movement
becomes possible, and the disease is terminated from the twelfth
to the fifteenth day. [Bui. Gen. de Ther., and lb.

Experiments with Atropia avd Epilepsy. By Dr. Max Maresch,

The great number of epileptic cases introduced, in complication
with insanity, into lunitic asylums, has led to numerous ex-
periments with various remedies, but hitherto without very
favorable results. Dr. Maresch, who is the physician to the Im-
perial Lunatic Asylum in Vienna, has employed atropia in
epilepsy in the case of some of the lunatic patients in that estab-
lishment. The preparation employed was pure atropia from
Merk's laboratory in Darmstadt, dissolved in the proportion of 1
grain of atropia to 500 drops of spirit, and the dose was 5, 10,
and 12 drops every day in the morning or evening, and contin-
ued for a month. The cases treated were very severe, and com-
plicated with maniacal and suicidal insanity, and the results

1859.] Treatment of Obstinate Intermittent Fevers. 63

therefore were not uniformly favorable. In fact, the writer
states that out of eight cases whicb were treated by atropia,
there were only three in which the epileptic convulsions disap-
peared. But he remarks, that in the asylum to which he is at-
tached, only those cases of epilepsy are received which are com
plicated with mental derangement, and that he has been unable
to extend his experiments to cases of pure epilepsy of recent
origin.

We understand that Dr. Sieveking has recently tried the ef-
fects of a solution of sulphate of atropia upon an epileptic patieut
as well as upon himself. In his own case, a hundredth part of
a grain produced brief vertigo, followed by dryness of the throat
of several hours' duration; vision not being affected. On the
following day he suffered from nervous depression, which was
the main symptom \ery urgently conplained of by the epileptic
patient, who took one'hundredth part of a grain on three suc-
cessive days. [Zeiischrift der k. k. Geselbschaft. der Aertze zu
Wien, and lb.

On the Treatment of Obstinate Intermittent Fevers by Cold Water,
and by the adoption of the most Simple and Ready Means. By
Dr. Dauvergne, Physician of the Hospital of Manosque.

Dr. Dauvergne, remarking that some writers believed in the
possibility of curing obstinate intermittent fevers by sea-baths
namely by the specific chemical powers of this kind of water
advances his own opinion, that the action was due only to the
impression of cold produced, and to the direction given to the
organic movements. Twenty-seven cases have been collected
by Dr. Dauvergne in proof of the efficacy of water in the cure
of these fevers; 26 of them attacked with intern. ittent fevers of
all kinds, but especially obstinate and chronic, were cured with
surprising certainty and rapidity. The only case which failed
was that of a soldier, who became puffy and cedematous after a
douche; and as the weather was cold, the sulphate of quinine
was given, and effected a cure. The cases of treatment by
water are recorded by Dr. Dauvergne, who seems to have adop-
ted a plan somewhat similar to those pursued in the hydropa-
thic establishments. The strength of the patient was supported
by generous diet.

[The bloated and cedematous condition of one of the patients
thus treated, and his subsequent cure by sulphate of quinine,
seems to prove that the water-treatment cannot be adopted
without great risk; and although some of the other cases may
have been improved, in a hot region like Africa, by the ap-
plication of water to the surface, there is no proof whatever that

64 Glycerine in Pseudo- Membranous Croup. [January,

the same treatment can be safely adopted in other countries, or
that it can supersede quinine in the management of intermittent
fevers. The exhibition of sulphate of quinine is attended with
no danger, and this cannot be said of the water-treatment.]

[Bui. Gen. de T herapeutique, and lb.

On Glycerine as a Local Application in Pseudo- Membranous Croup.
By D. Mayer.

Dr. Mayer was induced to employ glycerine in pseudo-mem-
branous croup, from observing the relief obtained by its being
snuffed up or injected into the nostrils in some cases of ozsena,
in which hard concretions form in the nasal fossae. Glycer-
ine is remarkable for its extraordinary power of adhesion, exten-
sion, and penetration, especially when applied to a mucous
membrane, and therefore it is not necessary to apply it to the
laryngeal surface by direct application, for its mere apposition
in any quantity to the rima glottidis, or the parts nearly adja-
cent, is followed by immediate entrance into the cavity, without
provoking to any extent the spasm and violent convulsive cough
which are always caused by the forcible introduction of a probe
or sponge into the orifice. In pseudo-membranous croup the
larynx is lined by an excretion somewhat analogous to that
thrown out in ozasna, and it seems probable that the introduc-
tion of the glycerine into the laryngeal cavity may loosen the
membrane and facilitate its expulsion by coughing or vomiting.
Dr. Mayer has employed the glycerine in severe cases in con-
junction with other treatment, and indeed he does not propose
this remedy as a substitute for, but as an addition to, other means;
and he has found the application to be followed by a manifest
improvement of the cough, and relief of the dyspnoea and gene-
ral distress. The article employed was Price's Candle Compa-
ny's glycerine, and it was applied by pressing down and draw-
ing forward the tongue with the finger, and squeezing out the
contents of a long and thick camel's-hair brush dipped in the
liquid over the chink of the glottis, or as near it as possible,
concluding the operation by swabbing the whole throat. Dr.
Mayer thinks that this mode of treatment is applicable to several
other diseased states of the respiratory passages. [American
Jour, of the Med. Sciences.

Caustic Glycerine for Lupus. (Bulletin General de Therapeutique.)
The formula proposed by Dr. Hebra, of Viennna, consists of iodine,
iodide of potassium, and glycerine. This topical application is laid on
every two days with a camel hair-brush ; it causes pain for more than
two hours, but it has the great advantage of curing the lupus without
producing unsightly scars. [Am. Jr. Med. Sci.

1859.] Editorial. 65

EDITORIAL AND MISCELLANEOUS.

The Fifteenth Volume of the New Series of the Southern Medi-
cal and Surgical Journal. A distinguished explorer relates the story
of a Greenlander, who was filled with pity and commiseration, for the
" poor Europeans," who were forced to drag out their existence without
ever knowing the luxury of fish oil and blubber, as a prime article of
food. " How do you live," says he, "without the fat of seals, and a
measure or two of oil every day f Surrounded, as we are, by periodi-
cal medical literature, breathing the stimulating atmosphere of medical
progress, living in the midst of our fifty or sixty highly prized exchanges,
domestic and foreign, greeting their coming, devouring their contents,
and imbibing, both improvement and pleasurable excitement from their
well-filled pages, we too, rejoice in a feast which many would dislike,
and feel inclined to pity any member of our profession, who does not
know the pleasure and advantage, of even, a single medical journaL
Dull and stationary must his life be, and feeble the impulses of that
physician, who, in the present age, can content himself to live in pro-
found ignorance of the progress and improvement, everywhere raakino-
rapid strides, in his profession. That which was, yesterday, the crown-
ing foam on the very front wave of scientific advancement, is often, to-
dav, found far behind in the career of improvement so rapidly do other
and stronger waves rush on, to overwhelm, or to surpass it. There is
but little that is stationary in the present epoch, and still less in the
science of medicine. " Progress" and " change'' seem stamped on even-
page of medical literature, and the books themselves, appear to us but
the shifting scenes of an ever-changing, ever-deepening drama.

Let us take any one department of medical knowledge ; let us buy
the best, or perhaps all the books written upon it ; devote months or
even years to its study in these books, and ere we have waded through
the heavy volume, a new edition informs us and most truly that the
advancement of the age demands a complete revision, or reconstruction
of this entire branch of knowledge. We are bewildered, we are dis-
couraged : we almost sacrilegiously wish we could clog the wheels of a
progress, which thus mocks and disheartens, which depreciates the value
of our hard-earned knowledge, and writes, "passing away" upon all our
attainments, even when they have scarcely come fully into our possession.
Do we ask, where our author obtains all the additional matter for his
new edition from other books? This cannot be: none others have
been published. Has he made farther investigations \ Xo ! he has not
had time, by his own single-handed efforts, thus to double the size of

Editorial. [January,

his records. Who, then, has done the work in so short a time, and
through what channel has it come to him ? A little reflection will soon
satisfy us on both these points : the whole world may have been stimu-
lated, at once, to engage in and complete the work, and the entire re-
sults of their united labors have found a place of record, and a medium
of publication, in the medical journals of the day.

Books, then, can only give the results of scientific investigations, for
they are of slow and laborious preparation, and tardy in coming into
our hands ; but the journals supply us immediately and constantly, and
faithfully, with the processes by which these results have been accom-
plished. They are the archives in which all ihe treasures of medical
lore are first laid up, and they are the storehouses whence this knowledge
is transferred, to make up the more complete and systematic science re-
corded in books. Without medical journals, then, we can gain medical
knowledge, only when it has become comparatively stale its freshness
has, in most cases, been there exhaled. Medical journals are to medical
books, what newspapers are to works of human history, and to works of
political economy they, each, have their own necessary use and function
in supplying the sum total of our knowledge. As the politician, or the
man of business, who neglects the record of passing events, found in the
current history supplied by daily journals, would necessarily fail to battle
successfully in the arena of life so, the practitioner of medicine, who
neglects the information and instructive precepts of the medical journals,
soon finds himself far in the rear, in many important departments, how-
ever diligently he may read, even the latest works.

Of the value of medical journals we are, at present, unwilling to say
more ; our wonder is, not that so many are supported, but that each mem-
ber of the profession does not subscribe for and read, not only one, but at
least two, viz., 1st, one monthly journal, to supply him with information
for the daily exigencies and necessities of practice ; and, 2ndly, one quar-
terly or bi-monthly review, to furnish information of a more general char-
acter, to direct his reading, and to save the necessity of much laborious
book-reading, by the comprehensive synopses of medical works, which
thev present. Books now exist in such profusion, that the task is, not so
much, to find something to read, but rather to know what works we can
safely exclude. The Reviews supply this important information, and
well deserve the attention of every one who would advantageously en-
gage in the pursuit of medical knowledge. In our own country are to
be found two of the best medical Reviews, which the world affords, viz.,
The American Journal of Medical Sciences, and the North American Me-
dico-Chirurgical Review, both published in Philadelphia.

1859.] Editorial ' 07

The present number initiates the fifteenth volume of the new series of
the Southern Medical and Surgical Journal ; during the past year, we
have endeavoured to discharge, faithfully, the responsibility imposed
upon us, as editors, by gathering into our seventy-two monthly pages, as
much valuable information as they would contain, that the work might
be useful and suggestive to the practitioner, as far as possible, keeping
him posted up with the rapid advancement in our science ; and we feel
assured, that there is yet lying veiled before us, though near at hand,
much golden treasure to gild the records of the coming year. We shall
endeavor still, to keep the Southern Medical and Surgical Journal, the
true exponent of Southern Medicine, and the medium of communication
for sound medical doctrine, from every part of the scientific world. We
again call on those who have so long and so well sustained it, by both
pecuniary and scientific aid, to renew their good wishes, and to enter
with us, heartily into the work. With an experienced and liberal pub-
lisher, a corps of able contributors, and editors, who are at least, devoted
and in earnest, we may hope still to find the journal valuable and inter-
esting to all who may become its readers.

Henry F. Campbell,
Robert Campbell.

To Subscribers. With the very encouraging list of payments, on the
cover, of the present number, we feel far more inclined to thank, than
to dun to continue the administration of " Honey" in preference to
" Vinegar." Let us then gratify our paying subscribers, by assuring
them, that it is to their promptness that our faithful publisher owed his
ability to meet his pecuniary engagements during the last year. On
taking charge of the journal at the beginning of fourteenth volume, Mr.
Morris did not purchase the accounts due the office ; he, therefore, was
cut off from the assistance which the payment of these " back debts," (a
great many of which have been paid,) would have afforded him, and
had to depend entirely upon the subscription of the current year. We
have made but a single appeal, and that a very good natured one, and
we are satisfied with its results. The price of the journal is very mod-
erate, but its payment is very important to the publisher. As there are
still many in arrears, we now respectfully request that they transmit the
amount before the distribution of our February issue.

As the journal has been sent, for some time, to the address of subscri-
bers who have removed, and, in some instances, to the address of others
who have died, thereby causing much loss to the publisher, he has con-
cluded to send the present number to the entire list, as usual, but to

68 Editorial. [January,

withhold the February number, from those who have not paid, until he
has some response, either an intimation to continue, or the payment for
the past year. This course has become necessary, on account of the
large number of removals which have taken place among our subscribers.
It will, doubtless, prove satisfactory to all concerned. We, again, thank
those who have responded promptly, and can assure all, that the journal
will improve in size, style, and value, in proportion to the encourage-
ment which the publisher receives at the hand of the subscribers.

Binding op the Fourteenth Volume. We scarcely ever take up an
old bound volume of a medical journal, but that we are loth to put it
down, so filled do we find it with the most interesting and valuable mat-
ter. Indeed, medical journals when indexed carefully and bound, make
the most valuable of medical books. They contain precepts upon every
department of the science and practical instruction, which applies to
every variety of case. It is proverbial, that systematic works on the
practice of medicine, are often mere compilations from the hands of
book-makers men who are not engaged in practice themselves, and
who are, therefore, liable to err in their precepts of treatment. Physi-
cians actively engaged as practitioners, find little time to write systema-
tic works, but when they are conscientious, they report their experience
in the medical journals, and thus, these medical journals, become the
most reliable sources of information ; they are, at least, worthy of pre-
servation.

We are requested by the publisher of the Southern Medical and Sur-
gical Journal to say, that he will endeavor to supply subscribers with
any deficient numbers, in case they desire to bind the volume for 1858.

For the information of subscribers, convenient to this place, we will
state that the Bindery Establishments of the Chronicle & Sentinel
Office, and of Messrs. Thos. Richards & Son, will do the work neatly,
promptly, and reasonably. We commend them to the attention of our
readers.

Nature and Art in the Cure of Disease. By Sir John Forbes, M.D.,
D.C.L. (Oxon.), F.R.S., Fellow of the Royal College of Physicians,
Physician to +he Queen's Household, etc., etc., from the 2nd London
edition, pp. 261, 12 mo. New York : Samuel S. & William WTood,
publishers. 1858.

So great an evil, in the practice of medicine, is the aggressive medi-
cation to which the sick are subjected, and so abundant are the books
which inculcate it, that when wre find one which attempts to argue for
the powers of nature, in the cure of disease, we, at least, are disposed to

1859.] Editorial and Miscellaneous. 09

listen to its counsels and to weigh, tolerantly, its opinions. It is the
experience of almost every practitioner that, as he advances in life, he
becomes less reliant upon indiscriminate drugging, and more willing to
trust to nature, in maintaining and in restoring health.

In the work before us, the distinguished author urges most powerfully
the recognition of the j^oivers of nature, to arrest the processes of disc
and, if he is ultra in his views, we still do not condemn his book, but
rather commend it on that account ; at the present day, nothing less than
the strongest argument, the most ultra earnestness, can arrest the tide
which has so long set in for " strong physic and a plenty of it."

Every young practitioner and student of medicine should purchase
and read this book should earlv lend his ear, to one who offers to whis-
per a word for nature, a word which may in after-life save him much
bitter self-reproach, and which may rescue from the jaws of death, many
a patient whom he would give his right hand to save.

In addition to the above work, we have received from the M-
Wood, two others, which, in their way, may be regarded as perfect
gems, viz., 1st, Mind and Matter, by Sir Benjamin Brodie ; and 2nd,
Uraemic Convulsions, by Carl R. Braun both these last shall receive
attention in our next issue.

Skoda of Vienna. From a review of a work on Clinical Teaching in
Germany, and especially in Vienna, by Dr. Gallarvardin, in the Edin-
burgh Medical Journal, we extract the following sketch, a pen and ink
portrait of the celebrated Skoda the very type " of the spirit and ten-
dencies of the Vienna school."

" That which constitutes the originality of Skoda among all the clini-
cal teachers of Germany, and which has made for him so universal a re-
putation, is his skepticism. In medicine there has been rarely seen, if
ever, a doubter so absolute, so fervent ; for his is no theoretical skepti-
cism (which is a very common thing), but a practical skepticism, which
he actively propagates both by his teaching and through the writings
of his pupils, and by its application at the bed-sides of the sick. Thus
from his name any physician who neither believes in, nor practices any
form of therapeutics, is termed Scodist. Scodism among the Germans
is pyrrhonism in medicine. We would lay long odds that our reader
could never divine the remedy which Skoda applies at the bed-side.
Every year during nine or ten months of clinical lessons, he employs on
his twenty-eight sick patients they may indeed be called in succession
all the most classical, most celebrated means of cure, and do you know
with what intention ? Simply to convince his pupils that all these med-
ications are always and completely inefficient. If by chance chance is
indeed the term to use here if on any treatment there supervenes a
prompt and very marked amelioration, he attributes all the honor to the
natural course of the disease.

70 Miscellaneous. [January,

Example. A young man of nineteen, very robust, comes into the
hospital on the 11th May, on account of a pneumonia of the right lung,
of a highly inflammatory and severe form.

On the 13th and 14th, Skoda causes him to take infusion of fox-glove,
which induces six stools a day.

On the loth a pound of blood is drawn from the arm by his orders.

Next day, the 16th, pulse, which on the preceding evening was at 106,
falls to 66.

To explain so notable and prompt a modification of the pulse, Skoda
expresses himself in these terms : " Perhaps it is the effect of the bleeding,
such things have been seen ; perhaps, too, it may have been the effect of
the fox-glove, that has been seen too ; it may also be considered as con-
nected with the natural evolution of the disease, that has been seen too."
Skoda reasons habitually after this fashion, never denying in a very de-
cided manner. In this way, little by little, he insinuates doubt into the
minds of his disciples, all the more surely that he does not insist on its
reception ; so that finally these come insensibly to lose all practical faith
to raze from their medical vocabulary the word causality, just as their
master does.

Skoda is of the young school. Thus we have never heard him quote
a single physician who flourished before the first years of the present
century, and of course a fortiori, he never cites any physician of antiqui-
ty. He thinks it perfectly useless to know how the problems of philoso-
phical and practical medicine, always the same, at all times, and in all
places, having always for their subject ' man sick,' how these problems,
we say, have been agitated, and resolved by Hippocrates, Galen, Baglivi,
Stahl, Boerhaave, nay, even by the men who shed lustre on the school
of Vienna, Van Swieten, Stoll, Hildenbrand, J. P. and Joseph Franck."

American Med. Monthly.

Constipation of Infants. It cannot too often be stated, that there is
nothing more dangerous to children than repeated laxatives. They oper-
ate once, but only to leave the bowels more subject to constipation than
ever. Prof. Clar (Jahrbuch far Kinderheilkunde und physische Erzie-
hung, 1858, iv., p. 230) gives two indications, which are to be fulfilled by
stimulation 1st of the intestinal mucous membrane ; 2d, of the action
of the intestinal muscular fibres. The first is effected by injections of
soap, sulph. magn. sulph. sod. chloret. sodii, dissolved in water ; where
any contra-indication forbids the injection of salts, injections of sugar and
water will be found useful. In order to stimulate the muscular fibres of
the intest. crassum, he recommends dec. tarax., dec. gramin., with an ad-
dition of tinct. colocyeth, tinct. rhei aq., tinct. rhei vin., tinct. aloes, or a
mild inf. rad. jalap, or inf. fol. senn.

[Wherever, for the last few years, I have met with obstinate constipa-
tion in infants, T generally succeed in giving speedy and full relief, by
ordering some sweet sugar water to be taken every day, besides the
breast. I am satisfied, that the chief cause of constipation in nurslings is
the insufficiency ot sugar in tne breast milk, the proportions of which
are, naturally, not the same with every mother. Wherever caseine ex-
ceeds the proportion of the other parts of the milk, it becomes indigesti-

1859.] Miscellaneous. 71

ble by a relative want of lactic acid in the contents of the stomach and
intestines. [New York Jour, of Medicine.

Bi-Sulphuret of Carbon. Mr. James Schiell, of St. Louis, describes
the mode of application, and some of the therapeutical uses of this sub-
stance. He directs that, of a mixture composed of equal parts of the bi-
sulphuret and alcohol, a little shall be poured on a tut't of cotton, which
is to be rubbed "pitilessly over the affected part four, live, or six seconds.
A strong, burning sensation follows, lasting only a few seconds, with the
cessation of which ceases also the suffering of the patient. Sometimes a
second or even a third application, at intervals of two or three minutes,
is necessary, and the pains will disappear as if the suffering part had been
touched by a magic rod.'' In two cases of bilious colic, after a strong
dose of calomel had been given, friction over the abdomen, with the mix-
ture as above, (bi-sulphuret of carbon and alcohol) removes the pain in a
few seconds. In addition to the treatment just mentioned, an injection,
containing half a teacupful of glycerine, was administered. [St. Louis
Med. and Surg. Journal, and North Aracr. Med. Chir. Review.

Treatment of Gonorrhoea by the Yelloiv Jessamine. (Charleston Med.
Journal and Review, July, 1857.) Dr. John Douglas describes a case of
gonorrhoea which w*as successfully treated by the yellow jessamine [Gel-
seminum sempervirens). The patient had been suffering for some months
from improperly-treated gonorrhoea. A small handful of the root of the
plant was put into a bottle of whiskey, and the patient was ordered to
take a tablespoonful of this tincture night and morning. The immediate
effect was rather alarming, as the vision was impaired ; but every symp-
tom of gonorrhoea had ceased, and the cure was permanent. It appears
that the flowers, roots, and the whole plant are narcotic, aud that in
South Carolina a saturated alcoholic tincture has long been used with
marked success in rheumatism. [Brit, and For, Medico-Chir. Reniew.

Pine Sap in Phthisis. The pine sap, recommended by Dr. Desmartes
as a remedy for consumption, we suppose is simply the juice of the pine-
tree any pine tree as it flow's from the incisions in the bark, before it
thickens by exposure to the air. It is obvious that it can differ but lit-
tle, if it differs at all, from the turpentine of commerce. It is by no
means a new idea to use the products of the turpentine tree in affections
of the lungs, and sometimes, we have no doubt, with decided advantage.
Everybody knows something of tar water, and the vapors of rosin, and
many persons have great confidence in their virtues. We have known
turpentine pills we don't mean the oil of turpentine, but the inspissated
juice to play the part of a specific remedy in the hands of a quack doc-
tor, who placarded the country with his wonderful cures of consumption.
A decoction of larch has been recently recommended in England and
Ireland by professional authority, for the like and other purposes. The
larch yields turpentine, and therefore it can hardly be questioned that
whatever remedial power it possesses is derived from the terebinthinate
quality of the decoction. Because it cannot be called a new remedy, is
no reason for refusing it a trial. [Druggists' Circular.

72 Miscellaneous. [January,

Scarlatina and Measles. Mr. Witt, member of the Royal College of
Surgeons, has published a pamphlet in which he states that carbonate
of ammonia is a specific for the cure of scarlet fever and measles. He
cites Dr. Pearl, of Liverpool, and other practitioners, who have never
lost a case out of hundreds since adopting this remedy. Two drachms
of the bicarbonate of ammonia are dissolved in five ounces of water, and
two tablespoons of the solution given every two, three or four hours, ac-
cording to the urgency of the symptoms. No acid drink must be taken,
but only water, or toast and water. The system is to be moved by a
dose of calomel if necessary. The room must be well ventilated, but
the patient protected from the slightest cold or draft. Gargles should
also be employed for clearing the throat. The ammonia, it is said,
counteracts the poison which causes scarlatina, and also acts on the sys-
tem, by diminishing the frequency, and, at the same time, increasing the
strength of the pulse. As so many children die from these diseases in
this country, this remedy ought to receive a fair trial from the profes-
si on. [Newspaper.

Lupus Exedens cured by Cod-liver Oil. Mr. Hunt exhibited a patient
who, under a protracted course of cod-liver oil in small doses, had been
cured of lupus exedens, of the strumous character. The patient was a
woman 22 years of age, and had suffered from the disease for 12 years,
the ulceration having involved a portion of the nose and face. The oil
was administered in drachm doses, three times a day, and continued for
some months. [Dublin Med. Press.

Uva Ursi, as an Obstetrical Agent. Dr. Beauvais strongly recom-
mends the substitution of this for the secale cornutum, being as effica-
cious, and far more innocent in its operation. In ordinary delayed
labor he gives grs. xv, in infusion every hour ; but when rapid effects
are desired, as in metrorrhagia, a decoction of 4 drachms to a quart of
water should be employed, in divided and frequent doses. In hematu-
ria, incontinence of urine, menorrhagia, etc., he has found a syrup, made
of 90 parts of the leaves to 1000 parts of sugar, and 9.8 of boiling water,
a good preparation. [ Virginia Med. Journal.

Vaccination in Germany. About twenty petitions, complaining of the
obligations imposed on all of the inhabitants of Wurtemburg to have
themselves vaccinated, were lately presented to the Chamber of Deputies
of that kingdom. The chamber referred them to a committee, and the
committee, at a late sitting, presented a report, recommending that a
special commission should be charged to make a searching investigation
into the grievance in question. But the Chamber passed to the order
of the day. [London Lancet.

Of the Preparation of Pastiles of Pepsin. In order to render pepsin
an agreeable medicine for children, M. Corvisart had recommended a
preparation of syrup of cherries with pepsin. But it was found by M.
Berthe, that by the action of sugar upon pepsin, the latter was modified
and transformed into glucose and lactic acid. The presence of water

1859.] Miscellaneous. 73

being the principal cause of the alteration, M. Berthe has adopted the
form of pastiles. They are composed of gum arabic paste, with a few-
drops of essence of lemon, and when the mass is quite homogeneous,
twenty-rive centigrammes of pepsin are added to each paatile, which is
very agreeable to the taste. [Bulletin General de Therapeutique, from
American Jour, of the Med. Sciences.

Pepsine Wine. We find in U Union Medicate th-<\\ the following pep-
sine wine is extremely agreeable and efficacious: Take of starchy pep-
sine, prepared according to Messrs. Corvisart and Bourdaulrs formula,
one drachm and a half: distilled water, six drachms; white wine (ofLu-
nel), fifteen drachms; white sugar, one ounce; spirit of wine, three
drachms. Mix until the sugar is quite dissolved, and filter. One table-
spoonful of this wine contains about fifteen grains of pepsine, and may
be given after every meal. [Pacific Med. Journal.

Neio Vienna Caustic. M. Dujardin, of Lille, having observed the
inconveniences attending the use of the Vienna caustic, owing to the
chemical reactions set up between the potash and the lime, which is nev-
er pure, and the composition of which is very various, has proposed to
combine the potash with calcined magnesia, with clay dried at the fire,
with fine dry sand, with impalpable powder of pumice stone ; of these,
he prefers the combination of caustic potash with clay. The prepara-
tion should be preserved in well stopped bottles. [Ibid.

Xew Caustic Paste with Chloride of Zinc and Gluten. M. Somme
has been led to the employment of gluten instead of flour in the forma-
tion of caustic paste, by observing that the paste was more adhesive and
easy to preserve in proportion as the flour which he employed was more
rich in gluten. The gluten is obtained from the best wheaten flour, and
the chloride of zinc and the gluten are mixed in the following manner.
The chloride is placed in a porcelain capsule, and dissolved in alcohol
with a gentle heat ; then the gluten in powder is spread uniformly over
the liquid mass and triturated, so as to incorporate the two substances-
completely together. This paste is very plastic, and may remain for a
long time exposed to the air without liquefying, and it may be handled
with impunity, if there are no excoriations on the skin. It may be used
in mass, in plates, and in cylinders, the latter form being applicable in
the case of deep fistula?. [Ibid.

Employment of Nitrate of Silver as an Abortive in Paronychia. Dr.
Guinier, of Montpellier, proposes to employ the nitrate of silver in the
treatment of whitlows, at a period when the disease is in a very early-
stage. He moistens lightly all the red and painful surface, and then
passes over it slowly the extremity of a stick of nitrate of silver, and the
operation is continued sufficiently long to be sure of the penetration of
the caustic through the epidermis, which is indicated by the brownish
colour of the latter. The skin is at first made brown, and after some
hours takes a beautiful black tint, and from this moment the cure is
complete. After some days the caustic epidermis peels off. [Ibid,

74 Miscellaneous.

On the Preparation of Valerianate of Ammonia of definite composi-
tion. This salt could never be obtained, up to a recent period, in a pure
state and solid. In fact, in treatises on chemistry, the valerianate of
ammonia is described as liquid and amorphous, and the persons who
prepare chemical products have never been able to present it in a solid
and crystalline state, pure, and of a constant composition. MM. Labour-
eur and Fontaine have attempted to supply the deficiency. Their pro-
ceeding consists in preparing, in a pure state, valerianic acid and
ammoniacal gas, and then uniting these bodies. In proportion as the
combination proceeds, the salt crystalizes in a form apparently confused ;
but under the microscope prisms may be very well distinguished, having
four terminal planes. The formula for preparing this salt is the follow-
ing : Take mono-hydrated and pure valerianic acid, dispose it in thin
layers in a flat capsule, covered with a bell-glass completely closed. Pass
into the bell-glass anhydrous ammoniacal gas to saturation of the vale-
rianic acid, and preserve the valerianate of ammonia in small portions
in well-stopped bottles. [Ibid.

Extemporaneous Preparation of Chlorine as a Disinfectant. The
chloride of lime, usually employed as a means of disengaging chlorine,
has, besides its price, the inconvenience of being rather rapidly exhaust-
ed. M. Lambossy substitutes for it a cheap and simple preparation,
consisting of common salt, red-lead, sulphuric acid, and cold water. The
red-lead is mixed with the salt, and introduced into a bottle full of wa-
ter. The sulphuric acid is added afterwards gradually, and shaken at
intervals. By this process, sulphate of lead is formed and precipitated,
and sulphate of soda and chlorine remain dissolved in the water. The
chlorine, which gives the liquid a yellow colour, is disengaged as soon
as the bottle is opened. To produce a more rapid disengagement, the
liquid is poured into flat plates, so as to offer a large surface for evapora-
tion. [Ibid.

On the Injection of a Solution of Chlorate of Soda into the Bronchi
of Children affected with Croup. In consequence of the troublesome
cough which often supervenes after the operation of tracheotomy in
croup (notwithstanding the great care recommended and practised by
M. Trousseau), M. Barthez has injected into the bronchi of the little pa-
tients a few drops of the chlorate of soda. He prefers the soda to the
potash-salt in consequence of the great solubility of the false membranes
in a solution of the former. Some cases have been thus treated in the
wards of the Hospital of Ste. Eugenie, and it is stated that their condi-
tion was improved by these injections. The instillation of water and
nitrate of silver is not a new practice, having been already adopted by
M. Trousseau ; but the question remains, whether the employment of the
chlorate of soda adds to the efficacy of the operation. [Ibid.

Professorial. Dr. Jas. B. McCaw, who has long and ably ediled the
Virginia Medical Journal, has been elected to the chair of Chemistry, in
the Medical College of Virginia, lately held by Dr. Martin P. Scott.

SOUTHERN

MEDICAL AND SURGICAL JOUMAL.

(NEW SERIES.)

Vol. XV.] AUGUSTA, GEORGIA, FEBRUARY, 1S59. [No. I

ORIGINAL AKD ECLECTIC.

ARTICLE IV.

Observations on Malarial Fever. By Joseph Joxes, A.M., M.D.,
Professor of Medical Chemistry in the Medical College of
Georgia, at Augusta.

[Continued from page 743 of November Xo. 1858.]

Case XXXVIII. Irishman : age 28 ; height 5 feet 7 inches,
weight 140 lbs.; dark brown hair, brown eyes, dark complex-
ion has been in America eight years, and in Savannah nine
months. Engiueer on steam-tug running up and down the Sa-
vannah river. One month ago was discharged from the steam-
tug, and commenced "day labor" along the wharves, and at the
saw-mill. Habits intemperate. Has been sick one week. Says
that three days ago he took a large dose of castor oil, which
operated ten times. On the following day took three blue pills,
and yesterday took another dose of castor oil, which has been
operating up to the present time.

_ August 24th, 1857, 1 o'clock P. M. Has just entered the hos-
pital. Skin cool ; tongue coated with yellow fur; pulse 120;
complains of great weakness.

R. Sulphate of quinia, grs. xv. ; infusion of Virginia snake-
root, f I xvi. Mix. flij. every two hours. Diet, gruel.

August 25th, 12 o'clock M. Complains of great pain in his
back; surface of trunk and extremities cool ; tongue dry at tip
and centre, and coated with yellow fur; no tenderness upon
pressure of epigastrium ; bowels loose.

R. Stopsulph. of quinia and infusion of Virginia snake-root.
R. Calomel grs. xij.; James's powder (pulvis antimonii composi-
tus) grs. xxij. Mix, and divide into six powders. Administer
one powder every three hours. If extremities continue cool,
apply mustards.

k. s. vol. rv. no. n. 6

76 Jones, on Malarial Fever. [February,

August 26th, 12 o'clock M. Daring the afternoon of yester-
day was ver}' feeble, and at one time was almost pulseless. The
nurse administered brandy. This induced reaction. Now, skin
of trunk and extremities cool and moist; complexion pale, sal-
low; lips and gums very pale ;# tongue crrated with yellow fur,
and dry at tip ; pulse small and weak so feeble that it is with
difficulty that it can be felt at all. Pulse 120; respiration 22.
Temperature of hand 95 5 F.

ty. Burnt brandy and infusion of Virginia snake-root. Ap-
ply shifting sinapisms to extremities. Diet, arrow-root and
brandy.

8 o'clock P. M. Pulse a little stronger, but still yery weak,
112; surface of trunk and extremities warmer ; tongue cleaning
off towards the tip the clean portion is very red, dry and
glazed. Has no pain, and rests quietly appears to be very
weak.

#. Continue brandy and infusion of Virginia snake-root.

August 27th, 12 o'clock M. Pulse 120, larger in volume, but
still very feeble and with difficulty counted ; respiration 24 ;
skin a little warmer. Temperature of atmosphere, 87.5 F. ;
temp, of hand, 98 ; temp, under tongue, 98.5. There is a great
Want of co-ordination between the actions of the circulatory and
respiratory systems. Says that he is very weak his appearance
is that of complete exhaustion. Superior portion of the tongue
coated with dry, yellow fur a lozenge-shaped space of the sur-
face of the tongue extending for one inch, from the tip to the
centre, is clean and of a brilliant red color. Teeth coated with
sordes; hands and tongue tremulous says that he feels very
weak. Has no pain anywhere, and lies quiet.

ty. Stop the calomel and James's powder. $. Sulph. of qui-
nia, grs. ij. every two hours up to grs. xvi. Continue brandy
and infusion of snake-root.

Urine, orange-colored, several shades higher than in health,
but much less highly colored than usual in severe cases of mala-
rial fever. Keaction slightly acid ; sp. gr. 1009 contained, as-
usual in uncomplicated cases of malarial fever, no albumen and
no grape sugar. Amount of urine collected during the last 24
hours, grains 16,144. The nurse states that this is the whole
amount that has been passed.

[Urine excreted in 24hrs.
ANALYSIS LXI. grains 16144 contained

grains,

Water, 15745. 3-36

Solid Matters,

Urea,

Uric Acid,

Extractive and Coloring Matters,
Fixed Saline Constituents

398.664

170.610

A trace, scarcely visible.

203.683

24.161

1000 parts of Urine
contained,

975.306
24.674
10.499

A trace.

12.560

1.496

1859.] Jones, on Malarial Fever. 77

7 o'clock P. M. Much worse. Pulse 140, feeble ; respiration
40, labored, panting. Extremities feel cold. Temperature of
hand, 90. Restless; groans and sighs frequently ; inclined to
stupor; intellect sluggish. When aroused, appears to be sensi-
ble, but articulates with great difficulty. The heart appears
merely to flutter the sounds are so rapid and feeble that they
are counted with difficulty. The circulation in the capillaries is
sluggish and feeble. The temperature, the index of the chemi-
cal changes of the elements of the solids and fluids, is below the
normal standard and does not correspond with the frequency of
the circulation and respiration. No pain upon pressure of epi-
gastrium. Asks for water continually, and complains of much
thirst. The nurse has just raised him up to administer brandy :
he groans, and tosses about the bed and makes several ineffectu-
al efforts to rise. In a few moments he is quiet, and apparent-
ly asleep.

This patient died thirty minutes after this observation.

(10). Autopsy twelve hours after Death.

Exterior. Body muscular, with well developed limbs and
prominent chest; trunk and limbs round and not emaciated;
adipose matter not wasted; color of muscles, when the integu-
ment was removed, red and normal. Color of the skin of the su-
perior parts of the corpse, pale, bloodless. Color of the skin of
the inferior parts of the corpse, of a dark purple. This dark
purple color gradually diminished towards the superior parts of
the body, and appeared to have been due to the gradual settling
of the blood in the capillaries of the moet dependent parts, to-
wards the close of life, when the general and capillary circula-
tions were feeble. Lips and gums very pale, almost white ; teeth
loaded with sordes.

Head. Dura-mater unusually thick and firm, and adherent in
several places to the arachnoid membrane. The thickening of
the dura mater and the adhesions were of long standing, and
were not connected with this attack of malarial fever. Blood-
vessels of the dura-mater filled with blood.

Arachnoid membrane opalescent, pearl-colored, and in many
places adherent to the pia-mater. These adhesions, like those
between the dura-mater and arachnoid membrane were appa-
rently of long-standing. Between the arachnoid membrane and
pia mater, bloody serum was effused, thus imparting to these
membranes (especially the inferior portions from the gravitation
of the blood) a red appearance.

Blood-vessels of pia-mater were filled with blood. The blood-
vessels of those portions of the pia-mater which extended into
the ventricles of the brain, were also engorged with blood. The
ventricles of the brain contained a small quantity of clear serum.

78 Jones, on Malarial Fever. [February,

Structure of cerebrum appeared to be softer than normal.
This softening may have been the result of partial decomposi-
tion. Blood-vessels in the substance of the brain, distinct, and
more engorged with blood than usual.

Structure of cerebellum, medulla oblongata, and superior por-
tion of spinal cord, appeared to be normal. Blood-vessels of
spinal cord appeared to be more congested with blood than
usual.

Chest. Heart, normal in structure ; cantained several clots
of blood, which, from their ragged appearance, light yellow co-
lor, and freedom from colored blood-corpuscles, must have been
formed before death. Long, fibrous coagula were found in the
aorta and vena -cava.

Lungs. Old adhesions in several places. Numerous small
tubercles were scattered throughout the tissues of the lungs: the
tubercles did not appear to have suppurated. During his sick-
ness, this patient showed no signs, either in appearance or
in action, of the existence of these tubercles.

Superior portions of the lungs (leaving out of view the tuber-
cles) were normal in color and density. The inferior portions
were engorged with blood, and the most dependent portions were
almost black from the great engorgement of the blood-vessels
and capillaries, and when cut, resembled in appearance and
density portions of liver. The accumulation of blood in the
lower portions of the lungs was due to the action of gravity,
during the feeble state of the circulation previous to death. The
chemical changes of the elements of the blood and tissues had
been greatly diminished, previously to death ; the physical for-
ces resulting from these chemical changes, which propelled the
circulatory apparatus and worked all the machinery, were cor-
respondingly diminished, and the blood gradually obeyed the
physical law of gravity, which, although constantly acting dur-
ing health, was counterbalanced by the physical forces, devel-
oped by the chemical changes of the elements of the organism.

Abdomen" lAver, normal in size, and of a slate color exter-
nally, and of a dark bronze color internally. Substance firm.
When pressed, the dark yellow, greenish bile flowed out in small
quantities from the cut ends of the hepatic ducts. Blood-vessels
of the liver appeared to contain more than the normal quantity
of blood. Blood of liver, dark purplish brown, and did not
change to the arterial hue when exposed to the action of the
oxygen of the atmosphere.

The liver contained animal starch, but do hepatic sugar.

Under the microscope, the cells of the liver appeared normal,
with the exception that many of them contained more oil glo-
bules than usual.

The gall-bladder was filled with bile, which was of a dark

1859.] Jones, on Malarial Fever. 79

brownish green, when seen in mass, and of a gamboge color,
when viewed in thin layers. The surface of the gall-bladder
was of this gamboge color, from the cndosmosis of the bile, pro-
bably after death.

Spleen, enlarged ; color, dark slate, two shades darker than
the liver. Tissues of spleen softened, partially disorganized.
When the organ was pressed gently between the lingers, it was
evident that the tissues gave way.

Mud of spleen, of a dark purplish-brown color. This dark
color was not altered, notwithstanding that it was exposed to
the action of the atmosphere for 2i hours. When first removed,
the mud of the spleen coagulated slightly the coagulum, how-
ever, possessed no consistency, and was readily dissolved. W hen
the mud of the spleen (pulp and extravasated blood) was ex-
amined under the microscope, it was found to consist of colored
and colorless blood -corpuscles, and numerous granules of a black
color. These black granules were frequently conglomerated
together, forming dark flakes, like the coffee-ground sediment of
the black vomit of yellow fever. Many of the colored corpus-
cles appeared to be swollen. The colorless corpuscles appeared
to be n. ore numerous than normal.

Alimentary Canal. Stomach, contained no fluid or gas;
blood vessels upon the exterior filled with blood; mucous mem-
brane of stomach of a dark purplish color. The color of the
mucous membrane was not uniform, it was much deeper in some
spots than in others, thus presenting a mottled appearance.

The compound muciperous follicles (Brunner's glands) of the
stomach and duodenum, were prominent and enlarged.

Blood-vessels of the superior and inferior portions of the in-
testinal canal appeared to be more engorged with blood than
those of the middle portions. The mucous membrane of the
small intestines was covered by a layer of mucus and fecal mat-
ter, colored yellow by the bile.

The solitary glands in the inferior portion of the ileum, and
especially in the region of the ileo-caecal valve, were enlarged
and distinct.

The glands of Peyer were distinct, but not enlarged or in-
flamed.

The serous membrane of the intestines bore the marks of an
old inflammation. The serous membrane was thickened, and
organized bands of coagulable lymph in many places bound
the large and small intestines together, and to the walls of the
abdominal cavity. This inflammation had nothing whatever
to do with the present attack.

Kidneys. Normal in size and structure blood had settled in
the vessels and capillaries of the inferior dependent portions.
Color of superior portions of kidneys normal ; color of inferior de-
pendent portions almost as dark as the slate-colored livtr.

80 Jones, on Malarial Fever, [February,

The "blood-vessels and capillaries of the cellular tissue of the
posterior dependent walls of the abdominal cavity were engorg-
ed with blood, whilst those of the upper anterior and lateral
walls were almost devoid of blood. This was due to the action
of gravity upon the enfeebled circulation. The facts which we
have presented, show that the capillary circulation had been
greatly enfeebled in every organ and tissue, previous to death,
and the blood necessarily accumulated in the most dependent
blood-vessels and capillaries. This view is farther confirmed
by the fact, that the vena-cava contained but little blood.

The bladder contained 5000 grains of light colored urine.

Reaction acid. Sp. Gr. 1008.7. After standing 48 hours no
deposit was thrown down. This was also true of the former
specimen of urine.

ANALYSIS LXIL

Water,

Solid Matters,

Urea,

Uric Acid,

Extractive and Coloring Matters,
Fixed Saline Constituents,

Grs. 5000 of Urine, con-
tained grains,

4863.140

136.860

38.945

0.240

88.005

9.120

1000 parts of Urine
contained,

972.628

27.372

7.789

0.048

17.601

1.824

CONCLUSIONS.

(1). The slate colored liver the dark greenish brown bile
the absence of grape sugar, and the presence of animal starch
in the liver the slate-colored, enlarged, engorged, softened
spleen demonstrated that this was a case of malarial fever.

(2). The rapid but feeble action of the heart the rapid but
feeble pulse the depressed temperature of the trunk and ex-
tremities the dry red tongue the complete exhaustion of the
muscular and nervous force the acid light-colored urine the
feeble general and capillary circulation, gradually overcome by
the action of gravity the gradual settling of the blood previ-
ous to death in the bloodvessels of the most dependent parts
of all the organs and tissues the alterations of the blood cor-
puscles of the liver and spleen the alterations in the color and
constitution of the bile the destruction of the special ferment
in the blood which converted the animal starch into grape
sugar demonstrated that the malarial poison, had not only
interfered with the action of the cerebro-spinal system, but had
also affected the sympathetic system, and produced profound
alterations in the structure of the nutritive fluids and correspond-
ingly interfered with the chemical changes, the developement
of the forces, and the formation of the secretions and excretions.

(3). The rapid exhaustion of the forces were, without doubt,
due, in a great measure, to the severe purgation to which this
patient had been subjected, previous to his entrance into the

1859.] Jones, on Malarial Fever. 81

hospital, and to his previous intemperate habits, and to the
presence of tubercles in the lungs. The administration of large
doses of purgative medicines (castor oil and blue pills) without
any sulphate of quinia, and without any stimulants, converted
an ordinary case of malarial lever into a congestive malarial
fever. The term congestive, as applied to this case, means
nothing more than a state of exhaustion, inability to resist
the action of the malarial poison, inability to react.

(4). The plan of treatment ill this case was correct in principle,
butradically deficient in energy. Stimulants were administered,
but not in sufficient quantities. Sinapisms were used, but not
often enough, nor large enough, nor long enough. "Sulphate
of quinia was administered, but too infrequently and in too
small doses, to be efficient, and much valuable time was wasted.
This case demanded prompt and vigorous action. Large doses
of the sulphate of quinia and the most diffusible and powerful
stimulants should have been promptly and frequently adminis-
tered, and the extremities should have been repeatedly covered
with sinapisms. We hope to demonstrate, by future cases, that
the patient would have stood a much better chance of recovery
under this mode of treatment.

Case XXXIX. German, aged 27; height 5 feet 9 inches;
weight 160 lbs. ; brown hair, blue eyes, florid complexion ; thick-
set, stout and muscular; thick short neck; person filthy;
habits intemperate. Last winter and spring he was in the hos-
pital with a large ulcer upon the leg. Has been working for
three weeks in a malarious locality, near Lover's lane, on Thun-
derboldt road. Has been much exposed to the hot sun and cold
night air.

August 21st, 1 o'clock P. M., 1857. Entered the hospital yes-
terday afternoon, at 4 o'clock P. M. The nurse states that du-
ring the night he appeared to be out of his head, and would
frequently start out of bed with a loud shout. Complained bit-
terly of his head. Had two convulsions during the night, one
at 12 o'elock M., and the other at 2 o'clock P. M.

Now, 1 o'clock P. M., this patient appears to be suffering in-
tense agony in his head and has a hot t'evar. Both hands are
clasped around his head and he tosses violently about in his
bed. Every breath is accompanied with a deep groan, and an
exclamation about the pain in his head. He is unable to give
a coherent answer.

Applied immediately four cut-cups to his head, (two to back
of neck and two to temples) ; also a large mustard plaster, over
his epigastrium, and one to each leg. Abstracted f I xviij. of
blood in the standing posture, until lie fell back upon the bed,
completely exhausted. The loss of blood was attended with

82 JONES, on Malarial Fever. [February,

almost immediate relief of the pain in his head. The burning
heat of the head and skin was almost immediately diminished,
and the dry and parched skin was soon covered with perspira-
tion. The pulse and respiration were diminished in frequency.
.Respiration 39 ; Pulse 92. Temperature of atmosphere 80 F. ;
temp, of hand, 89 ; temp, under tongue, 97. The temperature
under the tongue is 3, and the temperature of the extremities is
9, below the normal standard. The temperature was not ascer-
tained by the thermometer before the abstraction of the blood,
owing to the great suffering and restlessness of the patient, but
judging by the sense of touch, it is evident that the temperature
has diminished rapidly since the abstraction of blood. The
wild and restless glances of his eye, and the violent tossing of
his bod}7, have ceased ; the pain in his head has almost entirely
disappeared, his intellect is calm, and he converses rationally.

Tongue thickly coated with yellow and black fur, tip and
edges clean and of a scarlet color. Previous to the bleeding, the
tongue was dry, rough, and when the fur was absent, glazed
now it is more moist, but still much dryer than normal.

He states that the fever came on three days ago, with a chill,
and pain in the head ; and that it has continued unabated, up
to the present time. Says he took blue pills and oil yesterday
morning, before entering the hospital, which operated freely.
His testicles are much swollen and the scrotum is very red and
inflamed, and the cuticle is abraded in several places. Com-
plains of great thirst.

3 . Citrate of potassa, I i. ; Bicarb of potassa, 3 i. ; water,
f Bxviij. Drink ad libitum.

August 22d, 12 o'clock M. Head is well. Has not com-
plained of his head since the abstraction of blood. Superior
portion of tongue, coated with thick, dry, yellow fur, inclining
to black in the centre. Tip of tongue clear, bright red, dry and
glazed. Complains of an unquenchable thirst. Lies quietly,
inspiration 52, hurried, labored, thoracic, striking the atten-
tion of the most casual observer. Pulse 112. Skin of trunk
feels hot to the hand. Temperature of atmosphere, 81F ; temp,
of hand, 99. ; temp, under tongue, 104. Epigastrium very ten-
der upon pressure.

$. Blister, 6 inches by 6 inches, over epigastric region. 3.
Calomel, grs. v. ; Khubarb, grs. viij. Mix. Gruel and Flax-
seed tea.

August 23d, 12 o'clock M. Says that his head is much better
and that he feels perfectly well. Blister has drawn ; serum from
the blistered surface of a golden color. Medicine operated four
times ; evacuations small. The tongue presents the same appear-
ance. Tenderness of epigastrium greatly diminished. Pulse
72. Inspiration 34, thoracic, labored. Skin cool. Temperature

1859.] Jones, on Malarial Fever. 83

of atmosphere 78F. ; temp, of hand, 89 ; temp, under tongue,
96 to 96*5. The temperature under the tongue appeared to be
variable, rising and falling between 96 and 96"5. There is a
great want of co-ordination between the circulation, respiration,
and the chemical changes.

3. Calomel, grs. xij. ; James's powder (pulvis antimoniicom-
positus), grs. xxij. Mix and divide into six powders, and ad-
minister one powder every three hours in a tablespoonful of
snake-root tea. Sponge skin with salt dissolved in dilute
alcohol. Diet, gruel and gum water.

August 2-itb, 9| o'clock A. M. The nurse states that he has
been restless during the night and apparently out of his head.
Several times he sprang out of the bed with a loud shout. At
one time he insisted that he was perfectly well, and affirmed that
he was going down to the hotel to get a cup of coffee, some
boiled eggs, and a good drink of brandy.

Xow, his respiration is spasmodic, 40 to the minute. Pulse
cannot be felt. Have administered brandy, but he is unable to
swallow or to articulate.

He died 15 minutes after this observation. His death struggles
were severe and distressing. Deep and violent inspirations and
expirations; mouth filled with froth, which was scattered in
every direction with the violent expirations.

(11). Autopsy four hours after Death.

Exterior. Stout and muscular; limbs full. There had been
no wasting of the tissues ; skin sallow.

Head. When the skull-cap was removed, f 5 ij. of blood flowed
from the interior of the cranium.

Blood-vessels of dura-mater filled with blood.

Arachnoid membrane opalescent, pearl colored. Blood-ves-
sels filled with blood. There was a small quantity of yellow
serum effused between the arachnoid membrane and pia-mater.

Blood-vessels of pia-mater, engorged with blood.

Substance of the brain was softer than usual. Upon the cut
surface were seen the cut extremities of numerous blood-vessels,
filled with blood. The lateral ventricles of the brain were
nearly filled with yellow serum. Blood-vessels of pia-mater of
ventricles engorged with blood. Blood-vessels at the base of the
brain and superior portion of the medulla-oblongata, greatly
distended with blood. The blood-vessels at the base of the brain
appeared to be more distended with blood, than those of the
superior portions of the brain.

Chest. Lungs normal.

Heart. Normal in size. The exterior of the right auricle
and ventricle showed incipient fatty degeneration. Weight of
heart, grs. 5025, equals ozs. 11^. The auricles of the heart and
the sinuses of the brain, contained small clots.

84 Jones, on Malarial Fever. [February,

Abdomen. Liver exterior, slate-colored ; cut surface dark
bronze color. When the liver was pressed, dark-colored blood,
and green biliary matter oozed out from the cut surface. Blood-
vessels of liver filled with blood. When the hepatic veins were
cut across, several fluid ounces of blood gushed out. The blood
of the liver did not assume the arterial hue when exposed to the
oxygen of the atmosphere. Structure of the liver firm and ap-
parently not altered in consistency.

Under the microscope, the cells of the liver appeared to be
normal. There was a deficiency of oil globules and of the pecu-
liar granules, so common in the secreting cells of the liver. Sub-
jected to the action of acetic acid, nothing peculiar was observed
in the liver-cells.

The liver was carefully tested for hepatic sugar the action of
the appropriate chemical re-agents, demonstrated that it was en-
tirely absent. When a drop of a solution of grape-sugar was
added to the filtered decoction of the liver and tested with the
same chemical re-agents, the presence of the grape-sugar was
promptly and decidedly indicated. This experiment shows
that the failure of the re-agents to manifest the presence of grape-
sugar in the liver was absolutely and unequivocally due to its
absence.

Animal starch on the other hand was detected in all parts of
the liver. When the liver was boiled, or subjected for several
hours to the action of a strong solution of caustic potassa, it was
completely dissolved, and the solution assumed a deep purple
color, when seen in mass, and a bright pink color, in thin lay-
ers.

Gall Bladder, was partially filled with bile, of a blackish
green color, when seen in mass, and of a gamboge yellow, in
thin layers. Weight of liver, lbs. 5, equal grains 35000.

Pancreas, somewhat enlarged and indurated. This affection
of the pancreas was not connected with this attack. Weight
of pancreas, ozs. 8 J, equals grs. 1525.

Spleen, of a dark slate color, enlarged and disorganized. To
the touch, the spleen felt like a sack, filled with a viscid fluid.
The capsule was torn upon the least exertion of force. Whilst
gently lifting the spleen, in order to sever its attachments, and
lift it out of the abdominal cavity, the capsule was torn off for
the space of several inches, and my lingers, which grasped the
organ, plunged through the disorganized trabecule and pulp.
When the spleen was laid upon the table and pressed, the mud
within was forced into other portions, and the indentation re-
mained, thus showing that the cells of the spleen communicated
freely with each other.

The spleen was filled with a substance resembling purplish
black mud. This splenic mud was very thick, and dried rapid-

1859.] Jones, on Malarial Fever. 85

ly when spread upon glass slides. Under the microscope, this
was found to consist principall}7 of colored blood-corpuscles.
Many of the colored blood-corpuscles presented an altered ap-
pearance. Iu some cases the color appeared darker than normal.
Many of the corpuscles were swollen, whilst others were corru-
gated. That the colored corpuscles had undergone some change,
was conclusively demonstrated by the fact, that the color of this
splenic mud did not alter during 36 hours exposure to the oxy-
gen of the atmosphere. The splenic mud also contained numer-
ous granules. The number of colorless corpuscles were appa-
rently diminished. This diminution was in all probability re-
lative and not absolute; they appeared to be diminished rela-
tively to the immense number of colored blood-corpuscles.
Weight of spleen, ozs. 13-|, equals grs. 5895.

Kidneys, pale, but normal in structure ; much fat in the pel-
vis and infundibula of the kidneys. "Weight of kidneys, ozs.
11, equals grs. 4812.

Alimentary Canal. Stomach Mucous membrane corruga-
ted and of a purplish color, varying in intensity in different
spots.

The stomach contained f o viij. of a dark greenish-black fluid,
which resembled, upon a general view, the black vomit of yel-
low fever. Under the microscope this fluid was found to con-
tain, numerous mucous corpuscles, epithelial cells, of the mucous
membrane and gastric glands, peptic cells and dark granules.
These various bodies were of a greenish and yellow color, under
the microscope. The action of nitric acid demonstrated that
the color was due to the presence of bile. The color of a mass
of this fluid from the stomach, was like that of the bile from the
gall-bladder, of a dark blackish-green color, whilst the thin layers,
like those of the bile, were of a yellow color. I was unable to
distinguish any colored corpuscles, notwithstanding the close
resemblance to blaek vomit. The granules did not resemble
altered blood-corpuscles.

Small Intestines. Mucous membrane covered with mucous
corpuscles and epithelium, colored yellow by the bile; color of
mucous membrane darker than usual. Blood-vessels of the in-
ferior portions of the small intestines, especially in the region of
the ileo-ccecal valve, engorged with blood.

Neither the glands of Peyer, nor the solitary glands, were en-
larged.

Blood-vessels of colon filled with blood.

Exterior surface of rectum, diversified by numerous ecchymos-
ed spots, of a bright arterial hue.

The blood poured out into the abdominal cavity from the cut
vessels, coagulated and formed a firm clot.

86 Jones, on Malarial Fever. [February,

CONCLUSIONS.

(1). This case corresponded to that type of malarial fever,
which is called by many practitioners congestive fever.

(2). After the abstraction of blood, there was no correspond-
ence between the circulation, respiration and chemical changes.
Before the abstraction of blood, there was a rapid pulse rapid,
full, thoracic respiration and dry, hot skin and dry, red tongue,
accompanied by violent pain in the head. A fier the abstraction
of blood and the application of mustards, there was a slight re-
duction of the frequency of the respiration and circulation, and
a great reduction of the temperature of the the trunk and ex-
tremities the temperature of the extremities was reduced 9
below that of health the pain in the head vanished the tongue
became a little more moist, but none the less red. To a casual
observer, the disease would appear in a great measure to have
been conquered by the abstraction of blood : the symptoms,
however, were only moderated. The congested blood-vessels of
the brain were relieved, and the pain arising from the chemical
changes and the rapid circulation of the altered blood, through
the blood-vessels of this delicate organ, was correspondingly
diminished. The temperature of the trunk rose 5 above the
normal standard, on the next day, whilst that of the extremities
just reached the normal standard. This increase was attended
by a far greater acceleration of the respiration and circulation,
than was necessary, in health, to produce this increased chemi-
cal change.

We have before shown that, if the functions of the organs and
apparatus be properly performed, a full, rapid and vigorous
circulation and respiration must be attended by the rapid ab-
sorption and distribution of oxygen, and corresponding rapid
chemical changes.

In this case, we had the rapid circulation and respiration, but
a want of corresponding chemical change, and hence conclude,
that the malarial poison has acted, either by inducing directly
such changes in the blood, as to prevent its absorption of oxy-
gen, or to prevent the rapid action of the oxygen absorbed, or
by interfering with the metamorphoses of the solids and fluids
of the organs and tissues and nutritive fluids, or by a direct ac-
tion upon the nervous centres of the sympathetic system, which
preside over the chemical changes in the lungs and all the or-
gans and tissues, independent of all previous changes of the
blood, or primarily by direct action upon the nervous centres of
the cerebro-spinal system, and secondarily, by reflex action
upon the sympathetic system.*

* This last mode of action, would be the true excito-secretory action, so ably
discussed by our friend and colleague, Dr. Henry F. Campbell, Professor of Anato-
my in the Medical College of Georgia. See " Essay on the Influence of Denti-

1859.] Jones, o?i Malarial Fever. 87

"We conceive that either one of these modes of action would
be sufficient to have produced the subsequent phenomena. It
is probable that the malarial poison acted simultaneouslv in all
the modes stated, but chiefly by direct alteration of the elements
of the blood.

(3). The treatment of this case was radically defective. The
blood-letting was proper as a means of relieving the brain, but
not as a remedy applied alone, to combat the action of the ma-
larial poison. The blood-letting relieved the brain, but the
poison went on acting, altering the chemical relations of the
elements of the blood and liver and spleen, more rapidly than
ever. Here we have the cerebro-spinal difficulty apparently re-
lieved, whilst the war is raging in the domain over which the
sympathetic system is said especially to preside. There was a
calm, but it was the calm of conquest the calm of exhausted
nature. The mighty foe carried forward the work of destruc-
tion without noise or confusion, because all opposition was lev-
elled, all resistance was subdued. This state of things demanded
prompt and vigorous action on the part of the physician. Those
remedies should have been administered which would have
aroused the capillary circulation aroused the sympathetic and
cerebro-spinal system of nerves, and accelerated the absorption,
and distribution and action of oxygen and the chemical changes
of the nutritive fluids and organs and tissues, which are the
sources of all the forces which work the machinery, and without
which we can have the manifestation of no vital phenomena.
Brandy, sulphate of quinia, in large doses, and carbonate of
ammonia should have been promptly and freely administered,
and sinapisms applied.

We hope to show that, although the plan of treatment pursu-
ed in this case, when placed in this strong light, is radically
defective, still it is one which has been, and is now, extensively
employed, and recommended by men of influence in the pro-
fession.

Case XL. Irish laborer ; height 5 feet 10 inches, weight 150
lbs. ; black hair, black eyes, dark complexion, resembles an
Arab in appearance ; person dirty and filthy.

Sept. 2a, 1857, 12 o'clock A. M. Has been sick, on the bay,
for 10 days, with an abscess in the palm of his hand. Previous

tion in Producing Disease," by H. F. Campbell, M. D. (Southern Medical and
Surgical Journal, new series. Vol. vi., No. 6, June, 1850, p. 321.)

" An Inquiry into the Nature of Typhoidal Fevers, based upon a Consideration
of their History and Pathology," bv H. F. Campbell, M. D. (Transactions of the
American Medical Association, for 1853.

See his "Prize Essay, on the Excito-Secretory System of Nerves," Also, his
" Classification of Febrile Diseases by the Nervous* System." (American Trans-
actions, vol. xi. 1858.)

88 Jones, on Malarial Fever. [February,

to this, had been working on the river bank. When first
brought (this morning) into the hospital, he appeared to be stupid
and urinated in his bed. After the administration of a hot bath,
and the lancing of his hand, he was aroused, and now appears
to be entirely restored to the exercise of his intellect. Seems
to be wery weak and complains of no pain, or trouble any-
where, except in the palm of his hand. Skin not warmer than
usual ; tongue dry, red and glazed, and harsh and rough to the
touch. Pulse 82.

#. Infusion of Virginia Snake-root. Diet, gruel.

7 o'clock, P. M. Much better. Converses freely, and com-
plains of nothing.

fy. Sulph. of quinia, grs. v., every three hours, up to grs. xv.
Continue infusion of Virginia snake-root tea.

Sept. 3d, 12 o'clock, M. Says that he is much better and
converses freely. Supposing that the affection of the hand, and
probably, neglect, and intemperance, were his only troubles,
the state of his pulse and respiration and tongue were not ascer-
tained, and he was passed by with the simple direction to con-
tinue the infusion of Virginia snake-root tea.

3i o'clock, P. M. I was summoned hastily, and found this
patient insensible, with his mouth open, and groaning loudly
with every breath. His groans sounded very much like the
barking of a dog. Countenance distressed, anxious and expres-
sive of great agony ; tendons twitching violently; teeth coated
with sordes ; tongue dry, red and glazed, and harsh to the
feeling. Kespiration 40, thoracic, panting. Pulse 104. Tem-
perature of hand 103F. Skin hot, dry and rough. When the
attempt is made to arouse him, by violent shaking and loud
talking, he mutters incoherently. Great tenderness upon pres-
sure of epigastrium ; cries out, whenever this region is pressed.

$. Blister over epigastric region, 6 inches by 6 inches.

$. Two cut-cups to back of neck, and one to each temple.
Sinapisms to extremities. Brandy, infusion of Virginia snake-
root, and sulphate of quinia.

8 o'clock, P. M. The remedial agents have made no impres-
sion. Continues in the same condition, except that he is weaker
and his groans are not so loud. Eespiration 44, thoracic. Pulse
124. Temperature of Atmosphere, 795F. ; temp, of hand, 103
Skin dry and harsh.

ty. Calomel, grs. xij. Apply blister to calves of legs. $.
Continue stimulants.

Sept. 4th, 12 o'clock, M. The patient has just died.

The Blister drew, and the serum is of a bright golden color.
Several hours before death the whole surface of his body assumed
a golden yellow color. Urine discharged during the last 24
hours, copious and only a shade darker than normal.

1859.] Jones, on Malarial Fever. 89

(12). Autopsy three hours after Death.
Head. When the skull-cap was removed, the dura-mater,
presented the usual appearance. Serous effusion had taken

Elace between the dura-mater and membranes and surface of the
rain, f I iij. of bloody serum flowed from the base of the brain.

The arachnoid membrane was but slightly opalescent in
most places it was perfectly transparen. There had been an
effusion of golden colored serum between the arachnoid andpia-
mater.

The blood-vessels of the pia-mater were filled with blood.

Blood-vessels at the base of the brain and upon medulla ob-
longata and spinal chord, more engorged with blood, than those
upon the superior portions of the brain. This was without doubt,
due solely to the effect of gravity.

The substance of the brain possessed the usual consistencyT
and appeared to the naked eye, to be normal in structure.

Chest. Lungs normal ; trachea filled with froth.

Heart, normal. Weight of heart, grs. 5687, equals 13 ozs.
The right auricle contained a large golden colored clot, which
filled almost the entire cavity. The left auricle contained several
small yellow clots.

The right ventricle contained several small clots of blood,
which resembled, in all respects, coagulated blood. The main
trunk of the pulmonary arteries, contained along, flattened,
riband-like, yellow clot, which extended, not only through the
large trunk, but divided and sent off branches to each branch of
the pulmonary artery; and these again sub-divided and sent
branches off to the minor branches of the arteries. When the
main clot in the pulmonary artery was gently pulled, the bran-
ches were drawn out 12 inches in length, and at their extremi-
ties were not much larger than a fine silk thread. The clot was
almost entirely free from red corpuscles, of a yellow color, and
firm and elastic, and in appearance resembled an organized pro-
duct. A similar riband-like, yellow, elastic clot, extended through
the whole length of the aorta. The blood in the vena-cava
was coagulated, but the coagulum was like that of ordinary
blood, and much less firm than the clots of the right auricle,
pulmonary arteries and aorta.

Abdomen. Liver, exterior, slate-colored ; cut surface of a
dark- reddish bronzed color. The consistency of the structures
did not appear to have been altered. Blood-vessels filled with
blood. Hepatic vessels contained dark bile. Blood of liver of
a purplish and brownish-red color, and did not change to the
arterial hue, when exposed to the oxygen of the atmosphere.

The liver-cells, under the microscope, presented the normal
appearance.

The liver contained much animal starch, but no hepatic sugar.

90 Jones, on Malarial Fever. [February,

The liver was set aside for 24 hours, and again tested for gly-
cogenic hepatic matter (animal starch) and hepatic sugar, with the
same result an abundance of animal starch, and no grape
sugar. The liver contained much blood, and yet, the glycogen-
ic matter remained unchanged, thus showing that the special fer-
ment which converts this substance into hepatic sugar had been
destroyed. Weight of liver, grs. 35875, equals lbs. 5, ozs. 2.

Spleen Slate colored, softened, disorganized ; could not be
removed without rupture of its substance. The capsule and
trabecular appeared to be completely altered in structure
so much altered in structure that the slightest touch was suffi-
cient to rupture them. After careful washing under a stream
of water, the trabecular presented a red color. The cells of the
spleen appeared to be all connected with each other.

The pulp of the spleen was of a dark- reddish and purplish-
brown color, and consisted principally of red corpuscles. This
mud of the spleen did not change its color during 48 hours' ex-
posure to the oxygen of the atmosphere.

The pulp of the spleen and the fibrous tissue of the trabecular
and blood-vessels of the spleen contained animal starch. Weight
of spleen, 12687, equals lb. 1, ozs. 13.

Kidneys, normal. Weight of kidneys, grs. 5026, equals ozs.

iii.

Alimentary Canal. Stomach, distended with gas. Mucous
membrane discolored by yellow bile, and diversified with punc-
tated spots of a brilliant red color.

Small Intestines contained bile and feces, which were extraor-
dinarily offensive. The calomel and oil, administered previous
to death had commenced to operate. When the feces and
epithelial cells, colored yellow by bile, were scraped off, the
mucous membrane presented the normal appearance.

The glands of Peyer were remarkably large and distinct
several of them were three inches in length ; their surfaces were
pale, and exhibited no marks of inflammation.

CONCLUSIONS.

(1). This case illustrates the fearful power of the malarial poi-
son, and the necessity of a careful examination of every case of
disease occurring during the summer and fall months in a mala-
rious district. This patient, at first, appeared to be suffering
only from a local inflammation, and complained of no previous
sickness and no pain, except the abscess in the palm of the hand.
His companions, who brought him to the hospital, stated that
they believed this to have been the only source of pain and
sickness.

(2). This case illustrates the importance of always attending
strictly to the indications and relations of the pulse, respiration

1859.] Jones, on Malarial Fever. 91

and temperature, and the condition of the skin and tongue.
Throughout this case, the tongue was red, dry and glazed, and
there was a want of co-ordination between the pulse, respiration
and temperature.

(3). The red, glazed tongue, and spasmodic, panting respira-
tion, and rapid pulse, and the dull intellect, signified exhaustion,
and not inflammation, and was treated as such, but not with
sufficient energy. If 60 grains of sulphate of quinia, instead of
15, had been administered to this patient during the forty-eight
hours after his entrance into the hospital, it is probable that life
might have been preserved. We did not deem it necessary to
adopt this course of treatment, because we were misled by the
statements of himself and his friends, with reference to the his-
tory of the disease. In all cases of fever, occurring in a malarious
district, the action of the physician should be based upon the
relations of the pulse, respiration and temperature, and the state
of the tongue, skin, and the character of the urine, and seconda-
rily, upon the previous history of the case.

Case XLI. American seaman, from U. S. cutter, age 24,
height, 5 feet 10 inches; weight, 150 lbs.; brown hair, brown
eyes. This is his first summer in Savannah. Has been em-
ployed as a sailor on the United States revenue cutter, which
has been cruising during the summer, up and down the Savan-
nah river.

Ten days ago, the cutter was struck by lightning and was
placed in the dry dock, at the ship yard, on the river, east of the
city. This ship yard is located on the Savannah river, about
five hundred yards from the eastern boundary of the city in a
malarious district which was formerly under the rice (wet) cul-
ture; now the surrounding low-lands are protected from over-
flows by dams, and are under dry culture. The banks of the
river at this locality, are coated with mud composed in large
measure of animal and vegetable matters ; the banks and hottom
of the canal, in which the ships are floated at high water, also
contain large quantities of similar mud. The crew of the cutter
slept on board one night after she was placed in dry-dock. The
crew consisted often healthy seamen, and out of this number
six were taken sick in the course of ten days. Whilst the cut-
ter continued in the stream the men were healthy, but as soon
as they were exposed to the exhalations of the mud, and low-
grounds, they were taken sick.

September 24th, 1857. Has just entered the hospital, and
says that he had a slight chill yesterday, followed by fever.
Tongue coated with brownish-yellow dry fur. Pulse, rapid ; in-
tellect dull. Says that his bowels have not been moved for
several days.

N. 6. VOL. XV. NO. II. 7

92 Jones, on Malarial Fever. [February,

$. Calomel, grs. xv. ; castor oil in four hours.

Sept. 25th. Medicine acted freely. Has fever. Tongue still
coated with fur, but a little more moist. The fur shows a dis-
position to come off in patches. Pulse accelerated intellect
continues dull.

$. Sulph. of quinia, grs. v., every three hours, up to grs. xv.
Soda powders.

Sept. 26th. Has been passing his feces in bed, and lies in a
comatose condition.

#. Cut-cups to back of head. R. Sinapisms to extremities;
blisters to back of neck and epigastric region, ft. Infusion of
snake-root, and sulphate of quinia. ft. Calomel grs. xxiv,;
opium, grs. ij. Mix. Divide into 12 pills, and administer one
every two hours.

Sept. 27th. Continues comatose. Pulse 106, small and feeble.
The blisters drew finely. The blisters and sinapisms failed to
arouse this patient, and he died this afternoon at 1 o'clock P. M.

(13.) Autopsy 20 hours after Death.

Exterior Full; limbs round; subject apparently not at all
emaciated ; skin of the superior (uppermost) portions of the body
presented the us'ial appearance, whilst the skin of the inferior
(dependent) parts presented a mottled, purplish appearance.
This was due to the settling of the blood under the action of
gravity.

Head. Dura-mater presented the usual appearance.

Arachnoid membrane not opalescent, but presented the usual
transparency. Bloody serum was effused between the arachnoid
membrane and pi a- mater.

Blood-vessels of pia-mater, congested with blood.

Ventricles of brain, almost completely filled with reddish}
serum. Blood-vessels of the superior portions of the brain more
congested with blood, than those of the inferior portions,

Substance of the brain presented the usual appearance and
consistency, considering the length of time since death.

Chest Heart and lungs normal.

Abdomen. Liver Color of the exterior appeared to be nor-
mal, (perhaps a shade darker than usual), with the exception of
two slate-colored spots. The largest of these slate-colored spots
was four inches in diameter, and situated upon the anterior sur-
face of the right lobe, whilst the smallest was situated upon the
posterior surface of the left lobe. When an incision was made
into the surface of the liver, through these spots, the structures-
presented a bronze color for the depth of a quarter of an inch. In
all other parts of the liver, the cut surface presented a color only
a shade deeper that normal.

Spleen, enlarged, softened, and of a dark slate color.

1859.] Jones, on Malarial Fever. 93

When the mud of the spleen was exposed to the atmosphere,
a part retained the dark-purplish and reddish-brown color,
whilst another smaller portion changed to an arterial hue. The
difference between these two portions of the splenic mud were
clearly seen when a section of the organ was exposed for several
hours to the action of the atmosphere. The other portion of
the mud of the spleen did not change its color. It is probable
that this phenomenon was due to the tact, that the blood bad been
but recently effused into the spleen. The portions tirst effused,
had lost the power of changing to the arterial hue, whilst those
last effused had not lost this power.

Kidneys, normal.

Alimentary Canal. The mucous membrane of the alimentary
canal, from the oesophagus to the an us, presented the normal color,
and showed no signs whatever of congestion or inflammation.

CONCLUSIONS.

(1). This case illustrates the rapid and powerful action of the
malarial poison.

(2). The brain and its membranes appeared to be normal,
with the exception of the small serous ettusiou which was entire-
ly inadequate to account for the cerebral disturbance during
life the liver, with the exception of the small spots, appeared to
be normal in structure the affection of the spleen was recent
and the alimentary canal, from the mouth to the anus bore no
marks of inflammation, and yet this strong, hearty young man,
fell a victim to the malarial poison.

The malarial poison appeared to act in this case, directly upon
the nervous centres of the cerebro-spmal and sympathetic nerv-
ous systems.

(3). The treatment of this case was radically defective it
was wanting in energy. The effects of Oct disease were those of
exhaustion, and not >f inflammation and excitement. The chemi-
cal changes of the elements were interfered wuh, and the correlation
of the forces, as a necessary consequence, was disturbed. '1 he mani-
fest indication was to stimulate Uie exhausted neruous system, and
excite those chemical changes, by which tlie forces are generated,
which, work the animal machinery.

The blisters and sinapisms, and cut-cups, and small doses of
sulphate of quinia, were right, as far as they went. The last
doses of calomel were decidedly wrong, and worse than useless;
they simply worked in conjunetion with the malarial poison.
Large doses of brandy, carbonate of ammonia aud sulphate of
quinia, should have been administered promptly and energeti-
cally, in conjunction with the blisters and sinapisms. The fol-
lowing case, which resembled this one m all respects, will illus-
trate, in a forcible manner, these conclusions.

94 Jones, on Malarial Fever. [February,

Case XLII. Seaman, from the United States revenue cutter,
and a shipmate of the previous case, (XLI). ; and the remarks
which were made with reference to the history of that case, apply
also to the present one. Age 26; light hair, blue eyes, florid
complexion; height, 5 feet 1L inches; weight, 160 lbs. This is
his first summer in these regions.

September 25th, 1857. Has been sick two days, says that he
was suffering with a thick eruption of prickly-heat. This dis-
appeared suddenly and then the fever appeared. Has fever
now.

$. Calomel, grs. xv. ; castor oil in four hours.

Sept. 26th. Medicine acted freely; heat of skin much less;
tongue heavily coated with yellow fur, tip and edges very red ; in-
tellect dull ; appears to articulate with difficulty.

ty. Sulph. of quinia, grs. v. every three hours, up to grs. xv.
Infusion of Virginia snake -root.

Sept. 27th. Iutellect still dull ; tongue presented the same
coated appearance. Pulse 83.

$. Calomel, grs. x. ; sulph. of quinia, grs. v. Mix and ad-
minister immediately.

Sept. 28th, 10 o'clock, A. M. Was delirious during the night,
and it was necessary to use much force to keep him in bed.
Appears to be much worse this morning, and continues delirious ;
tongue, heavily coated and very red at tip and edges. Pulse
86. No pain upon pressure of epigastrium.

$. Blister to epigastrium and back of neck. R. Calomel, grs.
xxiv.,; opium, grs. ij. Mix. Divide into 12 powders and ad-
minister one every two hours.

7 o'clock, P. M. Appears to be very weak and stupid. When
aroused by shaking, whines and mutters incoherently. Pulse
82 ; respiration 20; skin dry ; tongue presented the same appear-
ance. It is evident that unless the calomel be abandoned, and a
more vigorous method of treatment adopted, this patient will die just
as the previous case.

ty. Two cut-cups to each temple; sinapisms to extremities. $.
Brandy, f I viij ; infusion of Virginia snake-root, f I viij ; sulphate
of quinia, grs. xv. Mix and administer a tablespoonful every
half hour. R. Sulph. of quinia, grs. v., every three hours, up to
grs. xx.

Sept. 29th, 11 o'clock A. M. The stimulants and sulphate of
quinia, have been productive of much good. Tongue, although
very red, and dryer and rougher than normal, is moister and
softer than it was yesterday. During the night, slept soundly,
and this morning his skin relaxed and was bathed in a copious
perspiration. Intellect clearer. Pulse 78; respiration 15. Tem-
perature of atmosphere, 80F. ; temp of hand, 99. Has taken
during the last eighteen hours, forty grains of sulphate of quinia.

1859.] JONES, on Malarial Fever. 95

$. Give 20 more grains of sulphate of quinia during the next
20 hours, and continue the brandy and inrlusion of Virginia
snake-root, tsblespoonful every hour. Diet, beef soup, and
tea.

7 o'clock P. M. Continues to improve and says that he is
much better. The blisters have drawn and discharged golden
colored serum. Intellect more active, but still much duller than
usual. Tongue red, dry and harsh, feels like sand paper su-
perior portion coated with yellow fur; face much Hushed;
reaction of saliva decidedly acid; urine high colored. Pulse, 80;
respiration, 16. Temperature of atmosphere, 78*5F. ; temp, of
hand, 100-33.

$. Mustard to extremities. Stop sulphate of quinia. Con-
tinue brandy and infusion Virginia snake-root. Diet, milk-
punch, and brandy and arrow-root.

Sept. 30th. Says, that he is much better. Pulse 79 ; respi-
ration 16. Temperature of atmosphere, 70 F. ; temp, of hand,
97.5; temp, under tongue, 100. Tongue still very red, but
more moist. Skin dry ; reaction of saliva acid.

Urine, of a bright red color, and decided acid reaction sp.
gr. 1022. Uric acid in 1000 parts, 0'538.

$. Continue stimulants and nutritious diet,

Oct. 1st, 1] o'clock A. M. Rested well during the night, and
continues to improve. Complains of great weakness. Tongue
much softer. Pulse 70; respiration 1-1. Temperature of atmos-
phere, 71 F. ; temp, of hand, 98; temp, under tongue, 99.5.
Urine only a shade higher colored than normal, reaction acid
sp. gr. 1010. Uric acid in 1000 parts, 0'0099.

$. Continue brandy and infusion of snake-root tea. Admin-
ister 15 grs. of the sulphate of quinia during the next 15 hours.

Oct. 2nd, 11 o'clock A. M. Surface of blister red and raw ;
tongue cleaning off; papillae enlarged and distinct; bowels tor-
pid. Pulse 60 ; respiration 13, slow and full. It is probable
that the frequency of the respiration is diminished by the blis-
tered surface. Temperature of atmosphere, 76 F. ; temp, of
hand, 97.75 ; temp, under tongue, 99.5.

#. Continue stimulants and nutritious diet, milk punch and
mutton soup.

Urine, of a bright red color, sp. gr. 1020 turbid after stand-
ing several hours. Amount passed during the last 24 hours,
grs. 13260.

Oct. 3rd, 11 o'clock A. M. Pulse 62 ; respiration 14. Tem-
perature of atmosphere, 76 F.; temp, of hand, 98 ; temp, under
tongue, 99.25. Reaction of saliva acid; urine of a deep orange
color heavy, light-yellow deposit after standing a few hours.
The acid has greatly diminished re-action alkaline after stand-
ing a few hours. Amount passed during the last 24 hours, grs.

96 Jones, on Malarial Fever. [February,

15330 ; sp. gr. 1022. Uric acid in grs. 15330 of urine, grs. 10.5.
Uric acid in 1000 parts of urine, 0.664. Bowels have not been
moved for four days.

ty. Calomel, grs. viij.; sulph. of quinia, grs. v. Castor oil in
four hours. Continue stimulants and infusion of snake-root.

Oct. 4th. Dressed and walking about the ward. Tongue,
moist and soft, and only a little redder at the tip than usual.
Pulse 60 ; respiration 12. Blister raw, and slow in healing.
Urine orange colored, re-action slightly acid, when first voided,
but rapidly changes to the alkaline, and lets fall a heavy deposit
after standing a few hours.

$. Quassia and soda. Full diet.

Oct. 5th. Urine, orange colored ; sp. gr. 1024. Heavy depos-
it reaction of saliva very slightly acid.

Oct. 8th. Entirely restored to health. Pulse 48 ; respiration
14. Temperature of atmosphere, 73 F. ; temp, of hand, 97;.
temp, under tongue, 99.5.

CONCLUSIONS.

(1). Although the pulse of this patient, at first sight, did not
appear to have been much accelerated, when compared with the
action of the pulse in other cases of malarial fever, still it was,
we think, greatly accelerated. The pulse was unusually slow in
health, only 48 to the minute. The respiration was also very-
slow in health, 14 to the minute. The temperature of the surface
was not greatly elevated.

(2). Aside from the cerebral symptoms, there was nothing to
alarm the practitioner, except the state of the tongue. The
prominent symptoms, as in the previous fatal case, from the
same vessel, were connected with the brain.

(3). Active purgation and alterative doses of calomel, so far
from benefiting, were, as was conclusively demonstrated, by
careful examinations and analyses of all his symptoms, working
in conjunction with the malarial poison, and rapidly bringing
on a fatal termination. Stimulants, blisters, sinapisms, andlarge
doses of sulphate of quinia, administered without any regard to
the state of the tongue and brain, so far from increasing the ce-
rebral disturbance, diminished it rapidly. Under the vigorous
use of these active remedies, the dry, red tongue became moist,
soft and pale the pulse was diminished in frequency, and
became fuller the dry skin became moist, and the delirium
entirely disappeared.

These facts demonstrate conclusively that the action of the mala-
rial poison is one of depression and not of inflammation.

Case XLIII. American seaman, from United States revenue
cutter, companion of the two former cases, (xli. and xlii.) Ta-

1859.] Jones, on Malarial Fever. 97

ken sick at the same time. Aee 23; brown hair, dark e.
florid complexion ; height 5 feet 7 inches ; weight 155 lbs. ;
large chest, and stout muscular limbs.

September 25th, 1857. Was taken sick two days ago. His
attack commenced with a prolonged chilly feeling, followed, in
the course of six hours, with fever. Has fever now.

3. Calomel, grs. x.; Sulphate of quinia, grs. v.

Sept. 26th. Medicine operated freely. Complains of pain in
his head. Tongue coated with fur; pain upon pressure of epi-
gastrium. Pulse 88.

$. Apply mustard over epigastric region; infusion of red
pepper.

Sept. 27th. Much better ; febrile excitement much less. Com-
plains of slight pains in his bones and bowels.

3. Sulph. of quinia, grs. v. every three hours, up to grs. xv. ;
infusion of Virginia snake-root.

Sept. 28th. Has no fever. Give 15 more grains of sulph. of
quinia.

Sept, 29th, 11 o'clock A. M. Much better.

7 o'clock P. M. Within the last two hours has taken a change
for the worse. Intellect wandering. Complains of great pain
in his head. Pulse 92. feeble; respiration 32. Reaction of sali-
va intensely acid. The secretions of the mucous membrane of
the mouth are almost entirely dried up, and it is with difficulty
that sufficient saliva is obtained to moisten the litmus paper.
Tongue, where the fur is absent, very red it is dry, harsh, and
rough to the touch. Pain upon pressure of the epigastrium.
Head and trunk hot, and extremities cool.

#. Sinapisms to extremities and epigastric region; cut-cups
to temples and back of head.

$. Sulphate of quinia, grs. vij. every three hours, up to grs.
xl. Administer brandy and infusion of Yirg. snake-root, freely.
Diet, brandy and arrow -root.

Sept. 30th, 11 o'clock A. M. The mustards and stimulants
have aroused the intellect, and rendered the dry, parched tongue
moist, and diminished the frequency of the pulse and respira-
tion. Pulse 68, rather feeble ; respiration 22. Temperature of
atmosphere, 80 F. ; temp, of hand, 95.5 ; temp, under tongue,
97. Skin slightly moist and cool to the touch ; face much flush-
ed; surface of head cool, although from its congested, florid, red
appearance, we would judge it to be hot. The temperature of
the trunk and extremities is below the normal standard, not-
withstanding that the pulse and respiration are much more rapid
than in health. During the night he was delirious, and it was
difficult to keep him in bed.

The blood from the cut-cups appeared to be normal under the
microscope, and showed no signs of inflammation.

98 Jones, on Malarial Fever. [February,

ty. Continue stimulants and sulph. of quinia. Diet, milk-
punch, brandy and arrow-root.

Oct. 1st, 11 o'clock A.M. Continues to improve under the
action of the stimulants and sulphate of quinia. Tongue moist-
er and softer. Pulse 66, rather feeble; respiration 20. Tem-
perature of atmosphere, 71.5 F; temp, of hand, 95; temp, un-
der tongue, 97.15. Complains of weakness. Kested well during
the night, and has had no pain in his head since the application
of the cut-cups. Urine orange colored sp. gr. 1013.

ty. Continue stimulants and nutritious diet.

Oct. 2nd, 12 o'clock M. Tongue moist and clean, redder than
normal. Pulse 62, regular, full and soft; respiration 20. Tem-
perature of atmosphere, 76.5 F. ; temp, of hand, 98; temp, un-
der tongne, 99. Keaction of saliva, decidedly acid. Urine,
orange colored and clear, reaction decidedly acid sp. gr. 1014.
Amount excreted during the last 24 hours, grs. 21,210.

$. Continue. Full diet.

Oct. 3rd. Face not so much flushed. Tongue clean, moist,
soft, and approaching the usual color. Eespiration 19. Tem-
perature of atmosphere, 76.5 F. ; temp, of hand, 96.5 ; temp,
under tongue, 98.8. Eeaction of saliva decidedly acid.

Color of urine, reddish orange; after standing several hours,
let fall a light yellow deposit sp. gr. 1017.

ty. Continue stimulants and infusion of Yirg. snake-root tea.

Oct. 4th, 12 o'clock M. Up, and walking about the ward.
Urine, orange colored the change from the acid to the alka-
line reaction took place in the course of a few hours, and a heavy
deposit was thrown down. Amount of urine passed during the
last 24 hours, grs. 15,270 sp. gr. 1018. Pulse 54, slow and
full; respiration 14.

IK Quassia and soda.

Oct. 5th, 11 o'clock A. M. Tongue, pulse, respiration and
skin normal. Color of urine, light orange sp. gr. 1020 reac-
tion of saliva acid.

Oct. 9th. Entirely restored to health. Pulse 43 ; respiration
15. Temperature of atmosphere, 72 F. ; temp, of hand, 96.5 ;
temp, under tongue, 99.75.

Case XLIY. Irish seaman, from United States revenue cut-
ter age 19: height 5 feet 7\ inches; weight 145 lbs.; light
brown hair, grey eyes, fair complexion.

October 4th. Was taken sick four days ago his attack was
two days later than that of his companions (cases xl., xli.,. xlii.r
and xliii). Has had no chill, but has suffered with pain and
dizziness in the head ; face flushed. Pulse 100 ; respiration 20,
Tongue coated with yellow fur, tip and edges red ; papillae en-
larged. No tenderness of epigastrium. Skin hot.

1859.] Jones, on Malarial Fever. 99

#. Calomel, grs. xij.; sulph. of quinia, grs.vi. Mix, and ad-
minister immediately, and follow with castor oil in four hours.
As soon as the medicine has commenced to act, give sulph. of
quinia, grs. v. every three hours, up to grs. xx.

Oct. 5th. Much better. Head relieved. Skin in a profuse
perspiration. Eeaction of sweat and saliva decidedly acid.
Pulse 104. Skin hot, but moist and relaxed. Eespiration 24,
full, thoracic. No lenderness upon pressure of epigastrium.
Tongue redder and dryer than normal. Medicine operated four
times. Has taken xxx. grs. of the sulphate of quinia.

$. As soon as fever remits, give brandy and infusion of Vir-
ginia snake-root.

Oct. 6th. Continues to improve. Pulse 96. Skin warm, but
moist. Continue stimulants.

The febrile excitement subsided and there was no return, and
this patient was discharged a few days afterwards.

Cases XLV. and XLVI. Two stout, athletic young seamen,
from ,the United States revenue cutter, who contracted their
sickness simultaneously with the four seamen mentioned in
cases xli., xlii., xliii. and xliv.

One suffered with a slight attack of intermittent fever, and
remained in the hospital only a few days.

The other suffered also with intermittent fever, but of a se-
verer type.

In this case, the chill was well marked, by a hot trunk and
cold extremities, and great disturbance of the sympathetic and
cerebrospinal nervous systems, and in the succeeding stnge
of febrile excitement, the pulse was full and strong, the respira-
tion accelerated and the animal temperature correspondingly
elevated, and in the intermission there was a marked subsidence
of the febrile excitement.

At first sight, the severe chill the full, bounding pulse the
thoracic respiration, and the hot and parched skin, would ex-
cite the belief that the patient was in danger. Such an opinion
would have been erroneous, for these phenomena signified pow-
ers of resistance.

This case yielded far more readily to the action of the sulpL
of quinia than the former cases from the cutter.

Conclusions drawn from an examination, analysis and compari-
son of these six cases of malarial fever, occurring in the crew of the
United States revenue cutter.

(1). Whilst the revenue cutter was cruising about the mouth
of the Savannah river, the crew remained healthy; but as soon
as they were exposed to the exhalations of the low grounds and
marshes, they were attacked by malarial fever. This fact de-

n.s. VOL. XV. NO. II. -8

100 LlGHTFOOTrs Surgical and Medico-legal History [February,

monstrates that a special cause resided in a special locality,,
capable of producing a special disease.

(2). There was a remarkable uniformity in the symptoms of
four out of the six young men from the cutter who were attack-
ed with fever.

In these cases, the malarial poison appeared to act either di-
rectly or secondarily, powerfully upon the nervous centres of
the sympathetic and cerebro-spinal systems.

The action of the malarial poison was depressing, rather than
inflammatory. Whatever diminished the forces, acted in conjunc-
tion with the malarial poison. Whatever stimulated the nervous
system, excited the action of the heart, excited the capillary circu-
lation, excited and increased the chemical changes of tlie nutritive
fluids and organs and tissues, acted directly antagonistic to the action
and effects of the malarial poison.

(3). A rapid pulse, rapid respiration and low temperature, and
wandering intellect, are alwaj^s dangerous symptoms, which
signif}r a perversion of the functions, an interference with the
normal chemical actions, which generate the forces, and an
unconditional surrender to the fatal poison.

(4). A rapid, full pulse, accelerated respiration, and a corres-
ponding development of heat, are favorable symptoms, and
signify an effort on the part of nature to get rid of the poison.
The fever is not the disease it is an effect of the action of the mala-
rial poison upon the living organism, and signifies a power of resist-
ance.

(5). The differences in the symptoms of these cases show that,
men living on the same small vessel, and exposed in an
equal manner, will not suffer alike. The effects of the poison
will depend, in great measure, upon the nature of their vital
and physical endowments.

(To be continued.)

ARTICLE V.

Surgical and Medico-legal History of a Case of Comminuted
Fracture of the Fore-arm, just above the Wrist-joint, resulting in
Anchylosis and Deformity. By W. S. Lightfoot, M. D., of
Macon, Ga.

[Remarks. We regard the following report a very interest-
ing and important one to Practitioners. It has become, of
late years, a great evil to our Profession that, on the slightest
pretexts, its members may be mulcted in large amounts, in sur-
gical cases, under the charge of mal-practice. " It has heretofore

1859.] Of a Case of Comminuted Fracture of the Fore-arm. 101

been more sorely felt by the Profession in the northern than in
southern cities, and the record of unjust and sometimes almost
ruinous verdicts, gained against Practitioners, found occasionally
in the journals of that region, is well calculated to attract the
attention of the Profession, and to make them feel called upon
to fix the principles upon which all such cases are to be hereaf-
ter equitably decided. Although the valuable reports of Prof.
F. H. Hamilton, of Buffalo, to the American Medical Associa-
tion,* "on Deformities after Fractures,'' must ever be resort-
ed to, as a tower of defence, in such cases, still the history
of others will serve to make testimony yet more abundant, and
settle more firmly the principles which should prevail in these
adjudications. Rdts. S. M. &. S. Jour.]

February 12th, 1855. John J. Kah, a German by birth a hire-
ling on the South-western Kailroad whilst pushing a car ahead
of him, another car came up behind him, unobserved, and struck
his left elbow while flexed, driving his hand against the front car,
fracturing the fore-arm, just above the wrist-joint. Called to see
him about one hour after accident Found the fracture as above
stated: in addition to which I also found the end of the bones
which were broken offj together with the bones of the carpus, so
much crushed as to induce me, when examining the parts, to re-
mark that they felt like a bag of little stones. Surrounding soft
parts much damaged. After examination of fracture, I remarked
to Kah, that the French surgeons would in all probability ampu-
tate the limb; but I would try to save the hand and arm. He
said, in his agony, if I could not straighten the arm, not to
touch it I told him to do the hallooing, and I would do the
work. Adjusted the parts as well as I could. Applied the
small compresses, long splints and roller bandages. Then direc-
ted the bandage to be kept wet with cold water; and should
there be much swelling and pain, to loosen the bandage a little.

Left patient in charge of a prudent and experienced nurse.
On the thirteenth day thereafter, I saw him again at the request
of Capt W, P. Anderson, the nurse. Found the dressing in a
filthy condition ; the fracture in proper condition. Cleansed the
parts; applied fresh dressings having the arm well supported
during the removal, and re-application of the dressings. Some

* See Transactions, vol. x., 1867.

102 LlGHTFOOT's Surgical and Medico-legal History [February,

time after my second visit, and whilst the arm was in sling, he
had a row with his wife, and also a fight with his brother-in-law.
Saw Kah no more until the fifteenth of June thereafter, when
called to see his son, whom I visited several times. Heard no
complaint from the arm during my visits.

May 1856. Kah commenced suit against me for malpractice,
claiming damage to the amount of ten thousand dollars.

Whittle and Tracy, for Plaintiff.

Poe and Grier, for Defence.

John K. Kah, ^

vs. > Case for Malpractice.

William S. Lightfoot. )

Came off at November term, 1858, in Bibb Superior Court.

EVIDENCE BY PLAINTIFF.

Interrogatories of Susan Arnold and Margaret Johnson read.

William P. Anderson, testified from the stand. Saw Kah
on the day of the fracture, about the first of February, 1855.
Doct. Lightfoot was sent for, and came immediately. Kah was
suffering great pain. He asked him if he could set it ? He said
he thought he could. Kah said, I would rather it had been my
head, if it can't be made straight. Kah asked if it would hurt
much. Dr. L. said, you do the hallooing, and we will do the
work. Dr. L. had some bags, or cushions, stuffed with meal-
bran, as he snid, to keep the bones apart. Dr. L. said, while
he was setting the arm that it felt like a bag of little rocks. Dr.
L. told Kah if it swelled to loosen the bandage. Dr. L. asked
witness to see Kah every day and attend to it. Nothing was to
be done except to keep the bandage wet with cold water. On
the 14th day, Kah complained so much, he looked at the arm
it was mattering, smelt bad bags pressed into the flesh. Dr.
L. was sent for, and came promptly. When he came, he said
oh dear! it ought to have been attended to sooner. Thought
he meant that he, the doctor, ought to have attended to it. Dr. L.
had been the physician of Kah before know that he once went
to see little boy with a nail in his foot don't know how often
he saw boy. Kah was a cabinet maker worked at Kailroad
depot. Dr. L. said nothing about the case being a pauper case.
Dr. L. did not see him again for fourteen days, so far as witness
knows. Skin not broken at first.

1859.] Of a Case of Comminuted Fracture of the Fore-arm. 103

Cross. Dr. L. had once before seen witness in a case of sur-
gery. Witness is a good nurse. Witness wanted to send for
Dr. L. before he came the second time and Kah refused. He did
his best to get him to send for Dr. L., but he would not let it
be done. The arm did not mortify the flesh-wound healed
the arm looked straight when it was first set. Can't say whether
it was straight or not at the second visit ; but the bags looked in
the same condition as when set ; and thinks the arm was in same
position. When Kah said, doctor, if you can't set it straight,
don't touch it he meant the then condition; that is, if he could
not set it right. After the second visit, witness did not see him
often. Kah told witness he got his arm hurt, while pushing a
car; another came up and struck his elbow, driving it up. Did
not observe the arm to be crooked until he commenced using
it. It grew crookeder and crookeder as he used it. Kah was
walking about the house. Don't know whether or not he could
have walked to the doctor's office.

Susan Arnold, Sworn. Answers, I know the parties. I was
at the setting of arm. Kah asked the doctor if he thought both
bones broken. The doctor replied that he did not think them
both broken. Kah said, if you can't make my arm straight don't
touch it ; for I would rather have my head cut off, than have
my arm crooked. The doctor replied, never mind, you do the
hallooing, and we will do the work; then called William P.
Anderson and William Dillard, to assist him in holding Kah's
arm. The doctor directed Kah to apply cold water to his arm,
if it pained him before he came again. I did not live in the
house with Kah's family. I lived about three-quarters of a mile
from Kah's. It was about two weeks from the time his arm was
broken and first bandaged, before I saw it again opened, which
was done by the doctor. Dr. L. had been Kah's physician two
or three years. I had known of Kah's paying him one or more
bills; and he had been in the habit when sent for to see a case
in the family, of continuing to come as long as he thought it
necessary. I thought it much neglected from seeing the matter
run through the bandages.

Cross. I live about three-quarters of a mile from Kah.
Was present when the doctor came to see Kah the first time
did not hear the doctor say that Kah's arm felt like a bag of

104 Lightfoot's Surgical and Medico-legal History [February,

stones did not hear him say that Kah would be likely to have a
stiff-joint cannot say whether the arm was correctly set, as I
am no doctor did not hear the doctor direct Kah to loosen the
bandage in case the arm became painful and swelled ; but I did
hear him give directions not to have it moved, and if it pained
him to have it wet with cold water. Never heard him say that
Dr. L. did not do his duty by him.

Margaret Johnson, Sworn. Says, I was present when Dr.
Lightfoot first bandaged Kah's arm. He asked the doctor if he
could set his arm straight, if not, not to touch it, for he would
rather have his head cut off than have it crooked. The doctor
said, nevermind, you do the hallooing and we will do the work.
He directed him to keep the bandage wet with cold water, and not
remove it until he came back. The doctor's instructions were
full}?- carried out during his absence. It was fourteen days before
the doctor came back to see Kah, and was then sent for. When
the doctor took off the bandage, he said it ought to have been
attended to sooner. The cords or leaders on his wrist were
entirely rotten or eaten off, and as green as grass, as his arm had
been bandaged so close, by having it laid in a little bag filled
with corn meal, and another one laid over it and kept confined.
The doctor said, the little bags were to keep the bones apart
and prevent their growing together. I lived in the house with
Kah's family during the time. Saw his arm every day after the
doctor came the second time saw it every time it was dressed,
and assisted. Kah conducted himself properly while his arm
was hurt; was not drunk during the time. I was present all the
time. Mr. W. 0. Hurt was not at Kah's during the time, to my
knowledge. Kah had no difficulty with his wife whilst his arm
was hurt. I know the doctor did not come the second time until
fourteen or fifteen days, and did not come then, until sent for.
Found the arm in a dreadful condition.

Cross, I lived with Kah's family. "Was present when Dr. L.
set his arm. Did not hear the doctor tell Kah that his arm felt
like a bag of small stones. Was present all the while, and did
not hear the doctor tell Kah that in all probability he would
have a Miff wrist. I cannot say whether the arm was set or not.
I am no doctor. The doctor did not direct Kah to have the
bandage loosed if the arm should swell and become painful ;

1859.] Of a Case of Comminuted Fracture of the Fore-arm. 105

but told him to let it remain as it was until he returned, except
to keep it wet with cold water. Kah and his wife did not have
a difficulty while the arm was bandaged. Kah did not drink
any ardent spirits while his arm was hurt. William P. Ander-
son did frequently see Kah in the absence of the doctor. An-
derson did advise Kah to send for the doctor before he came
the seeond time.

William Dillard, Sworn. Maj. Anderson was present when
Dr. Lightfoot set the arm. He set it straight ; it was greatly
crushed, felt like a bag of rocks ; heard the bones as the arm was
moved. The little bags used were stuffed with bran, and were
about the size of witnesses finger.

Dr. Hammond, Sworn. He examined the arm ; thinks it now
has half the use of sound arm. Can't say whether the arm could
have been made better, if properly attended to. Injuries of the
wrist are the most difficult to heal without deformity. Any
motion, for thirty to sixty days, will alter the condition. Heard
Anderson sworn. Thinks the arm was set and dressed right;
can't say it could have been better; thinks he would see a case
of the sort once in five or six days, unless he could leave him in
the hands of such a nurse as Maj. Anderson. This is my practice.
If the bandage had been removed sooner, perhaps there would
have been less sloughing.

Cross. The condition of the arm, shows that great violence
was done to it The joint was greatly damaged; in injuries of
wrist deformity is the rule, and not the exception. In injuries
of the kind, the exudation of pus or matter, is the result of an
effort of nature to restore the injured part. No fault of the
doctor, up to the fourteenth day, according to Maj. Anderson's
evidence to produce the deformity. Thinks it doubtful, whether
it could have been cured better. The rule is, not touch the
bandage, so loner as there is no pain.

Dr. Thompson, {Reformer) Sworn. Heard Anderson's testi-
mony, and saw Kah's arm. The arm might have been made
better. Doubts whether it is as good as half a hand to a cabinet
maker. Thinks Dr. L. ought to have seen Kah the second dav,
and ought to have seen him every day. My impression is, that
the arm would not have been so bad, if he had been seen and
attended to properly by Dr. L. The general rule is, that the

106 Lightfoot's Surgical and Medico-legal History [February,

joint is stiff. Kali's is both stiff and crooked. More care the
better.

Cross. Stiffness and deformity are the rule in injuries done
the wrist. A visit, if the arm is straight and not painful, is use-
less to the patient.

Dr. Fitzgerald, Sworn. Looked at the arm ; should have seen
the case in two or three days ; should have been unwilling to have
taken the case, unless he could have seen the patient three or four
times in the first two weeks. In pauper cases, he makes appoint-
ments for patients to come to his office to see him. In fractures
near the wrist-joint or in it, deformity most always is the result.
Where so many bones meet, great deformity is the result. Thinks
the deformity very great in Kali's arm; don't know that it was
the result of the injury ; but thinks the arm might have been
better cured.

Cross. In cases of this kind, it is bad surgery to disturb the
dressings while the arm is straight and not much swollen. It
is an exception to rule when there is no deformity. If I had a
good nurse, one in whom I had confidence, I would not visit the
patient so often. If, at the end of fourteen days, I had found the
limb straight and not swollen, I should have considered the
patient uninjured. External inflammation and exuding of pus,
does not injure the limb it rather aids the cure. If the limb
becomes offensive, more or less unnecessary pain would have
ensued.

Rebuttal. Don't see any occasion for so great deformity, but
don't know, as he did not see the injury.

Dr. H. K. Green, Sworn. Two years ago, may-be not so long,
Kah called on witness to ask advice. Surgeons differ as to
when they should visit the patient after the injury, as described.
Witness would have seen patient next day would have seen
him once a week. Custom of surgeons here not known, if noth-
ing is said about time when patient is to be visited. Thinks it
usual to have an understanding with him. Impossible to tell
whether the limb could have been cured better. If patient
should not do his duty, no skill on the part of the surgeon could
benefit him. Can't account for such deformity. When the
bones are shattered, it defies the best surgery to prevent defor-
mity. A case such as witness Anderson describes this to have

1859.] Of a Case of Comminuted Fracture of the Fore-arm. 107

beeD, is a most unpromising one. Such case could not be ex-
pected to be better cured.

Dr. Cox, {Reformer) Sworn. If patient had been injured as
described, it would have required close care. Would have seen
patient every day proper care and dilligence required it.
Thinks it would have been improper to have let fourteen days
elapse without seeing patient. Thinks the case not so good as he
would have expected. When he has a case, he either tells
patient not to expect him, or he visits him when necessary.

Cross. In injuries of this kind, if the bones are properly co-
aptated, no great deformity necessarily results. Practice is, let
the dressings alone, so long as the limb is straight. The worse
the injury, the longer it requires for the bones to unite. In in-
juries of the wrist like this, deformity is apt to ensue. Book*
is recognised by a respectable body of surgeons as being one
of authority. Thinks the system of surgery wrong. It is not
the science of life.

DEFENDANT INTRODUCED.

Mrs. McDarnold, who being Sworn. Knows Mrs. S. Arnold
and Mrs. M. Johnson, who testified in this case. Knows their
general character; has known them for twenty years; would
not believe them on their oath in a court of justice. Has seen
Margaret Johnson drunk. Has seen her in the unlawful em-
braces of a negro. Known Susan Arnold to keep a house of ill-
fame. This was in 1833 or 34. Kah's wife is said to be daugh-
ter of Susan Arnold. Witness is a relative of President Jeffer-
son.

Doctor Mettauer, Sworn. Saw the hand and arm ; heard An-
derson's testimony. The treatment of the arm by Dr. L. was
perfectly correct under the circumstances as sworn to by witness
Anderson. It would not have been necessary to see the patient
for two or three weeks. If the nurse had asked the patient to
send for the doctor and he had refused, the result would be his
own fault. If any thing had gone on wrong, the pain would
have been so great, that he would not have been able to bear it.
In pushing a car, the hand would have been lower than the
elbow, consequently, the tendons must be injured. If so, no

surgery could have made it better. If the injury had been such

. _ _

* Transactions of the American Medical Association.

108 LiGHTFOOT^S Surgical and Medico-legal History [February,

as described, he is greatly surprised at so good a cure. The
muscles must have been cut or injured.

Cross. Surprised at the good cure, after knowing the nature
of the injury. The bandage should not have been removed for
two or three weeks. Nature was doing her work. Sloughing
was a necessary consequence, no injury arose to patient from
it. Would not have gone to see him in two weeks.

Rebuttal. No neglect could have produced such a result. It
must have arisen from the injury of the muscles and tendons.
No sloughing or mattering of the arm could have altered the
result at all. Book shown is good authority. Every case in it
does not meet my approbation.

Dr. Harrison, Sworn. Has examined the arm heard Ander-
son's testimony. From the nature of the injury, deformity
must have issued. The result is owing to the cutting and other
injuries to muscles and tendons. When such wounds are
dressed, it is wrong to disturb them while the parts are straight.
Sloughing is of no moment. If I had left the patient in such a
nurse's hands as Capt. Anderson, I would not have seen the
patient in two or three weeks.

Cross. Has written several pieces in the paper signed " Band-
age". From nature of the injury, it would have been impossi-
ble to have avoided deformity as it exists. It must have arisen
from the injuries to the tendons and muscles. On the 14th day,
the arm was dressed, and could be cleansed and dressed without
injury. No neglect of the doctor could have caused such defor-
mity.

Wm. 0. Hurt, Sivorn. Knows plaintiff; he was not a good
cabinet workman making nothing but a dollar per day
nothing but a cobbler. Saw him some time after the injury on
Bridge-row chasing his wife. They were not in conflict, but
they were in an affray his arm in a sling.

Cross. Kah was not worth more than $1 a day. It was
about the third week after the injury, that I saw him chasing his
wife.

Ludwich, Sworn. Had a fight with Kah, whilst his arm was
in the sling. He knocked me with his well arm.

Capt. Anderson, recalled. Kah removed to Bridge-row 14th
March injury, 12th February. Only saw Kah occasionally

1859.] Of a Case of Comminuted Fracture of the Fore-arm. 10

after he went to Bridge-row. Did not see the fight with Lud-
wick. Knows Magaret Johnson and Susan Arnold.

Br. Thompson, recalled. Thinks Kah was good for his con-
tracts at the time of injury. He had money in his hands be-
longing to Kah.

ANSWERS TO INTERROGATORIES.

Dr. J. A. E 9a. Says the arm ought not to-

have been dressed again, until the dressings had become derang-
ed or uncomfortable to the patient, without reference to the
number of days. The loss of the arm, I think, would not be a
probable result. Anchylosis inevitable, and more or less defor-
mity almost certain. The responsibility should be thrown on
the patient under such circumstances. Under the very best
management, most probably, there would be more or less defor-
mity.

* Dr. L. A. Dugas, Augusta. Ga. He says, I am a practising
physician and surgeon. The dressing of fractures, should be
re-adjusted whenever it becomes deranged or painful. There
is therefore no specified period for the removal of dressings.
Such a fracture would not usually cause the loss of the limb, but
would most probably result in more or less deformity. I do not
think that the attending physician should be held responsible
for the misconduct of the patient. Injuries of the wrist-joint,
complicated with fractures, are very often attended with defor-
mity, under the best possible management.

Dr. H. F. Campbell, Augusta, Ga. He is a practising physi-
cian and surgeon. When a fractured limb has been dressed, I
do not contemplate the removal of the bandages so long as they
remain properly adjusted and comfortable to the patient.
Should inflammation and swelling ensue, it becomes necessary
to remove the dressings. The removal of the bandage is con-
sidered rather as an unpleasant necessity which may arise, than
as a part of the ordinary attention to be rendered in the treat-
. ment of a fracture.

The phrase, " setting a bone" implies permanently maintain-
ing the adjustment till reunion has taken place, provided, pain,
inflammation or derangement of dressing does not render surgi-
cal interference actually necessary. The dressings are only
removed, when such removal is unavoidable. There is no fixed

110 Lig-htfoot's Surgical and Medico-legal History [February,

time at which the dressings should be removed. In extensive
fractures, however, we delay disturbance of the limb as long as
possible, in order to allow full time for union to be effected.
Union progresses very slowly in comminuted fractures, and
the first dressing, after the setting, should be delayed as long as
possible. From four to five weeks, if the swelling of the limb or
the derangement of the dressings does not render their removal
necessary. A fracture of the kind described, need not necessa-
rily cause amputation, but deformity and impaired use are wery
common results in such cases. The responsibility should be
upon the patient in such a case. Should the patient neglect to
inform the physician even, of any accident which may have be-
fallen the limb, so as to give him the opportunity of remedy-
ing it, the physician, in my opinion, is free from responsibility
for any unfortunate result ; much more so, if the patient should
engage in fights or in any other exercise of the limb, which is
calculated to destroy the benefit of the treatment.

Br. Robert Campbell, of Augusta, Ga. If the arm remained in
proper position, as it was placed, and was doing well, it should
not be disturbed at all, unless there was a flesh wound which
might require washing and dressing. There is generally no
necessity for disturbing a fractured limb after it has been regu-
larly set with splints and done up. If care has been taken by
the patient or his attendants (i. e., his nurse or friends about
him,) to prevent the apparatus from displacement, unless some-
times in case of swelling ; for when a limb is set, it is presumed
that the splints are capable of keeping it in the position in which
it is placed, if not interfered with. It would be necessary to
examine the apparatus to see that it had not been deranged,
before the union between the ends of the bone had become con-
solidated or changed into bone. This consolidation takes place
sooner in some bones, and in some portions of bones than in
others, and to allow this variation, I would say, that from the
10th to the 15th day, a set fracture might safely remain unex-
amined. I do not think that union takes place as rapidly at the
ends as in the centre of the shaft of the long bones. If the limb
was in the condition described in the interrogatory, I would
hope to avoid amputation, probably, unless there was "com-
pound fracture," that is, a flesh wound communicating with the

1859.] Of a Case of Comminuted Fracture of the Fore-arm. Ill

fracture, and injuring the muscles, nerves, &c. ; but I consider
stiffness of the joint almost inevitable with so extensive an inju-
ry to the bones of which that joint is composed ; and I believe
that the more complicated a fracture, (i. e., the greater the num-
ber of pieces the bones are divided into) the greater are the
chances of deformity. The patient might have kept the arm in
the sling unnecessarily long. I do not think it safe to use a limb
after fracture, for five or six weeks; and even then, I believe,
there would be danger in subjecting it to any violent use. If the
patient should imprudently subject his limbs prematurely (or
before that time) to such dangers as those over which his physi-
cian could have no control, (as fights, &c.,) I think the responsi-
bility for the result should most unquestionably rest with him,
the patient. I believe that injuries involving the wrist-joint, are
very apt to result in deformity and stiffness, principally on
account of the great number of bones which enter into the con-
struction of that joint.

Dr. Paul F. Eve, of Nashville, Tenn. Says that he is a practis-
ing surgeon, and most conversant with surgery, and has been
engaged in teaching it the quarter of a century. Bones com-
menced to unite about the ninth day, and if the patient suffers
none, even if the fracture has not been reduced, all the surgeon
has to do at first, is to prevent the development of unfavorable
symptoms. It is best, however, to set the limb at once, which
when done, a second visit maybe deferred for from eight to twelve
days; provided the surgeon is to be apprized if the patient suf-
fers, or the apparatus applied becomes deranged. The definite
answer to the second interrogatory, is, that a fracture ought to be
seen under all ordinary circumstances about the ninth day. If
he had put up a limb, injured as this one was, and had given his
views to the patient as to the probable result namely, amputa-
tion he would not return to see it at all, without being sent for;
for he (the patient) would have received his (deponent's,) opinion,
and he had a right to act upon it according to his own judgment.
It was the patient's duty to let the surgeon know when his ser-
vices, if at all, were required. When the patient is in limited
circumstances, or able to be up and about, as the services ren-
dered are gratuitous, he certainly ought to come to the doctor's
office to have his fracture re-examined or the apparatus re-

112 07i the Theory of Inflammation. [February,

adjusted. It certainly is his place to let it be known, should he
suffer pain or observe anything wrong about the fractured parts.
The limb properly set, may never again be disturbed during the
whole course of treatment. Indeed, this is the best practice in
fractures.

The prognosis in such cases is very unfavorable. An injury
of the character described, generally requires amputation it
could not be cured without deformity and loss of motion. A
perfect fore-arm and hand in an ordinary fracture, at or near the
wrist-joint, is an exception, and not the rule. Deformity is the
result. He is surprised that the limb was saved, and the patient
did not die of mortification or lock-jaw.

After being charged by his Honor, Judge Henry Gr. Lamar,
the jury retired and returned a verdict for defendant.

On the Theory of Inflammation, By James Hinton, M.E.C.S.

Inflammation, being the most frequent form of disturbance
in the animal body, has received from : pathologists the largest
amount of study. By observation and experiment its phenome-
na have been traced from first to last. Yet the word conveys
to us still but an indefinite meaning ; the relation which the
changes implied by it bear to each other has not been distinctly
grasped. The senses have contributed their part, but the mental
element is defective. We still wait for that true knowledge
which consists in the recognition of order and mutual depen-
dence ; and our efforts must continue until we are able to place
before our intellectual sense the observed phenomena in a ra-
tional and necessary sequence.

Nor is there in such an attempt anything unreasonable. The
links of necessary causation must exist, and a right knowledge
of them must be simpler and more conformable to reason than
hypothesis constructed in ignorance. We seek the relation in
which certain observed processes stand to each other, the ration-
al bond between them. In a word, we require a dynamic view
of inflammation. Some progress in this direction has indeed
been made in the proposition now so generally held, that inflam-
mation is "an altered nutrition." Unquestionably this is so
far good. It recognises in inflammation a process, and excludes
therefore the idea, which is so apt to suggest itself to us in rela-
tion to all that is not understood, of a specific entity. But this
expression can hardly be said to advance us far on the road to
a positive knowledge. If we may, on the one hand, affirm it to

1859. J On the Theory of Inflammation. 113

be true, must we not, on the other, admit it to be a truism ?
"What is the amount of information it conveys to us which we
did not previously possess? It tells us that inflammation is a
diseased or perverted state of life, but are we not apt to think
that it tells us much more? Does not that unknown term
" nutrition" stand in our thoughts for some definite addition to
our knowledge? Does it present itself to us so clearly as it
should do that if the meaning of nutrition be so large, and we
know so little of its nature, it is but a form of words to say that
inflammation is an altered state of it?

All writers on inflammation have recognised in it processes
of two opposite characters and tendencies. Mr. Paget classifies
them into those that are productive, and those that are destruc-
tive, and the destinction is broadly obvious. Into the ordinary
conception of nutrition itself indeed both these processes enter;
it is regarded as including two opposite actions of series of
changes growth and decay. But this oppositeness of action
is ever more marked in inflammation than in health. In an in-
flamed part we may see a structure decomposing, not in invisi-
ble molecules, or by mere interstitial removal of its elements,
by dying in large masses, while all around it the evidences of
vital action, of the impetus towards growth, are seen in more
than ordinary energy. Is there any intimate relation between
these opposite actions ; may inflammation consist in either alone ;
or, if both be essential, what is their connexion ?

That an increase of both processes, the decay and the vital
action, is necessary to constitute inflammation, appears when we
consider the distinctive characters of that affection. It differs
from mere increased decay, as primary gangrene or atrophy, on
the one hand ; and from mere increase of vital action hyper-
trophy, repair, or development upon -the other. Its peculiar
characters involve at once an abnormal increase of destruction
and of growth.

If, then, both these changes be essential to inflammation, can
there be traced between them any other connexion than that of
co-existence? Are they related as cause and effects? What
is the starting-point of the morbid process ?

I answer: they are related as cause and effect; the increased
decomposition is the starting-point; the increased vital action is
secondary and dependent.

The first proof of this position is found in the nature of the
causes by wnich inflammation is induced. All of these, it has
often been remarked, are such as clearly tend to lower the vital
power or to produce actual destruction of the parts on which they
act. In every case in which the origin of inflammation is distinct-
ly traced, the starting-point is found to be in fact an anti-vital
change.

114 On the Theory of Inflammation. [February,

And this practical evidence is reinforced by the most cogent
theoretical considerations. Can we represent to our thoughts
any clear idea of a primary abnormal increase of the vital or
formative action that should be inseparable, as inflammation is,
from a concurrent increase of decay ? And this increased decay,
not such as attends and is subservient to increased growth, but
of so disproportionate an amount as almost always to result in a
lessened vitality of the affected part. Is it not a contradiction
that an approximation to death should be the result of an in-
creased life? It is not inquired now how such a primary in-
crease of the formative action should arise, and especially in such
circumstances of debility and depression as most favour inflam-
mation, because that subject will be considered hereafter in
tracing the relation between inflammation and adventitious
growths ; but there is a direct bearing on the question in the
fact that inflammation arises in tumours then first when decay
begins in them. It is incompatible with the increased forma-
tive action which produces them ; it is a constant attendant
on their disintegration.

Connecting thus the two series of changes, destructive and
formative, as cause and effect, both may be understood. For
the increased formative action some cause is demanded, some
additional and local acting force to which, it may be ascribed.
This demand is fulfilled by the increased decomposition, which
is a known source of force, and which is itself sufficiently ac-
counted for by the tendency of all organized substances to un-
dergo decay. The abnormal decomposition is referable to
known and sufficient causes, and itself supplies a cause for the
abnormally increased activity of the formative process. For
not only is decomposition of the tissues (a change belonging to
the class of chemical actions) a recognised source of force as such,
and thus capable of acting as a stimulus upon the vital activity
of adjacent tissues, but it is shown by well-known facts to be
immediately concerned in the production of the formative action.
Such facts are the liquefaction of certain portions of the embryo
as conditions for the development of other portions ; the decom-
position of the food which forms the first stage of digestion ;
and especially the immediate dependence of the nutrition of any
organ upon its functional activity.

Inflammation indeed stands thus but as an exaggerated instance
of this normal relation of decomposition and growth : it is strictly
correlated to the ordinary processes of life ; and abnormal or
excessive functional or decomposing change, producing a simi-
lar excess of the reparative action. It may seem strange indeed
how so natural an interpretation of the facts should have escap-
ed the sagacity of those observers who have especially noticed
the intimate connexion between functional activity and inflan>

1859.] On the Theory of Inflammation, 115

raation, and who have remarked that excessive function of an
organ leads to or becomes inflammatory action by such continu-
ous gradation that the line cannot be drawn between them.

Inflammation is excessive function, with or without qualita-
tive perversions: common in the absence of such perversions,
specific when they exist. The term " function" is here used to
signify that disintegrating change of which the functional activi-
ty is an indication. In attributing inflammation to an excess
in this respect, nothing is assumed but a known tendency, the
chemical affinities, which may always be presumed to act when
not prevented by opposing force, or absence of the requisite
conditions ; and which are therefore necessarily brought into
play by all that diminishes the perfection of the vital state.
From the operation of these forces all the main phenomena of
inflammation may be traced in a consequent series, and no re-
course is necessary, as upon the hypothesis of a directly increas-
ed vital action, to mysterious, or at least to unknown, powers.

The twofold nature of the processes concerned in inflamma-
tion has been one chief source of the difficulty that has invested
the subject ; these processes not being seen in their true relation,
nor recognised as corresponding, in respect to that relation, to
the healthy life. Two opposite views have been manifested by
different writers, each with great support from observation, yet
each failing to supply a theory of the affection that could be
accepted as complete, or as applicable to all cases. On the one
hand is the theory of " increased action ;" on the other, that of
11 debility," or diminished vital force. Each reposing on one
portion of the phenomena, with an insufficient recognition of the
other, and embarrassed, therefore, instead of aided, by half of
the facts with which it had to deal ; each capable of a most
plausible demonstration, yet leaving in the mind a painful con-
sciousness that the problem was not solved, nor the true nature
of the disease revealed. The old theory of increased action*
demanded as its complement the modern one of debility or di-
minished action; but the latter, though more philosophical, equal-
ly fails to express the whole truth, and had it existed first, would
not less certainly have been supplemented and supplanted by
the one whose place it has usurped. If inflammation be in all
cases merely diminished action, "depression of the vital force,"
what is the distinction between sthenic and asthenic inflamma-
tions? why should stimuli be in some cases useful, in others inju-
rious? Would not the term, diseases of debility," become then
a mere pleonasm, while yet we cannot but feel that it does ex-

* For a most ingenious argument in favour of this view, see a paper by Dr.
Cappie, on the Nature of Inflammation : Edinburgh Medical and Surgical Journal,
No. 81, p. 58.

K.8. VOL. XV. no. II. 9

116 On the Theory of Inflammation. [February,

press an actual and most important distinction between classes
of disease which may be both alike inflammatory? And are
not greater heat, more rapid circulation, a more vivid sensitive-
ness, among the indications of a higher life by which the warm-
blooded animals are elevated above the cold-blooded? Shall
we, to make a theory consistent, permit contradictory interpre-
tations of identical phenomena?

Let me not be misunderstood. I do not deny that inflamma-
tion is, in one sense, always a disease of debility ; that is, its start-
ing-point is an an ti- vital change, it originates in decay ; but it
includes not less an opposite class of actions, the downward pro-
cess generates an upward one ; decomposition adds intensity to
life.

The inflammatory process, then, is an affection primarily duey
as all functional processes are, to a disintegrating change which
generates a formative process that would not else exist. Thus
viewed, inflammation may not only be better understood in
itself, but may be brought into definite and intelligible relations
with a wide circle of kindred phenomena, mutually giving and
receiving light. And first, as to its own nature, it is found to
bear a distinct and decisive character. It may be denned.
The boundary which separates it alike from health and from
other morbid processes is distinct and legible. From health it
is distinguished in this, that it is an excess or perversion of
the functional activity, with its consequences ; the decompo-
sition which is normal in function exceeds in inflammation
that amount which is compatible with the integrity of the
tissues.

And from other local diseases it is clearly marked by these
characteristics, of involving a twofold action, and of starting
from a decomposition. Tumours may present the twofold action
of growth and decay, but the growth in their case has prece-
dence. Hypertrophy presents increased formation only ; atrophy,
diminished formation, and probably diminished energy of de-
composition also. Degeneration properly so called, if agreeing
with inflammation in having increased decomposition for its
starting-point, differs from it in the absence of the vital reaction ;
as also does primary gangrene, though the latter is a cause of
inflammation in the surrounding parts. It seems to me that the
difficulty, on which so much stress has been laid, of indicating
precisely lines of demarcation between inflammation and other
affections, does not exist if the case be rightly conceived. That
various abnormal processes may coexist is true, but there is no
necessary confusion among them. Where a local decomposi-
tion, carried beyond the bounds of the normal functional activity,
has brought in its train an abnormal formative action, in howe-
ver slight a degree, in whatever condition, of the system, or with

1859.] On the Theory of Inflammation. 117

whatever other morbid processes it may be mixed up, there has
been inflammation. The relation of the forms of action con-
cerned in the inflammatory process is well seen in the phenome-
na attending suppuration. For in the formation of pus-cells
there appears to be a true growth ; and we may conceive
that the force arising from the increased decomposition which
has previously been operating upon the solid textures, pro-
ducing in them the heat and redness and swelling which
are characteristic of inflammation, operates after the effusion
partly on the effused fluid. So that while the dynamical pro-
cess remains the same, the "symptoms" begin to subside.

Again, if inflammation start from increased decomposition,
and all exaggeration of the normal proportion of that process
tend to give rise to it, then its extreme frequency is sufficiently
accounted for. It must be that inflammation should result from
every form of irritation, should complicate every other disease,
should arise the more readily the more the vital powers are de-
pressed, should attend all injuries, should affect all structures,
should know no limitations of age or circumstance ; that it should
be, in short, the great disease, and the chief subject of the heal-
ing art. The producing cause of inflammation is one that is in
constant operation ; the tendency to it is involved in the very
existence of a living body. Life is a state of constant tension,
any relaxing of which results of necessity in that excessive de-
composition which initiates the inflamed condition. It needs not
any extraneous agent to sustain it. As is the spark to gunpow-
der, or the electric shock to a mixture of oxygen and hydrogen,
so is its " exciting cause" to inflammation. Take away, or
suspend by any means, the controlling force which holds in
organic relations the elements of the living frame, and that anti-
vital change takes place, that new arrangement approximating
to the inorganic state, which the familiar affinites of those
elements tend always to produce. Thus is inflammation, as it
were, the sword of Damocles suspended over the head of every
living thing. Even as death for ever threatens life ; for inflam-
mation involves a partial dying of the part affected, and the re-
action of the living frame against it.

Thus it conforms itself to the radical idea of a disease ; that of
a defect of life. For it was a fatal objection to the old doctrine
of increased action, that it assumed, as the essence of a disease,
excess of life. All disease deviates from health primarily by de-
fect, it is a sinking, not an elevation ; in so far as any organism
suffers disease, it has approached to death. Yet, in another
sense, there is in inflammation increased action ; it is not a mere
absence of the vital power, as atrophy perhaps, may be, it is
action opposed to it. The organizing process must have been
performed, or inflammation cannot be. It is like the running

118 On the Theory of Inflammation. [February,

down of a watch, which implies that it must first have been
wound up.

But is it true that decomposing actions in the body do originate,
or intensify, actions of an opposite character? or is this only an
apparent, and not a real, relation ? Has this conception so much
basis, in fact, apart from inflammation, that it may legitimately
be used as a guide in the theory of that disease? It is a wide
question that is thus suggested, but it is one that is fairly within
the scope of observation. Virtually, it amounts to this : Is
chemical action one among the forces by which the organizing
processes are instituted and maintained, under the conditions ap-
propriate to them ; or if not itself one of those forces, is it a source
of them ? For this inquiry the way has been perfectly prepared
by the researches which have established the dependence of the
organic state upon the operation of force ab extra. There is
clearly no theoretical or d priori reason that it should not be so.
For chemical force takes its place in the chain of organic forces,
mutually producing and produced. There are no characters
which separate it from the rest, or should forbid it to have its
share in the organizing agency so freely ascribed to the light and
heat with which it is interchangeable, or if the apparent opposi-
tion between chemical and vital processes should be objected, two
observations may be made in reply. First, that heat and light
show themselves in certain aspects opposed to life. Is not heat
unequivocally a determining cause of vital action, yet what is
more destructive of vitality than a temperature raised too high ?
Nay, is not cold itself often an agent invigorating to the vital
process ; yet what is more opposed to life than cold ? And light
too, may operate against vitality. The direct rays of the sun
will paralyse the retina, or passing as it were into heat, when
concentrated with a lens, will burn the textures. Overstimula-
tion by ordinary light injures the eye or withers plants. And
secondly, if chemical action be so directly opposed to vital, as is
implied in the objection, then must the two forms of action be
similar in kind though opposite in direction ; and nothing is
more familiar to us than the production by a given action of an
action opposite to itself. Does not the contraction of a substance
in cooling produce expansion in the substances around, the fall
of one scale of a balance, the elevation of the other ? Is not
every motion in a limited space (if it be not a vacuum) of neces-
sity two equal and opposite motions? What else, in truth, is
the conception of a vibration but that of an action producing
action of an opposite kind ? As when a tense string deflected
from the straight line is let go, its motion towards the central
line reproduce the deflection.

I conclude, therefore, that there is no reason why chemical
change should not have its part with other forms of action in

1859.] On the Theory of Inflammation. 119

determining die operation of the formative force, if observation
afford evidence that it is so ; and in this statement that particu-
lar form of chemical action concerned in the decomposition of
the tissues is of course included.

Now, that chemical change does stand in this relation to the
organizing process is indicated by very numerous facts, of which
those that follow are only examples. The albumen of the seed
partly decomposes with exhalation of carbonic acid, as the em-
bryo germinates; decomposing organic substances are the seats
in which fungi and animalcula are developed ; the increased
organic action produced by light in the leaves of plants is prece-
ded by a decomposition in those leaves,"

In fermentation, the yeast sporule grows while the liquid
decomposes ; and in this case the organic development cannot
be obtained without the decomposition, while the decomposition
may take place, although more slowly, without the organic de-
velopment. To these instances we may add those before alluded
to in respect to the animal body the decomposition which
takes place in the first stage of digestion ; the breaking up of
portions of the substance of the developing embryo (the relation
of which to the development of other parts has been noticed by
Mr. Newport) ; and the part borne by functional activity, which
means active decomposition, in effecting not only the mainte-
nance but the increased nutrition of the organs.

Such facts as these justify us in placing decomposition in
organic tissues among the circumstances which give rise to the
organizing process ; and their force is greatly increased by the
evidence afforded by the phenomena of inflammation itself. For
in this affection, whatever there may be of additional formative
action, points to a primary action of a decomposing character as
its source, the origin of the entire series of inflammatory changes
being always traceable to causes which overthrow the vital
equilibrium and operate injuriously to the organic statef.

For a full appreciation of the bearing of the phenomena of
inflammation on this argument, it only needs to be remembered
that a disturbance of the vital condition, or lowering of the vital
force, is not the inducing a merely passive condition in the part
affected, but that there necessarily arises under those circumstan-
ces an active change, although not a vital one in the strict sense
of the term ; a decomposition of the tissues which the vital condi-
tion warded off and restrained. To diminish vitality is to permit
a change more or less intense in the chemical constitution of the
body. A heavy body sustained by any force, falls and produ-
ces action when that sustaining force is removed or weakened.

* See Draper, On the Forces concerned in the Organization of Plants.

f See especially Mr. Paget's Lectures on Surgicaf Pathology, vol. 1. p. 437.

120 On the Theory of Inflammation. [February,

So after death the body decomposes ; it is in a truly active state,
though not a vital one an active state which can only be pre-
vented by means which operate to forbid the play of the element-
ary affinities within it. Such is the "increased action" in which
inflammation commences ; from such action, all the increase of
the vital energies which may be displayed in its course directly
or indirectly draws its origin.

Still, it may be said, the conception of inflammation as a chain
of effects, commencing with an excess of decomposing action in
the part which is its seat, is unsatisfactory, and that in two res-
pects. First, that the conception of excess or defect is too impal-
pable'and abstract ; the standard to which a reference is implied
is not sufficiently defined. The "normal state," or equilibrium,
itself perpetually oscillates within wide limits, and how can
disease be defined by a reference to health, when health is defi-
nable only by a reference to disease ? And secondly, that the
inflammatory process presents many characters other than those
of quantity, which involve diversities of kind or mode of action,
and cannot be formulated as differences of degree alone.

The first of these objections is more plausible than valid. The
idea of excess or defect is perpetually had recourse to in other
cases, and found not too indefinite even for rigid science. A
watch may go too fast or too slow ; the spring may be elastic in
excess, or in defect. The steam in a boiler may be expansive in
excess, or the resistance be defective. Nor is it true that health
is to be defined only by a reference to disease ; for the functions
and uses of a living body are as definite as those of any me-
chanical contrivance. There is a standard, known by expe-
rience, to which the balanced processes of growth and decay
should conform, and deviations from which of any considerable
amount manifest themselves by precise and definite results.

The second objection has more weight, and indicates another
of the causes that have made the theory of inflammation so dif-
ficult.

The phenomenon is complex, and demands analysis. The
various conditions to which the term is applied refuse to be
brought under any single definition which is not so vague as to
be almost unmeaning, as that of an abnormal nutrition, for ex-
ample. But since all of them in common do present symptoms
which we describe as those of inflammation, it is impossible to
narrow the meaning of the term by limiting the cases to which
it is applied. Only one course is open, but that is the same
which is adopted in all like cases ; the points of agreement,
being abstracted, may receive a common name. Now the points
in which all cases of inflammation agree are those which have
been mentioned, of an increased formative action consequent
upon an increased decay. To these conditions, therefore, the

1859.] On the Theory of Inflammation. 121

name of inflammation should be confined. Whatever other
circumstances whether of abnormal nutrition, or of any other
kind may be present in addition, that name of inflammation
should have no reference to them. Many of them doubtless are
causes of inflammation, such as the morbid diatheses, or poison-
ed states of the blood ; but between them and inflammation
itself no confusion should be allowed. The gouty, or rheuma-
tic, or scrofulous diathesis, may be an " abnormal nutrition"
(perhaps such conditions are better designated by that expres-
sion than inflammation is) ; but as they are perfectly separable
from inflammation, so is inflammation, even when occurring
with them, or as their consequence, perfectly distinguishable
from them. Little progress, 1 venture to submit, can be made
towards clear conceptions on these subjects until this distinction
is recognised, and the different elements of the morbid process
in what are termed specific or unhealthy inflammations are held
apart, and receive their separate investigation. The constitu-
tional morbid condition is one thing; the inflammatory action
is another.

But though the connexion of inflammation with various dis-
eased conditions has embarrassed the interpretation of the phe-
nomena, by leading men to mix together in their thoughts ele-
ments that required to be distinguished, yet it affords an insight,
hardly else to be obtained, into the use and meaning of that pro-
cess in the animal economy. For if the decomposition of the
tissues in inflammation be a source of increase in respect to the
vitalizing action, an immediate utility becomes evident in it. In
diseased conditions of the system, the vital power is depressed ;
in the inflammations to which they give origin there is a source
of increase of the vital power. Certain textures fail in their vital-
ity owing to the defective vitality of the wrhole, and that failure
is attended with chemical processes in them, which generate in
their reaction an increased energy of vitality. In a word, in-
flammation, destructive as it seems, is in one point of view strict-
ly a conservative and remedial process. In respect to the indi-
vidual, it is the sacrifice of a less for a greater good. The bene-
fit of it is often very evident, as when a blister induces healing
of an indolent ulcer, or mechanical irritation the union of old-
standing fractures. It is indeed from such cases as these that
the theory of " increased vital action" draws its chief support ;
for as a fact, such increase is in these cases undeniable. But
though less obviously, yet not less truly, I conceive, is the reac-
tive process in inflammation in every case a salutary, that is, a
saving or restorative process. Thai, we do not see it so, is that
we do not sufficiently perceive the elements involved in the
case. We do not carry our thoughts back to the loss or defect
of the vital power which necessitates it, and to which it stands

122 On the Theory of Inflammation. [February,

in the relation of a remedy or amelioration. Doubtless it is an
evil ; so is a forming callus, or a granulating wound. But these
are less evils than a useless limb or a torpid sore, and so is in-
flammation a less evil than the mere decay and loss which would
be without it. It is ever to be remembered that the symptoms
of increased activity in the inflammatory process can never go
beyond their cause, can never exceed the defect of vitality of
which they are at once the effect and the sign. How violent
soever or injurious in their results, the evil is not in them, but
in that approximation to death for which they are the divinely
appointed and only remedy. True, the results are often disas-
trous, the materials effused in inflamed organs may interfere with
essential functions, or the excitement of the general system may
exhaust the powers. But this is because the loss of vitality has
existed in a great degree, or has effected a texture of primary
importance. An organ that has suffered inflammation is a
damaged organ, but it is a better one than if it had not inflamed :
a constitution may thereby be weakened, but it might otherwise
have sustained a severer injury. So far as is possible, inflamma-
tion restores a life that has been lost : it adds to vitality, not
detracts from it ; loss of vitality is its starting-point, but not its
essence. I do not deny, indeed, that the effects of the inflam-
matory re- action may be injurious, and in a secondary way, as
by mechanical pressure or otherwise, may give rise to evils serious
or even fatal : nor that it may be wise in many cases to seek to
moderate or subdue it. These are questions which experience
must decide ; they do not affect the physiological significance of
the process.

And this aspect of inflammation becomes the more evident
when we view it in relation to the other processes which consti-
tute organic life. I have said it is an exaggeration of the func-
tional activity, and with some of the functions it corresponds
not only in being a decomposition followed by nutritive action,
but also in this, that a certain amount of the force, generated by
the decomposition, is given off from the organic to the inorganic
world. The heat of inflammation answers in this respect to the
mechanical force of muscular contraction. But the function to
which inflammation seems most nearly to approximate is that of
secretion. Almost it appears as if one might speak of it without
violence as a new secretion. To this idea, indeed, Marshall Hall
may perhaps be said to have lent the sanction of his great
authority, adopting the name of " excito-secretory" for inflam-
matory action produced by eccentric irritation, such as dentition,
or the application of cold to the surface. Almost we might
conceive the very same process to be secretion in an organ sup-
plied with ducts, and inflammation in one in which ducts are
not present: the secreting glands to be normally in a state

1859.] On the Theory of Inflammation. 123

which were inflammation in any other organ. Nor is it other-
wise than favorable to this conception, that when the function
of some of the secreting glands is hindered, other parts perform
a compensatory action through the medium of inflammation.
The urea which should pass off by the kidneys may find exit in
the fluid of a pleurisy.

Doubtless, between the processes of inflammation and secre-
tion there are many and important differences, but the question
is whether there be not also an interesting and instructive like-
ness. Not least among such points of likeness may be the vital-
izing, organizing power exerted on the blood by the secreting
glands, or some of them, and this by virtue of retrograde changes
involved in the process of secretion".

So far, secretion and inflammation would agree as an increas-
ed vital action produced by a decomposing change ; in the one
case normal, in the other abnormal, but in both the decomposi-
tion being due to diminution or withdrawal of the controlling
force. And as the natural secretions are rendered necessary by
the normal life, are the results and complements of it, without
which it could not be maintained, so may not specific inflamma-
tions be new secretions rendered necessary by that altered life
which constitutes the morbid diathesis ? As secretion is to life
in the healthy state, so is inflammation to life in disease.

But there are other events in the natural life of various or-
ganisms to which the inflammatory process bears an analogy.
Such are, for example, the reproductive processes of some of the
lowest animals, as excited by cold or injury. Mr. Paget has
remarked respecting the production of organized material in in-
flammation, that it is of large amount, but of the lowest grade.
Now a large amount of material of the lowest organization is
produced in the gemmation of the polypes, which we know to
result from some of the causes which give rise to inflammation
in the higher animals. Does not inflammatory new production
answer to an abortive gemmation ? Especially does this appear
when we extend our consideration to the case of repair, for be-
tween the gemmation of a hydra when wounded, and the granu-
lation of a wound in man, is there not an obvious parallel?

Nor can I pass from this subject without again adverting to
the phenommna of embryonic development. When we see one
portion of the germ deliquescing and other portions developing,
as if at their expense, can we avoid recognising in it a similari-

* See Bernard's Experiments on the Effect of Secretion in rendering the Blood
red instead of black as it issues from the Glands. The physiological doctrine,
however, is entirely independent of these experiments. Dr.Prout says of excre-
tion, "this function operates by denuding the matters excreted of their vitality
which is retained, and separating the excrementitious matters in the form of com-
mon chemical compounds."

124 On the Theory of Inflammation. [February,

ty to that which is the essential part in inflammation ? Is it not
as if, in inflammation, the system, under the pressure of adverse
circumstances, threw itself back, as it were, upon the mode of
existence proper to the embryo ? As if, to retain as much as
possible of perfectness under conditions threatening to destroy
it, the law of its first formation came again into operation? The
process which develops the life of the germ comes in to remedy
defect of life in the completed animal. Not, indeed, by any
special alteration of the laws of its being, but by the operation
of the universal conditions of organic existence. For the pro-
cesses of life in germ and adult are the same ; different to our
imperfect view they may appear, but the essential identity is
made manifest in disease. The generation of life from death,
organization from decay, striking to sense in germ-life and in
inflammation-life, is patent to the reason equally in the life of
maturity and health. It is the law of life. No new thing is
presented to us in inflammation. The embryonic powers come
forth in disease to meet the hostile agencies, only because they
are at work unseen in all the operations of the vital force*.

And if inflammation be thus parallel to the processes of health,
no less may its relation be seen to other morbid conditions. Of
these it may suffice to select for the comparison the class of
tumours. Differing in all other respects, these two diseases ap-
pear to possess in common but the one element of increased for-
mation, yet, if what has been advanced respecting inflammation
be well grounded, it affords a sufficient basis for the establish-
ment of an intimate connexion between them. For if the increas-
ed formation in inflammation has its origin in increased decom-
position, the same, it would appear, must be the case with tu-
mours. Let it only be granted that such an origin is possible,
and the evidence in favor of it is abundant. If all the known
causes of adventitious growths be analysed, they will be found
to correspond very closely to those of inflammation. They are
causes of irritation, things that operate antagonistically to the
vital power. Whether local or general, they have this character
in common. How often the development of a tumour follows a
blow, for example. It has indeed been frequently remarked

* Dr. W. Addison has observed the resemblance of the morphological condi-
tions in inflammation to those of the embryonic state. (On Healthy and Diseased
Structure, <fec). If it should occur to any one as an objection to this view, that
by inflammation the vital integrity is lowered and not elevated, it will be suffi-
cient to remind him that an injury to, and loss of, the vital integrity, is the sole
occasion of inflammation. The inflammatory action seldom or never wholly re-
pairs this loss, but its tendency is in that direction. Such repair is its object, its
final cause or use in respect to the organic body. A man is not ill because he
has an inflammation, but he has an inflammation because he is ill or injured. In
reference to this view of the subject I have been greatly benefited by the perusal
of an unpublished paper, entitled ' The Philosophy of Disease.'

1859.] On Hie Theory of Inflammation. 125

that it appears almost a matter of accident whether a given injury
shall produce an inflammation or a tumour. All the evidence,
therefore, which assigns an anti- vital stalling point for inflam-
mation, applies with equal force to tumours. Nor does the in-
creased formation in the one case furnish any opposing evidence
that would not bear equally upon the other. The distinction,
then, between tumours and inflammation is not that the one dis-
ease is primarily of the formative process, the other of the de-
composition. In this respect they do but appear to differ.
They are both increased formation, due to increased decomposi-
tion ; that is, to a diminution of the control maintained in the
living state over the chemical affmites existing in the body.
But they differ in the extent and intensity of this decomposing
process ; in inflammation it amounts to a true destruction, in part
of the vital condition, with a giving off of force to the inorgan-
ic world ; in tumours it produces only an increased local activi-
ty of the organizing process. So far these affections resemble
each other; they have this dynamical correspondence. But
into other questions relating to tumours, of course I do not enter.
A condition that appears like a gradation between inflammation
properly so called, and the growth of a tumour, may be seen in
the increased formation of bone from chronic inflammation *

It remains to consider the particular symptoms and termina-
tions of inflammation, in so far as they bear upon the view sug-
gested of its nature. But of these it is not necessary to speak at
length. For, in the first place, the insufficiency of microscopic
observations to furnish any clue to the essential character of the
inflammatory process has been proved, and indeed admitted,
long ago. Opposite theories dispose of them equally well, and
the most minute investigations respecting them do plainly leave
us entirely in the dark. In truth, these phenomena are to be
interpreted by a sound theory derived from other and more
appropriate facts, and not the theory to be framed on supposi-
tions about the meaning of these phenomena. Yery important
and suggestive it is to know the particulars respecting contrac-
tion or dilatation of the arteries, the stasis of the blood, the aggre-
gation of the corpuscles, and the nervous or other conditions
associated with these, when we know to what essential changes,
as respects the forces concerned in the life of the organism, they
are to be referred. But we may gaze on such appearances for
ever, and remain merely in blind wonder, or blinder theories
of mechanical obstruction, paralysis, or mysteriously altered
qualities. This is but a caricature of science.

f As indicative of the close connexion which has been felt to exist between in-
flammation and tumours, I may refer to Mr. Simon's representation of malignant
disease as an excretory process a "new secretion," we might say, the very con-
ception which has suggested itself so strongly in respect tomflamraation.

126 On the Theory of Inflammation. [February,

And it is also undesirable to say much about these local phe-
nomena, because we know so little. It is almost impossible to
attempt to explain them without assumptions which go beyond
our knowledge, and therefore, without creating hypotheses which
are neither necessary nor useful. To me it seems sufficient to
say at present that, under given circumstances, such conditions
of the vessels and the blood have been observed. The facts
must be valuable, but as yet they are not available for use.
This, however, we know, that neither any state of the vessels,
nor of the nervous system, can be primary or even essential
elements in the inflammatory process. For a condition identi-
cal with inflammation occurs in plants. What else is the " in-
creased formation" occasioned by the deposition in them of the
larvse of insects ? The same cause which in the leaves of plants
occasions swelling, hardness, and excessive formation of abnor-
mal structure, produces in the animal textures heat, redness,
swelling, pain, and the formation in excess of lowly organized
tissue. Would it not be unreasonable to refuse to recognise iden-
tity of condition ? In the plant, then, we see inflammation in
its purest and simplest form, and so understand at once the
secondary part which must belong to any changes affecting
the specifically animal structures.

But if the conditions of the circulation be of little moment in
respect to the essential nature of inflammation, they are of the
greatest importance in respect to its progress and terminations.
Constriction or dilatation of the vessels, stagnation or altered
qualities of the blood, merely consequences though they be of
dynamical changes wholly independent of them, may neverthe-
less be the chief agents in determining the course and results of
the inflammatory process. The accumulation and stagnation of
the blood in a part may be a cause of sloughing or of gangrene ;
its excess, with or without co-existent alterations in its quality,
may prevent the restoration of the normal vitality, or may give
rise to effusions of various kinds. So it may become a matter prac-
tically of the utmost importance, to control or remove the accumu-
lation of blood in an inflamed organ. The issue of life or death
may depend on it. But these therapeutical questions are so far
distinct from that which has been the subject of this paper, that
they are better treated independently. I would remark only,
that if inflammation be, as I have sought to show, a two-fold pro-
cess of increased decomposition and increased formation, having
its scource in" a diminution of the vital control over the coerced
chemical affinities in the living textures, a general conception
of the appropriate treatment is easily deducible therefrom. If
it be possible, let the vital power be restored, and the suspended
control reinstated ; all our efforts should be directed most stren-
uously to this end, to prevent or diminish that failure of the

1859.] On the Theory of Inflammation, 127

vital tension from which the active symptoms of inflammation
spring. But if this be not possible, then let the resulting changes
be so regulated as may be best adapted to conserve at once the
sufferers general strength and the integrity of the affected organ.
If the action be threatening from its violence, let those means
be adopted which check decomposition or divert the flow of blood.
But ever and above all, let two things be remembered : first, that
the process of inflammation, as it meets our view, is not wholly an
evil; that the formative process in it is the witness of, and the
remedy for, an injury to the system unseen and too often un-
thought of by us. If we could remove all these symptoms,
there would still remain that condition which has necessitated
them ; a worse evil, a more serious disease, in combatting which
we should have deprived ourselves of our only ally, in having
set aside Nature's only remedy. There would still remain that
diminution and loss of vital power which no art of ours could
then supply : a death in life from which we might well
shrink in impotent dismay. Let it be remembered ever, that
where the cause of inflammation in failing vitality exists, there
inflammation will be. No power of ours can prevent it, nor could
it be anything but most disastrous if it did. All her resources,
all her life, will nature pour into the gulf of local inflammation
rather than suffer the deteriorated organ to fail of its support.
The quick sympathy compels all the living powers to that work,
and sooner should the veins be drained of blood, and the most
vital functions droop and fail, than the weakened member not
receive its larger share.

And scondly: In cases of constitutional inflammation the
morbid condition of the system is a cause continually operating
to produce that lowered vitality on which the symptoms of
inflammation depend, and the removal of that diseased state is the
means whereby those symptoms must be averted.

In conclusion, I remark that inflammation is rightly enough
represented as an altered nutrition. I have endeavored not to
controvert this view, but only to add somewhat to its definite-
ness and value. As a formative or vital process, dependent on
a decomposing or chemical one, it corresponds to the clearest
conception of nutrition that we can gather from the phenomena
of life in all its forms. Inflammation is the same process that
constitutes all nutrition, but taking place under conditions other
than those which are natural to, or best for, the individual or-
ganism in which it is excited. As an abnormal nutrition, it not
only is illustrated by the other phenomena of life, but serves
also to illustrate them. The process of nutrition receives eluci-
dation from the comparison as well as gives it. For that which
is found to be the essential character of inflammation, must be
not less essentially the character of nutrition. This is perhaps

128 Narcotic Injections in Neuralgia, [February,

the advantage that results from the establishment of the parallel
between them, that all the knowledge which is obtained by a
study of the phenomena of inflammation, more definite and sus-
ceptible of rigorous investigation as they are, may receive a
direct application to the more extensive and difficult problem
of nutrition. [Brit, and For. Med. Ghir. Review.

Narcotic Injections in Neuralgia.

Chas. Hunter, Esq., House Surgeon to St. George's Hospital,
records {Med. Times and Gaz., Oct. 16th) the following cases of
neuralgia treated by narcotic injection into the part, as proposed
by Dr. A. Wood, of Edinburgh.

Case I. J. G., aged 55, was admitted into St. George's Hos-
pital, July 21, under Dr. Pitman, with tic douloureux. He had
been constantly subject to it for four years, with but little inter-
mission ; at one time he obtained for a few weeks from seven to
eight hours' sleep at night, but with that exception he used
-always to be in pain day and night, and seldom slept an hour
without a violent paroxysm.

On admission, he was suffering these repeated violent attacks
of pain all over the left side of the face, which caused him day
and night to keep up a cry of anguish. Various remedies to
palliate the pain were attempted, but unsuccessfully till the 7th
of August, when the local injection of morphia was commenced.
About one grain and one- third of the acetate of morphia was
injected at 8 P. M. ; the man fell asleep very soon after, and
continued to do so for seven hours. During the next few nights
the same dose was regularly injected, and he slept either all
night or for several hours.

On the 11th, he was asleep when visited, so no more morphia
was injected ; he, however, slept two hours ; the next few nights
the injection was not given; he slept either not at all, or most
indifferently.

16th. A larger dose was injected into the cheek from within
the mouth ; he went off to sleep at once, and did not awake all
night ; he was also easy the whole of the next day ; after this
the original dose was continued, both night and morning.

20th. He sleeps a good deal ; has good nights, and two or
three hours' sleep in the day. The paroxysms are now so slight,
that often no one except the patient can tell when they are on ;
no continued pain is felt, and the paroxysms are " sometimes off
for half a day, often for several hours."

30th. Until to-day the morphia has been injected night and
morning; but for the present the administration is left off on
account of a considerable sized abscess which has been gradually
forming the last few days, and which was opened to-day.

1859.] Narcotic Injections in Neuralgia. 129

The part injected was the gum over a back upper tooth, as
that was the most painful part, and the spot which, if touched,
always brought on a paroxysm; latterly, the adjacent tissue of
the cheek was injected close to the gum.

Thus, not only was sleep procured, but the patient obtained
considerable ease during the day while the injection was gone
on with. The constant recurrence of the attack of pain was put
an end to, and the paroxysms, when they did occur, were far
milder ; but a large abscess formed in the cheek.

Case II. E. P., aged 18, was admitted into St. George's
Hospital, July 25, under Dr. Tatum, suffering from excessive
neuralgia in the right eye, which was also extensively diseased.
As there were no hopes of saving the eye, and the pain was con-
stant, the globe was removed for fear the other eye should also
suffer ; unfortunately it did, and ran a most rapid course the
lids becoming swollen, hard, thick, and everted; the neuralgia
in this eye became even worse than it had been in the other.

All kinds of remedies were tried aconite, morphia, hyoscy-
amus, opium, quinia, etc., all failed to give relief; chloroform
was then used, and frequently, but it only gave her ease and
sleep for a few minutes, or at the most an hour or so.

Sept. 9. | gr. of morphia (the acetate) was injected under chlo-
roform into the eyelid, but produced no sleep, as sickness (which
had commenced in the afternoon after a dose of morphia by the
stomach) continued during the night.

10th. No morphia given by the stomach, 1\ gr. injected un-
der chloroform into the eyelid ; she went off to sleep for seven
hours continuously, which she had not done for some months.
She slept also once or twice the next day without chloroform.

11th. Injection repeated 10 P.M.; a part escaped; she slept
four hours ; had acute paroxysms between the periods of sleep.

12th. Sleep produced by the injection, and the severity of the
paroxysms much diminished.

In the next few days the morphia was injected, and gave ease
and sleep in proportion to the amount injected; from this time
no chloroform was employed while inserting the point of the
syringe in the skin.

16th. Slept four hours last night. The pain now is nothing
to be compared to what it previously was, the swelling is going
from the eye. In the evening nearly three grains of morphia
were injected; sleep was immediately produced, and continued
eight hours. The next day she was far quieter and easier, and
appeared so comfortable at night that no morphia was injected.

18th. No morphia having been injected, no sleep was obtain-
ed last night, although a six-hour dose (gr. i.) was continued to
be administered by the stomach.

19th. l gr. injected into the eyebrow, gave sleep for several

130 Narcotic Injections in Neuralgia. February,

hours at night, and a little in the day ; at night two grains were
given by the stomach ; it gave no sleep, but after an hour or so
caused considerable sickness.

Oct. 4th. The morphia injection is still continued, and with
considerable relief to the patient.

Remarks. In this patient, then, it appears:

1. That a very great change has been made for the better, the
progress of the affection appears arrested ; or, at all events, for
the present kept at bay ; the health of the patient is improved.

2. That the local affection appears so far improved, that all
the hardness, thickness, and eversion of the conjunctiva have
subsided ; the pain in the head is very much less, the pain in
the eye is far less acute, and the attacks much less frequent, so
that sleep is every now and then obtained during the day with-
out medicine.

3. But it must be observed that this girl, like the man, has
had abscess as a result of the local injection ; the eyelid, the eye-
brow, and the side of the eye, have all been opened for the lib-
eration of matter.

4. It is very interesting to observe, that in this girl the injec-
tion of morphia into the cellular tissue was most effectual ; but
that morphia given by the stomach was of no benefit at all, but
always did harm ; that general irritation to the nervous system
was produced ; that sleep hardly ever followed, and was then
probably accidental, because so seldom, but that sickness, nausea,
giddiness, etc., almost always accompanied its administration by
the stomach, whatever the strength of the dose happened to be.

In considering the results of the trial of the local treatment in
the two cases, the advantages obtained appear to me to be

1. That much less constitutional (nervous) irritation attends
the local introduction of the narcotic than when it is given by
the stomach.

2. That the effect of the narcotic is more immediately pro-
duced.

3. The action of the narcotic appears more sure when injected.
The exact amount taken into the circulation can be more read-
ily seen, and the risk of contamination or alteration which it is
exposed to, given by the stomach, is avoided.

4. It appears to exert more benefit on the local affection
when it has to be absorbed from the part affected itself, probably
from being brought more directly into contact with the nerves
involved in the disease.

On the other hand, there are the disadvantages ; these ^re
chiefly

1. The pain occasioned by the introduction of the fine ca^ula.

2. The chance of the fluid escaping from the wound or punc-
ture.

1859.] Pathology of Rheumatism. 131

3. The production of local inflammation, effusion of blood,
abscess.

To conclude : are the disadvantages of such import that they
ought to preclude the local employment of narcotics by injec-
tion? do the advantages preponderate over them? I think
they do ; and that the disadvantages are only those which, with
care and experience, may either be avoided, or much diminish-
ed; for instance 1. By employing such a syringe as that used
for the perchloride of iron (to inject aneurisms, etc.), with a very
fine point to the nozzle, the pain is not more than that occasion-
ed by the prick of a needle. 2. By having the injecting tube
no larger than that of such fine syringes, the puncture in the
integument is so small that the fluid does not escape. 3. With
regard to the formation of abscess; it is only, for the most part,
after repeated injections have been made in one place that such
happens. One great thing then to avoid it is, to vary as much
as possible the exact site to be injected, still injecting in the
painful part, or to cease injecting for a time. The necessarily
acid state of the solution of the morphia (for it must be strong),
is certainly another disadvantage ; but as irritation to the inte-
gument appears produced, as little acid as possible ought to be
employed, and any excess in the solution neutralized by potash.
These inconveniences being obviated as much as possible by the
means pointed out, I think such advantages as the more rapid
introduction of the remedy into the system, the avoidance of
constitutional (especially nervous) irritation, the greater certain-
ty of the effect, and the more concentrated effect of the remedy
on the painful part ought not to hinder the local treatment of
neuralgia from having a fair trial. [Am. Jour. Med. Sciences.

Pathology of Rheumatism.

Dr. Francis T. Bond analyzes {Midland Quarterly Journal,
April and July, 1858) the prevailing doctrines regarding the
intimate nature of rheumatism, and objects, with regard to the
lactic-acid theory, which may be said to be the one most gene-
rally prevailing at present : 1. That lactic acid has not been
shown to be in excess in the blood of rheumatic patients ; 2.
That, even supposing it to be present in excess, it would be
difficult to trace the connection between this circumstance and
the exudations in and about the different fibrous structures of
the body ; 3. That other acids being in excess in the secretions,
and therefore possibly in the blood, they may be as much the
cause of the phenomena as lactic acid ; 4. That, in regard to the
theory attributing the disease to suppression of the cutaneous
excretions, it is doubtful whether it is preceded by greater sup-

N. 8. VOL. XV. NO. II. 10

132 Pathology of Rheumatism. [February,

pression than the prodromata of all inflammatory diseases bring
with them ; and, 5. That the extreme tendency to sweating
which occurs during an acute attack of the disease may be much
better explained by another theory.

In order to establish a theory of rheumatism, Dr. Bond next
analyzes the phenomena of the disease, and finds that fatigue,
exnosure to cold, mental emotions, or some other depressing
agent, exercise a paramount influence in its production; febrile
symptoms making their first appearance, followed by local af-
fections in some fibrous tissue. A hyperinotic condition of the
blood exists from the first, and the excessive fibrin having a
special affinity for the fibrous structure, is specially deposited in
and about them; hence the joints and the valves of the heart
become the chief seats of the local affection. The preference
shown in different cases for particular joints depends upon their
greater weakness, or upon their labouring under some abnormal
condition, upon the principle enunciated by Mr. Paget, that the
depressed nutrition of a joint makes it more liable than any
other part to be the seat of inflammation excited by the diseased
blood. Dr. Bond's theory, then, reverses the order in which
the different constituents of the diseases are commonly supposed
to stand. Instead of regarding the hyperinosis merely as an
effect of the reaction of the local disease, upon the system at
large, he considers it to be the primary source of the exudation,
the causative agent of the latter, without which it could never
exist. The increase in the urinary and cutaneous secretions,
and the greater amount af urea, uric acid, lactic, phosphoric,
and other acids in them, the author attributes to the metamor-
phosis of the fibrin ; these substances being the products of the
degradation of fibrinous matter, " the relations of urea and uric
acid to highly nitrogenized matters as exhibited by the expe-
riments of Lehmann, by the recent manufacture of urea by ox-
idizing albuminous substances by M. Bechamp, and by the
general excess of these excreta in the hyperinotic states of the
blood, combined with that of lactic acid, to the muscular juice
as determined by the researches of Liebig amply corroborate
this statement as far as these three bodies are concerned; the
others, from the smallness of their amount, may be put out of
consideration."

Dr. Bond considers the sources of an excess of fibrin in the
system to fall under three heads : 1. As a result of imperfect
primary assimilation; 2. As a result of a metamorphic process,
normal in nature, but extreme in amount; 3. As a result of
defective elimination of the fibrin by the excretory processes
provided for the purpose.

Having said thus much, we must refer our readers for the
conclusions which the author draws as to treatment to the

1859.] Dislocation of the Cervical Vertebra. 133

paper itself; we will merely add that his theory possesses a
great resemblance to that propounded by Mr. Toynbee, a short
time back, at the Medico-Chirurgical Society, shortly after the
publication of the first part of Dr. Bond's paper. [Brit. & For.
Med. Chir. Rev., and Am. Jour. Med. Sci.

Dislocation of Hie Fourth and Fifth Cervical Vertebrae.

Dr. W. M. Ryer records {Pacific Med. & Surg. Jour., Sept. 1858)
a case of this rare accident. The subject of it was a girl seven
years of age, of lymphatic constitution, the daughter of Dr. Hep-
burn, of Mokelumne Hill. When seen by Dr. R, the patient's
head u was most singularly and immovably fixed, much bent to
the side, the ear approximating but little in advance of the right
shoulder, and in a position no child in a normal condition could
for a moment assume ; the slightest motion tending to change
the relative position of the head and body producing intense
pain.

"The father, Dr. Hepburn, an aged and very intelligent
practitioner of medicine, had watched the child with a parent's
solicitude for the six previous days and nights, and neither dur-
ing sleeping or waking did the child move its head from the
position it had assumed from the instant of the accident. As
the right clavicle was fractured at the time, the doctor was in-
clined at first to believe the child was favouring the fracture
and was unwilling to entertain the unpleasant thought of so
serious a complication as luxation of the spine.

u The child had fallen six days previous to my visit, from a
high bed, and is supposed to have struck the back and left side
of her head. The father saw her within a half minute after,
and found her head and neck distorted precisely as at the time
of my examination; there had been no change for six davs.
Such distortion, I believed, must have arisen from muscular
contraction or bony displacement. We examined every muscle
whose contraction would be likely to produce the deformity,
and found them loose, soft, and uncontracted. Upon tracing
the spinous processes from below to the articulation of the
fourth and fifth cervical vertebrae we found them form, at this
point, an obtuse angle, and depart from the natural direction
about forty degrees. The intellectual faculties were good, and
sensation and motion not greatly impaired. I could form no
other diagnosis than was formed by the medical gentlemen in
attendance previous to my visit. It was clearly a dislocation of
the left oblique articulating process the process of the fourth
riding over the upper margin of the one with which it was arti-
culated below.

134 Ether in Midwifery. [February ,

" As objections were made to the administration of chloroform,
we attempted the reduction without it, and failed. We then
administered this anaesthetic and succeeded to our fullest anti-
cipations, Dr. Sober, and other gentlemen who assisted, distinct-
ly recognizing the instant of time when the reduction was
effected. The child immediately had full motion of her head
and neck, and is now entirely recovered." [Am. Jr. Med. Sci.

The Extent to which Ether should be used in Midwifery.

In a discussion on this subject at a late meeting of the Norfolk
District Med. Soc. (Mass.), Dr. Cotting of Koxbury, gave the fol-
lowing as the result of his experience :

" In our own individual experience in several hundred cases
of normal labour, we have been led to observe that only a very
few patients were capable of taking just that amount which
would deaden the acuteness of the suffering without at the same
time diminishing the frequency and effectiveness of the uterine
contractions* that generally, as suspension of consciousness
approached, there was a marked and proportionally complete
suspension of the expulsative efforts that, with the greatest care
possible under the circumstances, there was frequently more or
less irritation of the air- passages ; often troublesome coughing ;
sometimes nausea and vomiting, attributable directly to the
anaesthetic; also, occasionally strong tendencies to hysterical
manifestations, which sometimes continued after the labor was
over ; with other minor inconveniences, such as unwonted im-
patience, jactitation, &c, &c; so, also, instances, not a few, of
subsequent retention of urine; as well as post-partum hemor-
rhage from imperfect uterine contraction, apparently due to the
same agent that, although something was apparently gained
by the occasionally greater relaxation of the organs, the duration
of these labours was unmistakably longer than those of a similar
character in which an anaesthetic was not used ; and, in generaly
there seemed to be greater subsequent debility, and a slower get-
ting up than was to have been expected that we have never
witnessed any undoubted evidence of subsequent permanent
injury to the life or health of the mother or child arising from
the use of ether during labour.

" In abnormal cases from a considerable experience in all
the various operations from podalic version to craniotomy and
other disintegration of the foetus, both before and since the dis-
covery of these anaesthetics our conclusion is that while the
judicious use of ether immeasurably increases the ease, certainty
and effectiveness of obstetric operations, the insensibility of the
patient, when desirable, and her comparative safety, are bene-

*This is our experience. [Edts. s. m. &. s j.

1859.] Ether in Midwifery. 135

fits to be obtained through its administration whose value is be-
yond all estimation.

"In puerperal convulsions, whether identical with uraemia,
according to the latest theory, or otherwise, anaesthetics during
the paroxysms seem to be supplanting what but yesterday was
considered the only orthodox practice. The convulsions seemed
to be completely controlled by the use of these agents in the
few cases in which we have had occasion to administer them.

"Such has been our private experience. TVe do not know
that it is at variance with that of any observant practitioner.
Whatever suggestions we may have gained from the reports and
practice of others, it is not improper to say that we here advance
nothing practical which has not been confirmed by personal
observation, the results of which alone are suited to this occasion
and the object of the present discussion.

" Bearing in mind, then, that the great object of our art is the
diminution of human suffering ; and that in the economy of nature
the pains of parturition may have some ultimate beneficial pur-
pose ; and further that, as sufficient time has not yet elapsed
since the discovery of the anaesthetic powers of these agents to
fully disclose all the consequent effects of their administration,
much must be left in each individual case to the intelligence,
judgement and tact of the medical attendant bearing all this
in mind, we conclude with the following generalizations :

" I. That in ordinary cases of midwifery, while ether may be
allowed in moderation when importunately demanded by the
patient, it is quite as well in the long run, to say the least, to let
normal, uncomplicated labours proceed uninterfered with.

" II. That in painful, laborious, or complicated labour, and
in cases of great tenderness or great rigidity of the organs, of
extraordinary susceptibility to pain, and where there is great
nervous irritability, or undue apprehension of danger, ether, if
favourably received, should be used to the extent of overcoming
the abnormal condition and suffering.

" III. That in cases requiring manual or instrumental inter-
ference, ether should be used to the same extent, and upon the
same general principles as in other operations involving pain
and danger to the patient.

" IY. That in puerperal convulsions, especially in those hav-
ing the characteristics of uraernic eclampsia, ether should be given
as soon as there are indications of an approaching fit, and be
continued, if seemingly efficacious, until the paroxysm has sub-
sided and quiet sleep is induced ; or until other medicine, if
desirable, can be swallowed care being taken to allow a suffi-
ciently large quantity of pure air, and not to continue the ether
if coma supervene.

" V. That all the volatile anaesthetics yet tried, except ether,

136 On Black or Blue Coloration of the Skin. [February,

have been known to cause severe accidents, and even instant
death, though given with the greatest care by experienced prac-
titioners, and this, too, before any considerable quantity had
been inhaled; ether only sho aid be used as an anaesthetic in
midwifery. Ether, likewise, should be administered with the
greatest caution, so that the safety of the patient may not be
unnecessarily put at hazard." [Boston Med. & Surg. Jour.

On a peculiar Black or Blue partial Coloration of the Skin, which
is sometimes observed in Women, particularly round the Eyelids.
By Leroy De Mericourt.

Besides the four cases of this singular affection described by
Neligan, M. quotes one case described by Yonge in 1709. She
was a girl of 16, native of Portsmouth, never menstruated, and
black coloration gradually disappeared in six months ; and ano-
ther described by Billard in 1813, also a girl of 16, whose face,
neck, and upper part of the breast, particularly the brow, alae
nasi, and round the mouth, presented a beautiful blue color,
which could be wiped off with a towel, and colored the white
linen. She had menstruated regularly for two years; and from
that date had observed the blue coloration round her eyes, which
disappeared in the open air, but speedily returned, so soon as
she began to work in a warm close room. After a year, the
blue coloration spread over her face, neek, and belly, and no
longer disappeared in the open air. Subject to a dry cough,
she occasionally expectorated a little blood, especially about her
menstrual period, after this had passed, accompanied by vomit-
ing and expectoration of blood ; she was paler, breathed more
freely, and the blue coloration was almost gone ; increased heat
and vascular excitement brought out the color stronger ; the
blue color was tested by various re-agents; and as amongst
those which neutralized the colour, bicarbonate of soda seemed
the least hurtful, it was given internally and in twelve days the
coloration was once more restricted to the circumference of the
eye, the brow, and the alae nasi. M. has himself observed in
Brest no fewer than five cases ; the first three he relates summa-
rily, as they occurred some years^ago, and the phenomena were
incompletely manifested. The respective individuals were from
seventeen to twenty years of age, previous health in two of
them normal, in the third dysmenorrhea, hysteria, and megrim
co- existed. Twice the dark coloration came on, after sudden
suppression of the menses. In one case, fainting, headache,
palpitation, and oppressed breathing, were the immediate results
of the suppression, the coloration beginning two days subse-
quently on the upper and lower eyelids, other dark stains like-
wise making their appearance on various parts of the body.

1859.] On Black or Blue Coloration of the Skin. 137

The dark color was paler in the morning, and became darker
after exposure to any excitement or high temperature. Aiter
two years her catamenia recurred; the dark color, how
remained, withstanding the effects of marriage and several con-
finements, experiencing, however, a perceptible diminution
during lactation. Since then the color has become markedly
paler, although the menses are still incomplete. In the second
case, there was also markedly less color in the morning, which
could also at such times be partly wiped off, but speedily recur-
red; in this case, as well as in the third, the color remained
during pregnancy. The fourth case was a newly married
woman; aged twenty-two, who first menstruated in her seven-
teenth year, and a year after, while menstruating, fell into the
water up to her waist, whereby the menses were suddenly sup-
pressed, and she was seized with headache, palpitation, oppres-
sed breathing, and colic pains, and also expectorated blood
several times. Four days subsequently, she remarked a dark
coloration of the lower lids, which speedily increased in extent
and intensit}7. Four months after the menses recurred, the black
color remaining, however, much the same, paler in the morn-
ing, more remarkable after excitement or exposure to high tem-
perature ; lately, however, it has become much less. The fifth
case was a brunette child's maid, aged twenty, who menstrua-
ted first at seventeen, and had been hitherto in good health.
About two months ago, three days after normal menstruation,
she remarked a dull blue coloration of both lowrer eyelids, which
had next day assumed a darker tint, like china ink, and extend-
ing down the cheeks. Examination with a magnifiing glass
showed that, as in Neligan's case, the coloration depended on a
multitude of dark points, wiping with a towel stained the latter;
but neither wiping nor washing sufficed to remove the color.
This coloration, according to M., consists in a pigment deposit
on the surface of the epidermis. Neligan and Hebra have sup-
posed, from the punctated appearance of the coloration, that
its seat was in the sebaceous follicles. M. rejects this, because
any connection between menstruation and these follicles is un-
known, while pigmentation stands in acknowledged relation
to many uterine conditions, as pregnancy for example. M. par-
ticularly refers to the evanescence and mutability of the colora-
tion in several cases as incompatible writh this theory of its origin,
and without speaking positively, seems to regard the punctated
appearance as more probably depending on pigmental alterations
of the openings of the perspiratory ducts. The eyelids are the
chief seat of this coloration, partly because of the fineness of
their integuments, partly because of the acknowledged
thy of the eye with the sexual organs. M. considers that Neli-
gan's definite, " Stearrhcea nigricans" is erroneous and prema-

138 Broth and Beef- Tea. [February,

ture, and that a circumlocutory title is to be preferred, until more
is known regarding the nature of the affection. From the ten
cases already described, M. draws the following conclusions :
Etiology. The individuals affected were from sixteen to twenty-
two years old ; two were sixteen ; eight had not yet menstrua-
ted ; the disease always commenced in the unmarried state. In
eight cases there were either dysmenorrhcea or amenorrhcea;
only in one case was menstruation unaffected ; thrice there was
sudden suppression of the menses (twice after exposure to cold,
once after mental excitement). Nine cases occurred in towns
situate near the sea, five of these in Brest. Two patients were
of fair complexion (Blondinen). The eruption of the disease
was usually sudden, yet it always took some days to reach its
height. The shortest duration of the disease has been three
months ; another case has already lasted seven years. In tedious
cases, the coloration endures in spite of the return of the menses,
or parturition itself, though both bring about variations in it.
In one case nursing was beneficial. Its disappearance was never
sudden, always gradual. The therapeutics must always have
respect to the apparent prime cause, anormal menstruation ; the
due regulation of that is sometimes followed by disappearance
of the coloration, always by a diminution of its tint. [Archives
Generates, and American Jour, of Med. Sciences.

Broth and Beef Tea. By Dr. J. B. Hicks, London.

I have ventured to occupy a few lines with a description of
an apparatus, constructed to my directions, for making broth
and beef-tea, &c, which, though simple, possesses what is I be-
lieve a desideratum for the invalid, namely, the property of pro-
ducing broth

1. Free from fat,

2. Free from smoky flavour,

3. Eeady for use five minutes after removal from fire.
Every one knows how disagreeable to a delicate appetite, or

a sickly stomach, is the smallest amount of fat floating on broths,
and how annoying it is to the medical attendant to be told on
inquiry in a case of urgency, that the patient had refused the
broth ordered, in consequence of grease or smoke, or that he
had to wait some hours for the fat to cool before^removal.

The apparatus consists of two tinned vessels, one fitting
loosely into the other. The outer is furnished with a small stop-
cock set flush with the bottom. There are three small knobs
about a quarter of an inch, soldered beneath, to keep it off the
saucepan, and allow water to flow under ; also a wire handle,
and covered like a small milk-can. The latter has a small hole
in centre to allow steam to escape, and is slightly convex to

1859.] Delirium Tremens Treated luith Chloroform. 139

throw oft' the wet. The inner vessel is perforated at the bottom,
and has on its rim a small projection for the ringer to draw it
easily out. In using it, place the one in the other, till the inner
with the meat, pour in cold water, cover over and place in a
saucepan which has been partly filled with cold water ; cover
that over ; gently simmer for four or five hours. When done
withdraw the apparatus from the saucepan, uncover and draw
out the inner vessel containing the exhausted meat, press out
the broth it retains into the outer vessel, which now contains
the fatty broth. "Wait five minutes to allow the fat to rise to
the surface, then draw off the broth by the tap, shutting it off
just before the fat is about to come, when it must be stopped.
The broth will be found to be perfectly free from fat or smoke.
Should fat have accidentally escaped, return the whole to the
vessel, wait five minutes, and draw off again. A glance at the
apparatus will show its principle, and it is not so troublesome as
the jar inside the saucepan. I send a section of it. I have used
one constantly at home, and all who possess them speak highly
of their certainty and convenience. [Med. Times and Gazette.

Delirium Tremens Treated with Chloroform. Under the care of
Dr. P. Fraser, at the London Hospital.

B. Gr., aged 32, a japanner by trade, residing in Stepney, was
admitted on May 8th, under the care of Dr. Fraser, suffering
from delirium tremens. He was immediately sent into the attics ;
and on account of his extreme violence, male attendants were
provided for him.

About 8 o'clock, chloroform was administered. It took a very
small quantity to bring him under its influence. Its action was
kept up for an hour, after which he continued in profound sleep.
The attendant was ordered to send for the medical officer if he
awoke ; this, however, was unnecessary, as the patient did not
wake till Dr. Fraser's visit at 1 P. M. He still suffered from
many delusions. After he was left, he fell asleep without the
administration of the chloroform, and slept for two hours, when
he awoke and partook of some beef-tea and brandy. He had
also a powder, consisting of five grains of calomel with fifteen
grains of jalap.

At 8 P. M., he was restless, with no delusions; complained of
pain in his head.

At 11 P. M., he was still restless, and said he felt no tenden-
cy to sleep ; his bowels had been relieved.

Chloroform was again administered ; a large quantity being
required this time to remove the stage of excitement. He con-
tinued to sleep for four hours.

140 On the Treatment of Scarlatina. [February,

May 9th. The delirium has entirely left the patient, and he
has made a very tolerable breakfast of bread and butter and
milk. He was ordered milk diet and beef-tea, three ounces of
brandy, and a pint of porter. He slept in the evening.

May 10th. He was ordered to have middle diet and a pint of
porter, and to omit the brandy. He slept well.

May 11th. He was ordered three grains of calomel and a
scruple of jalap. In the evening, he was removed from the attics
to the wards, and slept well.

May 12th. He was ordered decoction of cinchona with five
grains of sesquicarbonate of ammonia three times a day.

May 15th. He was discharged cured, and left the hospital.

On enquiry of the patient since his recovery, it was found
that he was taken ill on May 4th, and that the practitioner
called in to attend him gave him medicine to "sleep him," as
the patient says. He has never been an habitual drunkard, but
has been in the habit of taking as much beer as he could without
getting drunk. [British Med. Journal, and Braithwaites Retro-
spect of Practical Med. and Surgery.

On the Treatment of Scarlatina. By E. H. Meade, Esq., Senior
Surgeon to the Bradford Infirmary.

[The treatment of the severer forms of this disease is often most
unsatisfactory, and the introduction of any remedy more suc-
cessful than those in general use, would be a boon to the profes-
sion. Scarlatina has lately been very prevalent and fatal in
Bradford, and the symptoms presented by many of the cases
bore a close analogy to those of erysipelas, and were treated in
the same manner by the author. Mr. Meade says :]

I had long been convinced of the value of the tonic and stim-
ulant treatment in all forms of erysipelas, and formerly placed
my chief confidence in ammonia: I found however, that the
mineral acids with quinine were more efficacious, and generally
prescribed them, until a few years back, when the tincture of
sesquichloride of iron was recommended. Though the value of
this remedy has been doubted, I have found it so useful, that I
regard it almost as a specific, both in the idiopathic and trauma-
tic forms of the disease ; and invariably prescribe it both in hos-
pital and private practice ; and I have been assured by other
medical men that they have equal faith in its virtues.

Having so much confidence, therefore, in the tincture of iron
in erysipelas, I determined to try it in scarlatina, and I have,
accordingly, given it during the last winter and spring to every
case that I have seen, with the exception of a few, which were
so slight as scarcely to require any medicine. The success of

1859.J Muriate of Ammonia in Neuralgia, 141

this treatment has exceeded my expectations, and I have had
only one fatal case since I commenced its use. Several cj
in whieh the symptoms set in with severity, were apparently cut
short by it; and almost all the cases in which I gave it recover-
ed with unusual rapidity. I gave it in doses varying from live
to fifteen minims, according to the age of the patient, every
three or four hours; and when the throat is ulcerated I also ap-
ply a solution of nitrate of silver to the fauces. Several of my
medical friends have tried the tincture of iron at my suggestion,
and have reported favorably of its use. [Med. Times and Gaz.

Muriate of Ammonia in Xeuralgia.

Some of the preparations of ammonia have long been in use
in France, Germany, and elsewhere, as remedies in various
nervous affections, with variable success. At the Salpetriere
and the Bicetre hospitals in Paris, the valerianate of ammonia
has been much used in epilepsy for years, in the formula of
three parts of valerianic acid, two parts of alcoholic extract of
valerian, water ninety-five parts, and sesquicarbonate of ammo-
nia in sufficient quantity to neutralize the acid. The dose is a
drachm three times a day. Latterly, the muriate of ammonia
has been brought forward on the authority of the Germans, as
valuable in neuralgia, especially of the face, and we have recent-
ly had the opportunity of seeing it tried in a favorable case, at
Guy's Hospital, under the care of Dr. Wilks, and, so far, with
some benefit. The patient is a man aged fifty-five, who has
been subject to facial neuralgia of the left side for the last four
or five years, during which period he has undergone various
modes of relief ineffectually. He was put upon half a drachm
of the muriate, in water, every six hours, and although he has not
been more than a week under this treatment, he is certainly
much relieved, the pain having diminished. Even supposing
that this man is cured, a more extended trial of the agent is re-
quired to warrant the eulogium passed upon it by the Germans.
In certain forms of chronic diarrhoea it is really a valuable agent.

[London Lancet.

Changes of the Blood-Celh in the Spleen. The opinions of physiolo-
gists as to the functions of the spleen have been various. Some, as
Funke, Hewson, Bennett, <fec, believes it to be a generator of blood-cells,
while Kolliker and others maintain that it is a destroyer of them. Dr.
Henry Draper relates (N. Y. Jour, of Med., Sept. 1858) some microsco-
pic investigations made by him on the blood of frogs taken from the
splenic artery and splenic vein, and he found the latter to contain at least
double the general average of imperfect cells ; whence he infers that
"the spleen must bean organ for the disintegration of blood-cells.*'

[American Jour, of Med. Sciences.

1-12 Editorial. [February,

EDITORIAL AND MISCELLANEOUS.

Death of Professor George M. Newton.

By an inscrutable degree of Divine Providence, we are called upon to
sadden our pages with the melancholy record of the death of one who
long and ably held a distinguished position in our Profession as an
elegant Lecturer, successful Teacher, and a man of profound Science.
Professor George M. Newton has been cut off in the prime of life, and
the news of his death will becloud the countenances of thousands of
Medical Students and Physicians who, in times past, have enjoyed the
benefit of his teachings in the Medical College of Georgia, as they read
the melancholy circumstances of his demise.

The following brief sketch, prepared for the daily papers, by one of
his earlier colleagues, who knew him even longer than we did, we trans-
fer to our pages, feeling confident that it will be more acceptable than
anything we can say on this sad occasion :

" It becomes our melancholy duty to announce the death of one of our
most respected citizens Dr. George M. Newton. He died at his resi-
dence in this city, Thursday morning, at nine o'clock, of tetanus, caused
by injuries received some weeks ago, when he was thrown from his
buggy.

" Dr. Newton was born in this city in the year 1810. After completing
his collegiate career at the University of Georgia, he engaged in the
study of Medicine ; and, graduating with honor at the University of
Pennsylvania, he spent several years in the Schools and Hospitals of
Paris. Soon after his return to his native city, he was elected to the
Chair of Physiology in the Medical College of Georgia ; but was subse-
quently transferred to ths Chair of Anatomy, which he filled for about
twenty years with distinguished ability.

" It may be said with truth that he had in this position no superiors,
and but few equals. About two years ago he retired from the duties
of his profession, carrying with him, in his retirement, the profound re-
spect of his colleagues, and of hundreds of physicians scattered over the
land, who had had the good fortune to be his pupils.

" On the occasion of the announcement, in the Southern Medical and
Surgical Journal, of the resignation of Professor Newton, and the pub-
lication of the proceedings of the Board of Trustees on that event, (in
the June, 185V, number of the Journal,) the Editor said :

" Professor Newton. In giving place to the above kind expressions
of the Board of Trustees, it can scarcely be expected that we will refrain
from recording our own personal tribute to one, with whom for fifteen

1859.] utorial 143

years, we have been a co-worker in the same field, and whose place in
the Faculty we are now called to occupy. Sustaining towards him for
many years, the near relation of Prosector and Demonstrator, we have
had ample opportunity of knowing and appreciating his merit, as the
perfect Anatomist the urbane Teacher the erudite Lecturer may he
be as happy in retirement as he has been useful in public. Difficult, we
are fully aware, will it be for us to rill his place, but among our qualifi-
cations for the task, we do highly value the advantage, of having had
ever before us, such a model in the Art, as Professor George If.
Xewton."

M At the time Prof. Nkwtok resigned the Chair of Anatomy, the Board
of Trustees of the Medical College, at an adjourned meeting on the 2nd
of Ma\yl857, passed the following resolutions:

"Resolved, That his resignation be accepted, under the assurance that
any effort to induce his withdrawal of the same would be unavailing.

" Resolved, That we here record our testimony to the faithfulness,
zeal and ability with which Prof. Newton has uniformly discharged the
duties of his chair.

"Resolved, That as a mark of personal regard, and of our high appre-
ciation of his services. Prof. George M. Newtox be, and he is hereby,
appointed, Emeritus Professor of Anatomy, with the request that whilst
exonerated from formal and stated duty, he will yet continue to lecture
to the classes whenever his leisure and inclination may permit.''

" Dr. Xewtox never engaged in the active duties of his profession. An
ample fortune enabled him to devote his time to the cultivation of litera-
ture and science. His mind was clear, acute and vigorous. His judg-
ment was rarely at fault. His will was resolute, and he never faltered
in carrying out his plans and purposes. Had necessity compelled him
to exert his faculties, he would have reached the highest rank in his
profession. But his merit was excelled by his modesty ; and be shrunk
from the public gaze, and revealed his character in all its excellencies
only to his friends. His integrity was unimpeachable, while his benevo-
lence was large, but unostentatious. In his death, our city has lost one
of its most valued citizens. He bore his painful disease with unflinching
fortitude, and met death with resignation, and, we trust, with hope."

The following record, taken from the daily newspapers of the city,
will serve to show how highly he was regarded by his colleagues and by
the students of the Medical College of Georgia :

Medical College of Georgia, Jan. V, 1859 10 A.M.

At a meeting of the Faculty and Students of the Medical College of
Georgia, on motion of Prof. H. V. M. Miller, Prof. I. P. Garvin was called
to the Chair, and the following gentlemen were appointed Secretaries

144 Editorial. [February,

viz: W. E. Link, South Carolina; W. W. Peel, Georgia; B. S. Isbell,
Alabama.

The Chairman, in a few appropriate remarks, announced the death of
George M. Newton, M. D., late Emeritus Professor of Anatomy in this
Institution.

On motion of Prof. H. V.M. Miller, the following gentlemen were ap-
pointed as a committee to draft suitable resolutions in respect to the
memory of our distinguished Emeritus Professor of Anatomy, George M.
Newton, M. I). viz : On the part of the Faculty, Prof. L. D. Ford, and
on the part of the Class, J. R. Slayton, Alabama ; H. A. McKittrick,
South Carolina ; D. C. Young, Tennessee : E. E. Andrews, Georgia ; M.
A. Gastin, Texas ; M. M. T. Huchingson, Florida ; Colin Bethune, North
Carolina whereupon the committee reported the following :

Resolved, That the Faculty and Students of the Medical College of
Georgia have heard with profound regret, the melancholy intelligence of
the death of George M. Newton, M. D., late Emeritus Professor in this
Institution. His long continuance with this College, his distinguished
ability as a teacher, his nice sense of honor, his genial and social quali-
ties, his benevolence of heart, his unobtrusive modesty, gained for him in
this life our highest admiration, and warmest personal attachment,
which renders it peculiarly proper that we give some feeble expression
of our sorrow for his death, of our respect for his memory, and our sense
of the greatness of our loss.

Resolved, That the exercises of this College be suspended for this day.

Resolved, That we join the procession to the place of interment.

Resolved, That we wear the usual badge of mourning the remainder
of the session.

Resolved, That the proceedings of this meeting be recorded in the
minutes of this College, and that they be published in the newspapers
of the city.

I. P. GARVIN, Chairman.

B. S. Isbell, Ala., )

W. W. Peel, Ga., > Secretaries.

W. E. Link, S. C, )

The Science and Art of Surgery : being a Treatise on Surgical Injuries,
Diseases, and Operations. By John Erichsen, Professor of Surgery
and of Clinical Surgery in University College, and Surgeon to Uni-
versity College Hospital. An improved American edition, from the
second enlarged and carefully revised London edition, illustrated by
four hundred and seventeen Engravings on wood. 1 vol., pp. 996
royal octavo. Philadelphia: Blan chard & Lea. 1859. (For sale by
Thomas Richards & Son, Augusta, Ga.)

To prepare a complete and yet a convenient and uncumbrous work on
Surgery, is, at the present day, one of the most difficult feats of modern
literature. Surgery has grown into a vast science which, in order to

1859.] Editorial 145

present it in its entirety, requires not one but many volumes. The au-
thor, therefore, who exercises the best judgment in the selection of his
materials, and who embodies in his work the essential parts of all its
various departments, and yet wastes no space in protracted discussionsr
is ever the one whose Treatise on Surgery will be found the most useful
both to the Practitioner and to the Student of Medicine. Prof. Erichsen
has regarded these precepts perhaps more successfully than any writer of
the present day. Adding largely to it in the present edition, be has
shewn excellent judgment in still keeping his materials within the bounds
of a single volume. The numerous wood-cut illustrations, amounting to
four hundred and seventeen, give a definite and most graphic view of
every thing in which the coup d'oiel can aid us and the descriptions in
the text are clear, terse and to the point,

The American Publishers have done full justice to themselves and to
this great work, in the style of execution both of the printing and ligno-
graphing, and in the present edition they present to the American
Profession one of the most complete and comprehensive and yet most
convenient works on the Theory and Practice of Surgery to be found in
any part of the world. We commend it now, as we have ever done, to
the purchase aud careful perusal of all Practitioners and Students. Per-
form no new operation about which you may be doubtful, until you
consult Erichsen ; he is reliable.

Our List of Payments. In behalf of our worthy publisher, we thank
our readers for the very encouraging list which our cover presents this
month. It is wonderful how we advance in our ideas of expenditure,
with the extension of our pecuniary resources. Pope, in whose satires
we find every human motive and feeling most clearly presented, illus-
trates this restlessness in a few lines :

" I've often wished that I had clear,

For life, six hundred pounds a year

A handsome house to lodge a friend,

A river at my garden's end,

A teiTace walk and half a rood,

Of land set out to plant a wood.

Well, now I have all this and morer

I ask not to increase my store,

But here a grievance seems to lie,

All this is mine but till I die ;

I can't but think 'twould sound more clever

To me, and to my heirs forever."

"We think we can illustrate this almost as well as Mister Pope : A few
months ago, our friend, Mr. Jeremiah Morris, the laborious, indefatigable
publisher of the Southern Medical and Surgical Journal was a most
" frugal swain whose only care was to increase his store," sufficiently to

146 Editorial and Miscellaneous.

meet his current expenses. We " baited with honey," and sent our bag
round for the collection of subscriptions they have come pouring in ;
it has enabled him to procure his paper, ink, type, &c, and a small resi-
due remains, which doubtless he could find many to borrow ; but no, he
has a better application in view, with the interest of The Journal ever
uppermost in his heart ; his ambition now points to a Power Press, with
which he will be able to print more expeditiously, and at less expense
and labor, the monthly issues of the Journal. We heartily join him in
his laudable desire, as will every one of our readers.

There is yet on his books about $800 of back subscriptions, which we
know, by experience, will be promptly paid without asking for it. He
only waits the receipt of this amount to add to what he now lias on
hand, and he will order his power press. Our readers may feel assured,
that, with the extension of his facilities, their own interests will be cared
for in the preperation of a better and, probably, even a larger and more
comprehensive Journal.

Port Wine Enemata as a Substitute for Transfusion of Blood in
cases of Post-Partum Hemorrhage. Dr. H. L. Williams recommends
enemata of port wine in cases of post-partum hemorrhage, and records
[British Med. Journal, Sept. 4, 1858), a case in which he successfully
resorted to it. The patient was in the most alarming state of prostration,
pulseless at the wrist, with cold extremities, &c. Dr. W. commenced
by administering four ounces of port wine with twenty drops of tincture
of opium. The patient speedily manifested signs of improvement. In
half an hour he repeated the enema, with marked advantage, and the
patient was soon out of danger. [American Jour, of Med. Sciences.

The Charity of Speech. When every physician and every medical
journal is moved by the following impulses, we shall have the millenium
of medicine:

" Can a higher compliment be paid to a man than to say he speaks
no ill of any one ? And is any man better spoken of by all than he
who never opens his mouth to the detriment of his fellow creatures ?
And does any one in the long run live more happy than he? The
charity of speech surpasses that of almsgiving; the latter, even if it
be the widow's mite, is rewarded by the feeling the donor experiences,
but the latter waits for its reward. The impulse that prompts one to
look kindly upon his brother's sins of omission or commission, even while
living as he w^ould, if he were dead, that prompts to suppress all mention
of the evil within him, and readily to acknowledge his good traits, to
speak of man with the same delicacy of women, to remember that there
is no existing creature without some redeeming trait this impulse is one
of the noblest that actuates the mind, and dwells within the heart. We
never meet one who has a kind word for the faults of another, without
the mental conviction that he would be the first to lend him a helping
hand," [Newspaper.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XV.] AUGUSTA, GEORGIA, MARCH, 18ft [No. 3.

ORIGINAL AND ECLECTIC.

ARTICLE VI.

Observations on Malarial Fever. By Joseph Jones, A.M., M.D.,
Professor of Medical Chemistry in the Medical College of
Georgia, at Augusta.

[Continued from page 100 of February No.]

Case XLYII. American seaman, native of Boston : age 21 ;
weight 150 ; height 5 feet 10 inches ; dark brown hair, brown
eyes ; muscular system moderately well developed. This is his
first trip to Savannah. Has been in Savannah 10 days during
this time 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 at the saw-mill, opposite the
low, marshy shore. Was taken sick four days ago. The crew
consisted of eight four of the crew slept on deck and the same
number in the cabin. v The former are now sick, whilst the latter
are well.

September 26th, 1857. Tongue dryer than normal, and coat-
ed with yellow fur; complexion sallow ; pain upon pressure of
epigastrium. Has some fever, and appears to be very weak.

$. Sinapism over epigastric region.

$. Sulphate of quinia, grs. v. every three hours, up to grs. xv.

Sept. 27th. Has taken a change for the worse. Has been
passing his water in bed and is in a comatose state. When the
epigastrium is pressed, exhibits signs of pain. Pulse and respi-
ration accelerated.

#. Blister over epigastric region and sinapisms to extremities.

$. James's powder (pulvis antimonii compositus), grs. xxij. ;
Calomel, grs. xij.; opium, grs. ij. Mix. Divide into twelve
powders, and administer one every two hours.

Sept. 28th, 11 o'clock A. M. The blister has aroused the

N. S. VOL. XV. NO. III. 11

148 Jones, on Malarial Fever. [March,

nervous system, and the patient is restored to the use of his rea-
son.

ty. Continue calomel and opium. ^. Neutral mixture.

7 o'clock P. M. The action of the blister has been only tem-
porary, and the patient is now stupid, almost comatose. Pulse
120 ; respiration 22. Pulse is so feeble that it is with difficulty
counted. Tongue coated with yellow fur, dry and rough the
surface feels harsh like the surface of a board. It is evident that
the stimulant effect of the blister has vanished, and that the
calomel is exerting no beneficial effect.

$. Sinapisms to extremities.

3. Brandy, f^viij.; infusion of Virginia snake-root, f l viij. ;
sulphate of quinia, grs. xv. Mix. Administer f l'\. every half
hour.

$. Sulph. of quinia, grs. v. every three hours, up to grs. xx.

Sept. 29th, 11 o'clock A. M. Lies in a stupor, with mouth
and eyes partially open. When aroused by shaking, answers
sluggishly, and in a few moments relapses into a stupor. Teeth
coated with sordes. Tongue coated with black and light yellow
fur, swollen edges indented by the teeth perfectly dry and
rough: the surface of the tongue is traversed by several deep
cracks. Surface of blister red, raw and dry. The serum which
issued from the blister was of a golden color. This patient
emits a disagreeable nauseous smelt Has taken 40 grains of
sulph. of quinia.

ty. Continue brandy, infusion of Virginia snake-root, and
sulphate of quinia.

Examination of Blood No. IX,
2 o'clock P. M. Blood coagulated slowly. Seram of a deep
golden color. Nitric acid showed that the color was due to the
presence of bile. Eeaction of serum, alkaline. Specific gravity
of blood 1040 ; specific gravity of serum 1022.

Water

In 1000 parts of Blood, 833-449

" " " " Serum, 912-386

(1) " " "Liq.Sang., 910-798

(2) " " " " " 875-813

Solid Matters

In 1000 parts of Blood, 166-551

" u "Serum, 87-614

(1) " " "Liq.Sang., 89-203

(2) " " " " " 124-187

In Serum of 1000 parts of Blood, 80-033.

Fixed Saline Constituents,

In 1000 parts of Blood, 6-314

" Serum, 6-620

(2) " " Liquor Sanguinis, 8*759

" " Dried Blood Corpuscles, 6-595

" " Moist Blood Corpuscles, 1-648

" Dried Residue of Blood, 37-909

" " " Serum, .... 75-558

" Serum of 1000 parts of Blood, 5-747

1859.] JoxES, on Malarial Fever. 149

1000 Parts of Blood Contained,

Water, 833-449

n. JB, , ~ , 0-n*o) Dried Organic Residue, 84*400

Dried Blood Corpuscles, 8o*968 J. Fixed sJne ConstituentS) 0.567

Fibrin, .... - - - 1.450

Albumen, Extractive and Coloring ) Dried Organic Residue, 74*186

Matters, - - 80*033 j 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

1 Water, - - - 574*646

T. 0 . . *.,ftQ Albumen, Ext. & ColV Matters, 74*185

Liquor Sanguinis,- bo6*128 ^ Fixed Saiine Constituents, 5*747

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,

Water, 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

1\ o'clock P. M. The stimulants and sulphate of quiniahave
exerted the chemical changes and aroused the nervous system,
and the patient is now restored to the exercise of his intellect.
He is still, however, very weak and has a great tendency to
sleep. Pulse 98 ; respiration 18, full. Temperature of atmos-
phere, 80 F. ; temp, of hand, 98. Skin of head aud trunk feels
a little warmer than normal, and is slightly moist. Tongue pre-
sents the same dry, coated, rough appearance. Eeaction of
saliva decidedly acid.

ty. Mustards to extremities. Continue brandy, infusion of
Virginia snake-root and sulphate of quinia. Diet, milk punch
and brandy and arrow-root

Sept. 30th, 2 o'clock, P. M. His intellect is clear, and there
is less tendency to sleep, and he appears to be decidedly better.
Pulse 80, much fuller ; respiration 14. Temperature of atmos-
phere, 71F. ; temp, of hand, 97. Tongue is still very dry, rough
and black in the centre ; it appears however, when pressed with
the finger, to be somewhat softer.

150 Jones, on Malarial Fever. [Marehf

Urine passed this morning, high colored. Urine passed du-
ring the night, several shades lighter, and of the usual color.
Eeaction decidedly acid ; sp. gr. of urine passed this morning
1016. Owing to the weakness of the patient, the whole amount
was not collected. Amount of uric acid in 1000 parts of urine,
0*59. Eeaction of salvia acid.

$. Continue stimulants, sulph. of quinia and nutritous diet.

October 1st, 1 o'clock, P. M. Says that he feels better and is
hungry. Pulse, 90; respiration, 20. Temperature of atmos-
phere, 73F.; temp, of hand, 98.75; temp, under tongue, 101.
Complexion very sallow. Tongue slightly moister, cleaner and
softer.

Urine of a deep orange color, clear and limpid ; reaction acid ;
sp. gr. 1016. Uric acid in 1000 parts of urine, 0.659.

Oct. 2d, 1 o'clock, P. M. The expression of the countenance
is better, and the surface of the blister looks much better. Ton gue
still coated with dark brown fur, but moister and softer. The
sordes around his teeth and the disagreeable smell, are rapidly
disappearing. Abdomen tumid. Pulse 88; resperation 18.
Temperature of atmosphere, 77F. ; temp, of hand, 102. Was
able to get up and walk across the ward this morning.

ty. Continue brandy and snake-root tea and sulph. of quinia,
tablespoonful every three hours.

Urine orange colored; sp. gr. 1016. Uric acid in 1000 parts
of urine 0*511 reaction of saliva decidedly acid. As in the
former examinations, there was scarcely sufficient saliva to*
moisten the test paper.

Oct. 3rd, 1 o'clock P. M. Has apparently taken a change
for the worse. Inclined to stupor ; goes to sleep whilst conver-
sing; countenance anxious and distressed. This inclination to
stupor may be the effect of the brandy and sulph. of quinia.
During the last four days has taken about one hundred grains
of the sulphate of quinia. $. Stop stimulants and sulphate of
quinia. Pulse 94. Eespiration 18. Temperature of atmos-
phere, 77F. ; temp, of hand, 1025. Bowels are costive. 3. Ci-
trate of magnesia and soda powders.

Urine of yesterday deposited a heavy light yellow deposit.
Urine just passed, light orange colored, limpid. Eeaction acid,
sp. gr. 1006. Uric acid in 1000 parts of urine 0*238.

Oct. 4th, 2 o'clock, P. M. Medicine operated slightly. Pulse-
94. $. Infusion of Virginia snake-root, ty. Tincture of muri-
ate of iron, nix., three times a day.

Oct. 5th, 2 o'clock, P. M. Anxious expression of counten-
ance ; bowels costive ; abdomen tumid ; tongue a little softer
and cleaner, but still much dryer, harder and rougher than nor-
mal. Notwithstanding the slight improvement of his strength,,
there is still an almost complete absence of the secretions of the-

1859.] Jones, on Malarial Fever. 151

raucous membrane of the mouth. Pulse, 90; respiration, 15.
Temperature of atmosphere, 7F. ; temp, of hand, 96 ; temp,
under tongue, 103.

The temperature of the extremities is two degrees below,
while the temperature of the trunk is four degrees above that
of health. Accompanying this loss of animal heat in the ex-
tremities and exaltation in the trunk, there is a rapid, feeble
pulse, normal respiration, dry harsh skin, dry mouth, feeble di-
gestion, torpid bowels, sluggish intellect and feeble forces. These
facts, taken in connection with the analysis of the blood, show
that the malarial poison has produced profound alterations in
the constituents of the blood, interfered with the formation of
the secretions, interfered with the chemical changes of the blood
and nutritive fluids, interfered with the development and corre-
lation of the physical, vital and nervous forces.

The dry harsh tongue, the scanty, acid secretions of the mu-
cous membrane of the mouth, the torpor of the bowels, the high
colored acid urine, the dry harsh skin, the feeble circulation in
the capillaries of the extremities, the elevation of the tempera-
ture of the trunk, the loss of harmony between the actions of the
circulatory and respiratory system, all point to profound disturb-
ances in the domain, over which the sympathetic system
presides. The sluggish intellect, indicates derangement of the
cerebro-spinal system. The feeble forces, point to derangements
in both the sympathetic and cerebro-spinal systems.

The fact that the temperature of the extremities is but two
degrees below the normal standard, whilst that of the trunk is
several degrees above the normal standard, afford evidence that
the chemical changes of the organs, tissues and blood, are suffi-
cient in quantity to work the machinery with the accustomed
vigor. But the machinery is not worked with the accustomed
vigor ; the patient is weak, "and unable to accomplish any me-
chanical effort at all corresponding to the chemical changes of
the elements and solids. The forces are generated, but they
are not properly applied, or they are not properly related to
each other, or they are not generated in the right position,
or in the proper apparatus. If muscular force is generated by
the chemical changes of the elements composing the muscu-
lar tissue, and if the nervous force is generated, by the chemi-
cal changes of the elements composing the nervous and mus-
cular systems, if the transmission of the nervous excitement
is dependent upon chemical changes in the elements of the
nerves along which the excitement passes, it is evident that what-
ever interferes, with those chemical changes, must be attended by
either an exaltation, or depression, or aberration of muscular
and nervous force. If the colored blood-corpuscles, taken col-
lectively, be an immense gland, which elaborates the materials

152 Jones, on Malarial Fever. [March,

for the nutrition and development of the forces of the muscular
and nervous systems, then, their destruction by the malarial
poison would, in great measure, account for the disturbances in
the muscular and nervous systems.

Important questions present themselves. Do the disturban-
ces in the sympathetic and cerebro-spinal systems arise from a
direct action of the malarial poison upon one or the other of
these systems? Do the alterations in the secretions and excre-
tions, and in the amount and character of the chemical changes
and physical forces, depend upon the direct action of the mala-
rial poison upon the organs elaborating the secretions and se-
parating the excretions, and preparing the materials destined to
form the elements of the tissues and undergo those chemical
changes, by which all the forces are generated ? Or, do the
alterations of the secretions and excretions depend upon altera-
tions of the blood, which is the great reservoir of materials for
chemical change and nutrition ? or, do they depend upon a de-
ficiency, or excess, or perversion of nervous influence, which is
supposed to influence secretion ? A correct solution of these
problems is impossible, in the present state of medical science,
because the ultimate facts are wanting.

Specific gravity of urine 1006 ; reaction alkaline after stand-
ing 24 hours. Amount of uric acid in 1000 parts of urine, 0*078.
ty. Stop tincture of muriate of iron immediately. At 10
o'clock P. M., this night, (12 hours afterwards,) administer
calomel, grs. x., followed by castor oil in four hours. If he is
weakened by the action of the medicine, administer stimulants
freely.

Oct. 6th, 1 o'clock P. M. Medicine operated four times, and
has produced great exhaustion. Tongue clean and much moist-
er and softer ; the moisture of the tongue, however, varies great-
ly. This morning, at 10 o'clock A. M., it was moist and soft ;
at 12 o'clock M., it was almost entirely dry, and now, it is moist.
Pulse 100, very weak, feels like the vibrations of a spiders thread.
It requires time and care to find the pulse, and much more time
and care to ascertain correctly its number of vibrations. It ap-
pears that I have made a mistake in giving the calomel and oil.
His system is so much exhausted that it is doubtful whether he
will rally.

ty. Brandy and infusion of Virginia snake-root.
ty. Compound tincture of gentian, f 3j. ; compound tincture
of bark, f 3j. Mix, and administer three times a day in a
wineglass full of infusion of snake-root.

ty. Chlorate of potassa, 3j.; water, f Bviij. Dissolve and ad-
minister during the 24 hours. Diet, mutton soup, boiled rice,
brandy and arrow-root; milk punch.

Oct. 7th. 3 o'clock P. M. Looks better. The anxious ex-

1859.] Jones, on Malarial Fever. 153

pression of his countenance is removed, his intellect is brighter,
and his spirits better. Tongue softer and moister than it has
been during the sickness. Pulse 92, watery and feeble, but
stronger than yesterday; respiration, 13. Temperature of at-
mosphere, 705F.; temp, of hand, 97; temp, under tongue 103.

$. Continue medicine and diet $. Spirits of Turpentine,
10 drops, four times a day.

Oct. 8th, 2i o'clock P. M. Says that he feels very weak.
Tongue moister and softer ; pulse 96, feeble and watery ; respi-
ration 16. Temperature of atmosphere, 72*5CF. ; temp, of hand,
9725 ; temp, under tongue, 102-5. Has not had a motion of
the bowels since the action of the calomel.

$. Phosphate of soda, 3iij.; water, fi v. Dissolve, and ad-
minister in two doses. Continue tonics, stimulants and nutri-
tious diet.

Oct. 9th, 2 o'clock P. M. Complains of great weakness. His
sallow complexion, anaemic lips and gums, feeble pulse, and
feeble forces, demonstrate that his feelings are founded in the
effects of the malarial poison.

Pulse 92 ; respiration 16. Temperature of atmosphere, 73F. ;
temp, of hand, 86 ; temp, under tongue, 103. The hand in
which the thermometer was placed was carefully surrounded
with the non-conducting blanket. Notwithstanding this favora-
ble arrangement for the accumulation and manifestation of ani-
mal heat, the thermometer during the period of one hour indica-
ted a temperature of 86 , which is 12 degrees below the normal
standard. The temperature of his trunk, on the other hand, is
four degrees above the normal standard and 17 degrees above
that of the extremities. Here we have a disturbance of the
temperature, analogous to that of the well-marked chill of mala-
rial fever, and yet the patient does not complain of the sensation
of cold, and there is no shivering of the muscles, and the respi-
ration is normal in frequency, and the violent action of the res-
piratory muscles, characteristic of a well marked chill, is absent.
The feeble pulse, on the other hand, attended with an elevation
of the temperature of the trunk, and a depression of the temper-
ature of the extremities, corresponds with the phenomena of a
well-marked chill, and indicates a deficient circulation of blood,
and an arrest of chemical action in the capillaries of the extremi-
ties, and at the same time, an accumulation of the blood and an
increase of chemical change in the capillaries and blood-vessels
of the large organs of the trunk. The increased heat in the
trunk during the cold stpge, may arise, in part, from the chemi-
cal changes in the blood-corpuscles, resulting in their destruc-
tion, and in the liver, resulting in the alterations of its secretions
and nutritive fluids. The heat thus generated by the destruc-
tion of the blood-corpuscles, by the alterations of the other ele-

154 Jones, on Malarial Fever. [March,

merits of the blood, and by the alterations of the secretions and
nutritive fluids of the liver, induced by the presence of an ex-
traneous poisonous body, would be generated in the wrong
position, and by a wrong collocation, action and reaction of
elements, and would, so far from adding to the forces, produce
derangement and interfere with the carefully adjusted balance of
the forces. It is a well established truth in physiology, that vital
phenomena are manifested by matter having a definite chemical
and physical constitution, and whatever alters the arrangement
of the matter destroys the essential conditions of the manifesta-
tion of the vital phenomena. The study and investigation of
man should be, not what are the essences of the physical, chemi-
cal and vital forces, but what are the essential conditions and
laws of their existence and manifestation.

Whilst the low temperature of the extremities, accompanied
by a feeble rapid pulse, is a very dangerous symptom, still the
condition of the patient would be much worse, if the tempera-
ture of the trunk corresponded with that of the extremities. A
definite temperature of the trunk, is absolutely essential to the
maintenance of life in man. An elevation, or depression of the
temperature of the great organs of the trunk, of only a few de-
grees, is attended with death ; because this fixed temperature is
one of the essential conditions for the conduction of those chemi-
cal processes by which the forces are generated ; and by which,
under the guidance of the vital principle, poisonous compounds
are removed, and new matter elevated into a state of force and
rendered suitable for the habitation of the vital principle by the
action of the forces of the sun through the apparatus of the
vegetable kingdom, is introduced into the position of that chem-
ically altered and removed : and by which that constitution of
matter is preserved which is indispensable for the existence of
the vital principle and the manifestation of vital phenomena,
by the correlation of the chemical and physical forces acting
under the guidance of the vital principle, upon and through
special apparatus. Whilst even a moderate elevation or depres-
sion of the temperature of the great organs of the trunk is ne-
cessarily attended by the generation of abnormal compounds,
or by a complete arrest of the chemical and physical and nerv-
ous actions ; the elevation or depression, even to a great extent,
of the temperature of the extremities, is not, on the other hand,
attended by such serious consequences, because these parts of
the body are destined to act as mere servants to the spiritual
nature, as mere organs of locomotion and mechanical action,
and not as chemical laboratories for the preparation of the nutri-
tive elements, and of the matters destined for the development
of the forces. Nevertheless, as the forces which work the mus-
cular system, are developed by the chemical changes of the

1859.] Jones, on Malarial Fever. 155

structures of the muscles, aud of the compounds and elements of
the surrounding blood ; and as the excitement and transmission
of the nervous force, to the muscular system, is the result of the
chemical changes of the elements of the nerves and probably of
the muscles : it is evident that a reduction or elevation to any
great extent, of the temperature of the extremities, must also, but
in a much smaller degree, interfere with the chemical changes
going on in those muscles and with the correlation of the chemi-
cal, physical and nervous forces. The development of the muscu-
lar and nervous forces, depends upon the constitution of (tie muscu-
lar and nervous apparatus, and a free supply of oxygen (the great
agent of chemical change), and of the nutritive and force generating
elements of tfie blood. In the case before us, the muscular and
nervous system appear to be normal in constitution, whilst the
blood and oxygen are wanting.

To restore the action of the muscular and nervous systems, and
prevent the generation of noxious compounds by the reduction
of temperature, we must restore the circulation of blood and the
distribution of oxygen. Acting upon these principles, I endea-
vored to arouse the circulatory, respiratory and nervous systems,
by sinapisms.

Applied large mustard plasters to the extremities.

In 10 minutes after the application of the mustards, the tem-
perature of his extremities had risen six degrees (from 86 to 92),
and his pulse had become fuller and increased eight degrees,
(from 92 to 100 beats).

In half an hour after the application of the mustards, the tem-
perature of the extremities had risen sixteen degrees, from 86
to 102, and the pulse had increased 12 beats to the minute.
During these changes, the respiration and the temperature of
the trunk has remained uniform. The elevation of the tempera-
ture from 86 to 92 during the first 10 minutes, was more rapid
than the subsequent elevation during the succeeding 20 minutes,
from 92 to 102. After reaching this temperature, the thermome-
ter indicated a stationary temperature, both in the hand and un-
der the tongue, and at 8 o'clock P. M., five hours after these
observations, the pulse was 94 ; respiration 16. Temperature of
atmosphere, 70 : temp, of hand, 102, and under tongue, 103F.

Here we see, that although the frequency of the pulse has
been reduced, and it has returned back to within two beats of
what it was when the temperature of the hand was only 86,
still the temperature of the hand is 102 The pulse has increas-
ed in volume, and hence the increased elevation of temperature
is due to the increased circulation of blood. It is evident that
the action of the mustards has not been evanescent. The fol-
lowing table will exhibit in a clear light the changes induced by
the revulsives.

156

Jones, on

Malarial Fever.

[March,

Before the ap-
plication of
the sinapisms.

10 min. after
application of
sinapisms.

30 min. after
application of
sinapisms.

5 hours after
application of
sinapisms.

Pulse-,...,

Respiration,

92
16

73 F.
86
103

100

16

73 F.

92
103

104
16
73 F.

102
103.2

94

16

Temp, of Atmosphere,
" of Hand,.
" under Tongue,. .

71 F.
102
103

The restoration of the circulation and chemical changes in the
capillaries of the extremities was attended by a subsidence
of the twitching of the tendons, by a disappearance, in a great
measure, of the feelings of exhaustion, by an increase of the se-
cretions of the mucous membrane of the mouth, tongue and fauces,
and by an increase of muscular and nervous force. The patient
says, that the mustards have made him feel much stronger.

In this experiment the volatile stimulant, oil of mustard, has
not simply called forth the nervous force existing in the system,
but has produced a permanent exaltation of the nervous and
physical forces. This was accomplished by the absorption of the
stimulant principle of the mustard, and its distribution, by the
blood-vessels, to all parts of the sympathetic and cerebro-spinal
nervous systems. The action of the heart was thus increased,
and the absorption and distribution of oxygen, promoted by an
acceleration of the general and capillary circulation.

Before the action of the stimulant, the chemical changes in
the capillaries of the extremities were slow and small, because
the circulation in the capillaries of the extremities was sluggish,
and the amount of oxygen and blood supplied to the muscles
and nerves of the extremities insufficient to sustain vigorous
chemical changes.

When the circulation was aroused, the chemical actions in
the extremities were correspondingly increased, because the
elements of these changes were presented in abundance, and
with rapidity. As the muscular and nervous forces depend
upon chemical change, the excitation of the chemical changes
were necessarily attended by an increase of muscular and nervous
force. Thus the increased supply and distribution of the
elements of chemical change, led to an increase of nervous and
physical force, and this nervous and physical force, in turn, led
to a still farther excitement of the machinery devoted to the
absorption and distribution of the oxygen, the great element of
chemical change. Hence the excitement was permanent.

$. Carbonate of ammonia, grs. x., every four hours.

$. Oil of turpentine, ^Ix., every three hours. Continue
stimulants, tonics and nutritious diets.

Oct. 10th. Much better. Temperature of the extremities
corresponds with that of the trunk.

1859.] Jones, on Malarial Fever. 157

Urine has a strong smell of turpentine. Amount passed
during the last 18 hours, grains 12168 ; sp. gr. 1014 deep
orange color, inclining to red ; reaction decidedly acid ; slight
turpidity, but no deposit. Grs. 12168 of urine passed during
24 hours, contained urea, grs. 209*520 ; uric acid, grs. 12*60.
1000 parts of urine contained, urea 17*212 ; uric acid 1*035.

4 o'clock P. M. Appetite good; tongue moist. Pulse 100,
much stronger than yesterday before the application of the mus-
tards; respiration 16. Temperature of atmosphere, 69l5F. ;
temp, of hand, 101; temp, under tongue, 102*5.

Urine high colored, reddish brown ; sp. gr. 1016 ; reaction de-
cidedly acid, clear, limpid. Amount passed during the last 5
hours, grs. 4562. ft. Continue.

Oct. 11th. Continues to improve is able to walk about the
ward.

ft. Citrate of iron, grs. ij. ; sulph. of quinia, grs. iij. Mix. Ad-
minister three times a day.

ft. Continue stimulants, tonics and nutritious diet oysters,
soft boiled eggs, milk punch, &c.

Oct. 17th. Has continued to improve and is now able to
walk in the hospital grounds. He is still, however, pale, sallow
and very weak. Pulse 76, full and strong ; respiration, 14.
Temperature of atmosphere, 67F. ; temp, of hand, 97*25 ; temp,
under tongue, 100. Eeaction of saliva very slightly acid; du-
ring his sickness it has been decidedly acid.

I have been informed, upon reliable authority, that one week
after the admission of this patient into the hospital, his captain
weighed anchor and sailed for New York. The crew consist-
ed of the men whom he had compelled to sleep on board the
vessel lying along the low, marshy shore. Several of the crew
were unwell at the time of sailing. Before getting well out to
sea, the captain and the whole crew were taken sick. In a few
days, there was not a man with strength to navigate the ship.
Fortunately a small vessel perceived their signal of distress, 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 of eight, and these were extremely ill. The se-
verity of the disease, in this case, resembles the accounts of Afri-
can fever.

From the report of this case, which came under our own ob-
servation, it is evident that any carelessness or neglect would
have been attended by a fatal termination. Notwithstanding
the administration of the most active tonics and of the most nu-
tritious diet, this patient exhibited for a great length of time, the
effects of the bilious remittent fever, in his pale, sallow, anaemic
countenance, pale lips and gums, and tottering gate.

158 Jones, on Malarial Fever. [March,

Case XL VIII. English seaman: height 5 feet 1\ inches;
weight 145 lbs. ; black hair, black eyes ; dark complexion ; age
46. Well built, muscular man. First trip to Savannah. Has
been in this port three weeks, and during this time has slept on
board ship.

October 13th, 1857, 11 o'clock A.M. Says that he was ta-
ken sick two days ago, with pain in the head and bones and
loss of appetite. Last night, between 8 and 9 o'clock, had a
chill, which lasted for one hour, and was succeeded by fever, which
remitted this morning, . with a profuse perspiration. Tongue,
pale and clean. Bowels have not been moved for three days.

^. Calomel, grs. xij.; sulph. of quinia, grs. vi. Mix. Ad-
minister immediately, and follow with castor oil in four hours.
As soon as the medicine has operated once, give 5 grs. of the
sulphate of quinia every three hours, up to grains xx.

Oct. 13th, 11 o'clock A. M. The medicine operated freely.
Has taken xxvi. grains of the sulphate of quinia. The patient is
weak and stupid pays no attention to inquiries, even when the
voice is greatly elevated. When aroused by violent shaking,
answers incoherently, and in a few moments relapses into a stu-
por. Great tenderness upon pressure of epigastic region pres-
sure here arouses him, and he cries out. Pulse 120, very feeble,
so feeble that it is with difficulty that it can be felt, and with
still greater difficulty that its number of beats to the minute
can be ascertained. Kespiration 40, thoracic, labored. Tongue
coated with yellow fur, moist and soft. Skin warm and moist
in a perspiration. Administered flij. of a mixture of equal
parts of brandy and infusion of Virginia snake-root. As soon
as the fluids entered the stomach, they were ejected again with
great violence, over the table and the neighboring bed. The
brandy and infusion of snake-root had mingled with the con-
tents of the stomach, and were of a green color. The act of
vomiting was performed, apparently, without any effort. There
was no retching previous to the ejection of the fluids: they came
up in a stream.

ty. Mustards to extremities and interior surface of thighs, and
a blister, 6 inches by 5, over the epigastric region.

$. Lime water, f 3 i j . ; milk, f 3 ij . ; acetate of morphia, f 3j.
Mix. Administer immediately, and repeat every half hour,
until his stomach is settled. As soon as the stomach will retain
this mixture, administer sulphate of quinia, brandy and infusion
of Virginia snake-root, freely.

8 o'clock P. M. More sensible than this morning, but weak
and restless. Breathing not so accelerated and labored. Pulse
120, still very feeble. Blister is drawing.

B. Sulph. of quinia, grs. v. every three hours, up to grs. xxx.

If his stomach rejects this, give the following injection :

1859.] JoXES, on Malarial Fever. 159

ft. Sulphate of quinia, grs. x. ; starch, grs. f 5 i j - ; tincture of
opium, "ixv. Mix. Eepeat every three hours, until xl. grains
of the sulphate of quinia have been administered.

&. Administer brandy, infusion of Virginia snake-root and
spirits of mindereri, freely.

Oct. 1-ith, 11 o'clock A. M. Says that he is much better.
Intellect clear answers coherently. He is much more quiet.
Blister has drawn well serum golden colored. Pulse 96, much
stronger and more regular, but still feeble. Respiration 24,
Tongue soft and moist, superior portion coated with white fur.
Under the action of sulphate of quinia and stimulants, the pulse
has diminished in frequency and increased in volume, and the
respiration has dimiuished in frequency, and the spasmodic ac-
tion of the respirator}' muscles have ceased, and the nervous
system has been aroused, and the dull intellect has resumed its
normal actions. If stimulants had been withheld, it is highly proba-
ble that this patient would have died, from complete exhaustion of
the nervous and vital powers, consequent upon the action of the
malarial poison, either directly upon the nervous ganglia of the
sympathetic system, presiding over the respiration and circula-
tion ; or primarily upon the cerebro-spinal system, and seconda-
rily upon the sympathetic system by reflex action ; or by such
changes in the elements of the blood (especially of the blood-
corpuscles) as resulted in the perversion of the nutritive elements
of the nervous ganglia ; or by the generation of compounds in
the blood and in the secretions of the liver, spleen and alimenta-
ry canal, which acted as poisons upon the sympathetic and
cerebro-spinal nervous system ; or by the simultaneous action of
the poison in all these different wavs.

B. Continue brandy and infusion of Virginia snake-rooL
Stop sulphate of quinia. Diet, milk punch and arrow -root.

Oct. 15th, 11 o'clock A. M. Continues to improve. Has no
pain anywheres. Tip of tongue clean, and redder than noxmalf
posterior portion coated with patches of black fur. Pulse 88 \
respiration 16; temperature of trunk normal; reaction of saliva
neutral. R. Continue stimulants and nutritious diet.

8 o'clock P. M. Continues to improve. Up to the present
time, owing to the action of the medicine, the congestive chill,
delirium and weakness, it has been impossible to obtain any
urine for analysis. Urine passed this afternoon orange eolorecL
Amount passed during the last 2-1 hours, grs, 5050 ; calculated
amount for 24 hours, grs. 15,150; sp. gr. 1010; reaction acid.

ANALYSIS LXEX

t'rea, ,

Uric Aeid,

Fix'd Saline Constituents

Grs. 5050 of trine 'Grs. 15150 of Urine' 1000 parts of
excreted during 8 'calculated for 24 hrs. L'rine contain^

hrs, contained grs. contained grs.

IS 495 338.395

3.250 9.750

8.500 26.500

ed,

25.642
0.643
1.683

160 Jones, on Malarial Fever. [March,

Oct. 16th, 11 o'clock A. M. Continues to improve. Tougue
soft, moist and normal in appearance. Keaction of saliva deci-
dedly acid. His appetite is good. Pulse 84; respiration 15.
Urine passed during the night, of a deep orange color; sp. gr.
1014; reaction, when first voided, acid after the lapse of 15
hours, slightly alkaline. Simultaneously with the change from
acid to alkaline, there was the formation of numerous well form-
ed prysmatic crystals of triple phosphate. When the urine was
held in the sun- light, these crystals sparkled like particles of
silver. 1000 parts of urine contained urea 24*761, uric acid
0*029, fixed saline constituents 1*773.

ft. Continue brandy and infusion of Virginia snake root, and
nutritious diet.

ft. Quassia and soda.

Oct. 17th. Greatly improved ; dressed and walking about the
hospital yard. Pulse 72 ; tongue, skin, respiration and tempera-
ture normal. Complains of nothing but weakness.

The captain of the vessel to which this seaman belonged, has
just informed me that his crew consisted of eight men and a
woman (the cook). Four of the men and the cook slept on
board of the ship, lying in the Savannah river. Every one
were taken sick, with malarial fever, and entered the hospital.
Of the four seamen who slept on shore, two were taken sick ;
their attacks, however, were much lighter than those who slept
on board the ship.

CONCLUSIONS.

1. This case illustrates the necessity of watching the action of
purgatives in malarial fever.

I have treated numerous cases of malarial fever, both with
and without purgatives, and from a careful comparison of the
results of the different modes of treatment, have found that the
disease yields much sooner to the action of the sulphate of qui-
nia, after the action of a purgative. The purgative which I
have almost invariably employed at the commencement of the
disease, is calomel. It was administered in doses of from vij. to
xij. grains, conjoined with from v. to vij. grains of the sulphate
of quinia. The liver and portal circulation, and perhaps the
spleen, to a certain extent, are relieved by the action of the pur-
gative, and the sulphate of quinia is absorbed much more readi-
ly and rapidly. The sulphate of quinia appears to affect the
head much less after the action of a purgative. I have frequent-
ly observed, that in both intermittent and remittent fever, the
action of calomel on the alimentary canal, and liver, especially
when accompanied by, and followed with large doses of sulphate
of quinia, was attended with a relaxation of the hard, dry skin,
an increase of the secretions of the dry, red mucous membrane
of the tongue and mouth, and a relief of the cerebral symptoms.

1859.] Jones, on Malarial Fever. 161

The purgative by no means cures the disease. This has been
clearly demonstrated by Cases xxviii., xxxix., xl., xli., xlii.,
xliii., xlvii. The purgative simply excites the alimentary canal
to eliminate and throw off offending matters, and relieves the
congestion of important organs, and thus equalizes the circula-
tion, promotes secretion, and secondarily relieves some of the
nervous phenomena. If the patient was left thus without far-
ther treatment, the malarial poison would still continue its work
unchecked. The purgative " prepares the system " for the ac-
tion of sulphate of qninia and stimulants.

In the administration of purgatives in malarial fever, how-
ever, the practitioner should always bear in mind the important
fact, that there are certain cases, as the present one, and certain
others, already reported, or to be examined hereafter, in which
purgatives will produce, in conjunction with the malarial poi-
son, a sudden and dangerous depression of the system. It is
important that the practitioner should study carefully the indi-
cations for and against the employment of purgatives.

I will state my experience in the following propositions:

(a) Whenever there is a full, rapid, bounding pulse, rapid respi-
ration, and correspending chemical change and development of heat,
whether the tongue be red or pale, dry or moist ivhether the skin be
dry or moist whether the intellect be clear or clouded, a moderate
dose of calomel, especially if it be mixed with sulphate of quinia,
will prove highly beneficial, and expedite the subsequent action of the
sulphate of quinia, and hasten the termination of the disease.

(b) Whenever thefre is a feeble, rapid pulse, and rapid thoracic
respiration, and no corresponding elevation of temperature, {in many
cases a great depression,) with or without a dry, red tongue, with a
dry, harsh shin, or with a cold, clammy sweat, with or without cere-
bral disturbance, with or without restlessness, purgatives should be
rigidly avoided.

(c) Whenever there is a marked want of coordination between the
actions of the circulatory and respiratory systems, and the chemical
changes and consequent development of the physical and nervous
forces, purgatives should be avoided.

(d) If purgatives be administered without being followed
with sulphate of quinia, they act in conjunction with the mala-
rial poison, by diminishing the amount of the blood and de-
pressing the forces.

(e) If purgatives be administered repeatedly, with or without
sulphate of quinia, they may convert a case of simple intermit-
tent or remittent fever, into one of congestive fever.

(f) The best purgative is calomel.

(g) The proper time for the administration of the purgative is
at the commencement of the disease.

(h) After the free evacuation of the intestinal canal, the pur-
gative should not be repeated.

162 Jones, on Malarial Fever. [March,

(i) The action of the purgative, in all cases of malarial fever,
should be carefully watched, and if there is any depression of
the forces, stimulants and sulphate of quinia should be immedi-
ately and liberally administered, and sinapisms or blisters appli-
ed. Carbonate of ammonia is one of the most valuable stimu-
lants in these cases.

2. The tongue did not present the dry, harsh, red appearance,
so common in these severe cases.

I have observed that the dry, red tongue is more common in
the first, than in the second, or succeeding attacks of malarial
poison. This patient stated that he had a severe attack of fever
several years ago on the coast of Africa, at the mouth of the
river Sierra Leone says that this attack was similar to the pre-
sent one. He was out of his head, and no hopes were entertain-
ed of his recovery. The fever was of a malignant type. The
crew of the ship was composed of eight strong, active men, and
out of this number six died. It is highly probable that the dis-
ease was malarial fever. It is reasonable to suppose that this
severe attack of malignant malarial fever left a permanent im-
press upon his constitution, and influenced the symptoms of the
present attack.

In attempting to account for the different manifestations of
disease, we have not, in the present state of science, access to all
the data, such as original constitution, previous habits, and pre-
vious diseases.

It is probable that the course of severe diseases is always modi-
fied by the constitution, diet, occupation and previous habits,
whether virtuous or vicious, temperate or intemperate, and by
previous diseases, and by the relations of the individual and his
ancestors to the climate and soil. We know that in a body of
strong, healthy men, exposed to precisely the same sources of
malarial disease, we may have manifestations of disease, from a
slight febrile excitement, scarcely deviating from the condition
of health, down to the most malignant type, commonly called
congestive fever.

If all have been alike exposed upon the same small ship to
the same poison, whence this difference ?

The difficulty and complexity of this problem, may be com-
prehended, when we state that amongst many other things, its
solution would demand, a knowledge of the previous history of
the physical, chemical, physiological and moral influences of
soil and climate and disease upon the ancestors and even upon
the races would demand a knowledge of all hereditary tenden-
cies, peculiarities of temperament and idiosyncrasy would de-
mand, a knowledge of the relative activity and perfection, of
the individual organs and apparatus, and of the relations of
these to each other would demand a knowledge of the relations

1859.] Jones, on Malarial Fever. 163

of the vital force to the matter of each organ and tissue and ap-
paratus, and to the morbific agent or agents would demand a
knowledge of the action and reaction of the morbific matter
upon the different forms of organized structure, and the conse-
quent derangement of the physical, nervous, intellectual and
moral phenomena would demand a knowledge of the relations
of chemical action to the development of the physical and nerv-
ous forces, and the action of the intellectual and moral faculties
would demand a knowledge of the correlations of the physical,
vital, nervous, intellectual and moral phenomena would de-
mand a knowledge of the relations between physiological phe-
nomena and the phenomena of the exterior universe. Every
candid man will admit that the solution of such a problem is
impossible at the present time, because the facts are wanting ;
and they will be long wanting, owing to the extreme complexi-
ty of the phenomena. A thorough knowledge of pathological
phenomena necessarily includes a knowledge of the relations of all
the phenomena of the universe. The dignity and glory of a sci-
ence should certainly depend upon the multitude and complexity
of its phenomena. We hope, however, that the day will come
when the science of medicine shall be founded upon the im-
movable basis of inductive philosophy, and the world be com-
pelled to recognize the truth, that the solution of the problems
of medicine, requires a higher exercise of the reasoning faculties
than the solution of the most complicated and difficult problems
in physical and chemical science a higher exercise of the rea-
soning faculties, than the solution of even the grandest problems
of astronomy.

Case L. American seaman : height 5 feet, 9 inches ; weight
160 lbs. ; stout, well built; large chest; brown hair; bronzed
complexion ; bilious temperament ; age 45. Has been in Savan-
nah three weeks. Was taken with a chill, Oct. 8th, at 12 o'clock
M., which lasted one hour, and was followed by fever, which
continued without remission for eight hours. On the 9th inst.
(the next day) had no chill.

Oct. 10th, 1.30 o'clock P. M., 1857. Entered the hospital
this morning, at 10 o'clock A. M. At 12 o'clock M., the chill
came on. The chill was well-marked rapid small pulse; rapid
thoracic respiration ; shivering, quivering muscles ; high tempera-
ture of the trunk, and low temperature of the extremities. The
chill lasted one hour and twenty minutes. Nov. 1st, 3 o'clock P.
M. The shivering has ceased, and the circulation in the ca-
pillaries is more vigorous and the difference between the temp-
erature of the trunk and extremities less.

Pulse 130, full ; respiration 46, thoracic. Temperature of at-
mosphere, 685F.; temp, of hand, 100; temp, under tongue, 106.

K. 8. VOL. XV. NO. III. 12

164 Jones, on Malarial Fever. [March,

The difference of temperature between the trunk and extremi-
ties, shows that the relations between the general and capillary
circulations, have not as yet been completely established.

Tongue perfectly dry and feels rough under the finger like
sand paper. Those portions which are not coated by yellow
fur, are of a bright red color. Pressure over epigastric region
causes some pain. Has pain in his chest and a very bad cough ;
says that he has suffered with a cough for one month, and three
weeks ago, " spit blood" ; complains of pain in his bones ; has
taken no medicine.

ft. Calomel, grs. xii.; sulph. quinia, grs. vi. Mix and admin-
ister immediately and follow with castor oil in four hours.
R. Neutral mixture. As soon as fever remits, give 5 grs. of
the sulphate of quinia every three hours, up to grs. xxv.

8 o'clock P. M. Febrile excitement is declining; skin in a
good perspiration, has no pain anywhere, and is very comforta-
ble, ft. Commence with the sulphate of quinia immediately.

Oct. 11th, 11 o'clock A. M. Severe vomiting commenced
last night at 11 o'clock P. M., and has continued unchecked, up
to 4 o'clock A. M., when the nurse administered a mixture of
milk, lime water, and acetate of morphia, which has in a great
measure, checked the vomiting. 26 grains of the sulphate of
quinia have been administered since 8 o'clock P. M. Only 11
grains have been retained. Saj^s, that the calomel and oil opera-
ted immediately, and he was upon the night chair, almost the
whole night. The discharges appear to have been serous fluid,
colored with bile. Says, that he has always been greatly affect-
ed by cathartics, even the smallest doses have produced violent
purgation followed by great exhaustion. I was not aware of
this idiosyncrasy, when the medicine was administered.

Now his extremities are covered with a cold clammy sweat,
and he is completely exhausted. During the action of the
medicine, he was almost senseless from the great prostration con-
sequent upon the violent purgation and vomiting. Pulse, 94;
respiration 22. Temperature of atmosphere, 71F.; temp, of
hand, 79 ; temp, under tongue, 97.

The temperature of the extremities is 19 degrees below the
normal standard, whilst the temperature of the trunk is only 2
degrees below that of health. The pulse is accelerated, 34 beats
to the minute. The respiration is but slightly accelerated. The
temperature of the extremities and trunk do not correspond to
the increased action of the circulation and respiration.

This remarkable reduction of the temperature of the extremi-
ties and trunk, is attended by a complete prostration of the for-
ces.

The respiration is sufficiently rapid and full to introduce large
quantities of the great element of change oxygen ; and the action

1859.] Joxes, on Malarial Fever. 165

of the heart is sufficiently rapid, but not sufficiently powerful,
to distribute the elements of nutrition and chemical change, in
the capillaries of the extremities. The pulse is full and the cir-
culation in the capillaries of the extremities exceedingly slug-
gish. Here we have a condition of the extremities, resembling
that of a well-marked chill. The elevation of the temperature
of the trunk, and the shivering and quivering of the muscles,
characteristic of the well-marked chill, however, are absent.
The temperature of the trunk is absolutely lower than that of
health, notwithstanding the acceleration of the respiration and
circulation. This disturbance of chemical action, this disturb-
ance of the physical forces, this prostration of the nervous and
muscular systems, are, without doubt, due to the simultaneous
actions of the purgative, and malarial poison. Here we have an
instance of vomiting and purgation producing such a disturb-
ance of circulation, respiration abd chemical action, and such a
prostration of the muscular and nervous systems, that a simple
case of intermittent fever is converted into what is ordinarily
called, congestive fever.

The phenomena of this patient during the febrile excitement,
were such as warranted the administration of calomel. The
rule laid down upon a former occasion, did not, however, hold
good, on account of the idiosyncrasy of the patient.

Administered stimulants and sulphate of quinia. His stomach
is so irritable that it will not retain these medicines. Sinapisms
have been applied to the extremities ; bottles of hot water ap-
plied to feet and legs. The mustards have been very slow in
their action, producing but little or no coloration of the skin,
after the lapse of hall an hour. They remained on for three
quarters of an hour, before the skin was decidedly reddened
After the action of the mustards, for three quarters of an hour,
the temperature of his hand is 88, and that under the tongue
97|. The temperature of the extremities has risen 9, whilst
that of the trunk, has risen only fths of a degree. The action of
the stimulant principle of the mustard, has been to excite the
general and capillary circulation, through the sympathetic nerv-
ous system. This excitement has been attended by a more
rapid distribution of the elements of nutrition and chemical
change. These increased chemical changes have been attended
by an increased generation of the physical, muscular and nerv-
ous forces. The increase of chemical change, the increase of
physical force, is attended by a rectification of the aberrated
phenomena of the sympathetic and cerebro-spinal nervous sys-
tems. The restlessness, the feeling of complete exhaustion and
prostration, and the vomiting, have in great measure disappear-
ed. The stomach is now able to retain .stimulants and sulphate
of quinia.

166 Jones, on Malarial Fever. [March,

R. Continue sulphate of quinia, grs. v. every three hours, up
to grs. xl. If the stomach rejects the sulphate of quinia, admin-
ister 10 grs. by the rectum, combined with starch and tincture
of opium, ever j three hours. Continue stimulants and infusion of
Virginia snake-root.

Urine of a brownish red color sp. gr. 1014; reaction decided-
ly acid, even after standing 48 hours. When treated with hy-
drochloric acid, the urine was changed to an almost black color.
After standing 48 hours, there was no deposit. Uric acid in
1000 parts of urine, 0*0197. It was impossible, on account of
the severe purgation, to determine the whole amount of urine
excreted.

Oct. 12th, 12 o'clock M. Says, that he rested well during the
night, and feels better, but is still very weak. Has vomited three
times this morning. The col<|c clammy feeling of his skin, has
disappeared and the patient appears to be decidedly better.
Tongue red at tip, and pointed ; papillae enlarged and distinct.
Pulse 100, much fuller and stronger than during the state of
prostration ; respiration, 30, quick, but gentle ; does not resem-
ble the full, labored, thoracic respiration of many cases of con-
gestive fever. Temperature of atmosphere, 74F. ; temp, of
hand, 100'75 ; temp, under tongue, 101*20. This observation
demonstrates that the increased distribution of blood and oxygen,
has been attended by a decided elevation of temperature. When-
ever there is an imperfect capillary circulation, whenever there
is a deficiency of the elements of nutrition and chemical change,
there will we have feeble forces, and aberration of muscular and
nervous action. The temperature, the muscular force and the
nervous force, depend absolutely upon the chemical changes of
the elements of the living organism, which have been elevated
into a state of force, by the action of the forces of the sun upon
special apparatus, or rather upon a great laboratory, the vegeta-
ble kingdom. The rapidity of the chemical changes, which
develope the forces of the machinery, depend first, upon the sup-
ply and distribution of materials capable of entering into the
constitution of the organs, tissues and apparatus ; secondly, upon
the supply and distribution of materials capable of undergoing
chemical change, within and around the machinery, and thus
generate the forces in positions advantageous for their ap-
plication ; thirdly, upon the replacement of the chemically
altered matter which once formed part of the apparatus (machi-
nery), by new matter ; fourthly, upon the removal of the pro-
ducts of chemical change, which derange chemical action first,
by occupying positions in the apparatus which should be occu-
pied by matter in a state of force, and not by matter which has
lost the amount of force originally received from the sun ; second-
ly, by inducing chemical changes in the wrong position in parts

1859.] Jones, on Malarial Fever. 167

of the organism, where the forces resulting from these chemical
changes cannot be applied, and thirdly, by a direct poisonous
effect upon the organs, tissues, and apparatus, especially upon
the nervous system, which keeps up a communication between
all parts of the system, and controls in a great measure the dis-
tribution of the elements of nutrition and chemical change, by
controlling the action of the respiratory and circulatory appara-
tus. The supply and distribution of the materials of nutrition
and chemical change, depend first, upon the perfection and
action of the vegetable apparatus, and secondly, upon the per-
fection and action of the animal digestive circulatory and respi-
ratory apparatus, related and coordinated by the nervous system.
The study of the animal kingdom, as a whole, demonstrates
that the perfection and action of the respiratory and circulatory
systems may be taken as an index of not only the physical and
chemical changes of the organized fluids and solids, but also of
the development and perfection of the organs and tissues and
apparatus, and of the activity and intelligence of animals. The
action of the respiratory and circulatory apparatus, the coordi-
nation of this action, with the action and wants of the muscular
and nervous systems, and of all these organs and tissues and
apparatus, is guided by the nervous system, in which a special
force is generated excited and guided by nervous force, but not
carried on by nervous force, independent of chemical change.
Chemical change in the organs and apparatus, and chemical
change in the nervous systems, is the source not only of heat,
but of muscular and nervousforce, and of all the forces generated
in the animal economy. The generation of any force vital, ner-
vous, chemical or physical,in the animal economy, independent of
antecedent force, would destroy the great law upon v:hich the stabili-
ty of the universe rests, that force is indistructible would destroy
the gi*eat law Uiat action and reaction are equal. All the forces
in the animal economy are generated by chemical action. The
various organs and apparatus are simply arrangements for the
preparation of materials suitable for chemical change, and for
the application of the forces generated by chemical change. Ac-
cording to this view, the action of the vital force, like that of foe intel-
ligence, is limited to a guidance and direction of the forces with which
the Creator has endowed all matter. The action of the vital prin-
ciple upon matter, like that of the intelligence, does not consist,
either in a creation of matter or in a direct movement of matter,
independent of the forces of matter, but in the mere guidance and
application, of the forces of matter, so that definite forms are de-
veloped from formless matter, and definite results accomplished.
According to this view, the vital principle and t)ie intelligence, can-
not create force, any more, than they can create matter. Their in-
fluence is limited to an excitement and application of the forces

168 Jones, on Malarial Fever. [March,

of matter. We judge of the influence of one just as we judge of
the influence of the other. The complicated machine points to
the existence of an intelligence distinct from matter, which has
so applied the forces of one portion of matter, that another portion
has been moulded into definite shapes and formed into definite
apparatuses, capable of accomplishing definite results when acted
upon by forces generated and applied in the right manner. We
infer the existance of the intellect by the results of its applica-
tion of the forces of matter. In precisely the same manner, do
we infer the existence of the vital principle. The vital princi-
ple directs the forces, resulting from the chemical changes of one
part of matter, in such a manner, that surrounding matter is
fashioned, moulded into definite forms and apparatuses, destined
to accomplish definite results. This apparatus cannot be worked
by the vital principle, independent of chemical change, any more
than a watch will run, or any machine accomplish various me-
chanical effects, without a supply of exterior force, or a steam
engine accomplish mechanical effects, without the development
of force by the chemical changes of matter, which has been eleva-
ted into a state of force (placed in a state capable of undergoing
chemical change), by the forces of the sun.

The development and structure of the vegetable kingdom, the
development and structure and actions of the most simply con-
structed animals the appearance of the nervous system in the
animal kingdom, and in the foetus of the higher animals, subse-
quently to the grouping of the atoms of formless matter into
definite forms and apparatuses; the formation of the digestive
and circulatory apparatus before the formation of new cells
and nervous systems, demonstrate unequivocally, conclusively
and absolutely, that development, nutrition and the direction of
the forces of one part of matter, to the fashioning of another
part, are under the guidance of the vital principle demonstrate
unequivocally, conclusively and absolutely, that the nervous
system itself is developed, and its perfection maintained under
the guidance of the vital principle. The nervous system, is the
last and best work of the forces of matter directed by the vital
force ; and is destined to connect together and influence the vari-
ous organs and apparatuses; and is destined to regulate secretion
and excretion, and the consequent development of force; and is
destined to excite and control the actions of the dynamic muscu-
lar apparatus, not by the possession and emission of a peculiar
force generated de 7iovo, but rather by a modification of physical
force generated by the mutual chemical reactions of the elements
of the blood and nervous systems. The truth of this proposi-
tion is conclusively demonstrated, by the fact, that an arrest of
chemical action is immediately atttended by an arrest of nerv-
ous and muscular force.

1859.] Jones, on Malarial Fever. 169

During the last 24 hours, has taken and retained, 25 grains of
the sulphate of quinia. R. Continue stimulants. Diet, wine
whey and arrow root.

Urine orange colored ; sp. gr. J 020; reaction decidedly acid,
and remained so longer than 60 hours. After standing 5<> hours,
there was a slight deposit of epithelial cells, mucous corpuscles
and cylindrical casts of the tubuli uriniferi. Amount of urine
collected during the last 24 hours, grains, 6120. The patient
affirms that this was the whole amount passed during the last
2-i hours. When the urine was evaporated to the consistence
of a syrup, and treated with nitric acid, there was a powerful
effervescence, and the urine assumed a dirty, brownish yellow
color, and the nitrate of urea, presented a brownish black color,
and imperfect crystalization. When the urine was concentra-
ted by evaporation, it assumed a brownish black color. When
the unconcentrated urine was treated with hydrochloric acid,
it assumed a dark mahogany, almost black color. The solid
matters of the urine appeared to consist principally of the color-

ANALYSIS LXIV.

Grs. 6120 of Urine, collected dur-
ing 24 hours, contained grs.

1000 part* of Urine
contained,

Urea,

41.960

.060

43.800

6.822

Uric Acid,

0 . 0( i9

Fixed Saline Constituents.

7.156

This examination of the urine shows, that during the reduc-
tion of the temperature of the body and exhaustion of the forces,
the urine was excreted in less amount, and altered in quality.
Here we have a demonstration of the previous propositions,
that animal temperature and muscular and nervous force, are
the results of chemical change, and that the reduction of tem-
perature is attended by the generation of chemical compounds
different from those of health, and that the malarial poison acts
by inducing chemical changes in the elements of the blood and
organs, different from the chemical changes of health. The fact
that the chemical changes of the nutritive and force elements in
the capillaries of the muscles and nerves and bones of the ex-
tremities, and surface of the trunk and head, were very small,
and the fact that the blood was congested in the blood-vessels
of the trunks, render it probable that the peculiar coloring mat-
ter of the urine was derived from the disintegrated blood-corpus-
cles.

8 o'clock P. M. Says that he feels very weak ; has been vom-
iting bile. Three hours ago, 6 cut cups were applied over the epi-
gastric region, without any arrest of the vomiting. Tongue very
red at tip, and the surface is dry and rough, like sand paper.

170 Jones, on Malarial Fever. [March,

The patient appears to be completely prostrated. Pulse 104.
ft. Apply a blister, 6 inches by 6 inches, immediately over the
epigastric region, and as soon as it blisters, if the vomiting is not
arrested, remove the cuticle, and sprinkle over the raw surface,
1 grain of the acetate of morphia. Stop all stimulants, and ad-
minister internally small fragments of ice, and milk and lime
water, and acetate of morphia.

Urine, orange color ; sp. gr. 1016. Amount passed during
the last 8 hours, grs. 10160 ; calculated amount of urine for 24
hours, grs. 30480 ; reaction decidedly acid. Here we have a
decided increase of the urine.

Oct 13th, 1 o'clock P. M. Says that he feels much better.
Pulse 86, fuller and stronger; respiration 28. Temperature of
atmosphere, 76. ; temp, of hand, 91 ; temp, under tongue, 98*5.
Surface of the body in a profuse perspiration, which feels cold to
the hand. The temperature of the extremities does not corres-
pond with the increased circulation and respiration. The blister
has drawn well and the serum is of a light yellow color, and
not the golden color of many cases of remittent and congestive
fever. The blister and the accetate of morphia and ice have
completely arrested the obstinate and violent vomiting, ft. Sul-
phate of quinia, grs. xv. ; tincture of opium, ^[ xx. ; starch, f I iv.
Mix and administer immediately as an enema, and repeat in the
course of four hours. Diet, arrow-root and chicken soup.

Amount of urine passed during the last 15 hours, grs. 8112.
Color only a shade darker than normal ; sp. gr. 1014 ; reaction
decidedly acid after standing .30 hours. No deposit after stand-
ing 30 hours.

ANALYSIS LXV.

Grs. 8112 of Urine, | Grs. 12979 of Urine, 1 1000 pts. of

Urine, con-
tained,

excreted during 15 calculated for 24 hrs
hours, contained grs. I contained grs.

Urea,

Uric Acid,

Fixed Saline Constituents,

159.080

254.528

2.000

3.200

16.800

26.880

During the last three days the patient has been able to retain
little or no nourishment, so that this is the urine of starvation.

Oct. 14th, 11 o'clock A. M. Much better dressed and
walking about the ward. Pulse 72, full and strong ; respiration
22. Temperature of atmosphere, 78"5F. ; temp, of hand, 96.75 ;
temp, under tongue, 98. Skin feels normal. The cold clammy
sweat has disappeared ; tongue clean, but redder than normal.
Although the vomiting has almost entirely disappeared, still the
stomach is unable to retain the sulphate of quinia. ft. Kepeat
the enema of sulphate of quinia. Diet, wine whey, soft boiled
eggs and arrow -root.

Oct. 15th. Continues to improve. Pulse 64 ; respiration 24.

59.] Jones, on Malaria. 171

Temperature of atmosphere, 743F.; temp, of hand. 8 mp,

under tongue, 98*33. Tongue still quite red. but moist and soft.
The amount of urine has greatly increased. During the last 20
hours, has passed 30,360 grains of light yellow urine, which
rapidly changes from the acid to the alkaline reaction, and lets
fall a yellow deposite. Sp. gr. of the urine passed during the
night, 1010 ; sp. gr. of the urine passed during this morning,
1014. Amount of uric acid passed during the last 10 hours,
grains 28. This is at the rate of 67 grains of uric acid during
the 24 hours. This examination confirms the statement previ-
ously made and substantiated in former numbers of the journal,
that, as a general rule, the uric acid is either normal in amount
or diminished, in the activ of malarial fever, and increas-

es during convalescence. As in the present case, this increase
of the uric acid may take place even whilst the patient is under
the influence of sulphate of quinia. ft. Infusion of Virginia
snake-root, and sulph. of quinia. Diet, oyster soup, wine-whey
and arrow-root.

Oct. 16th. 1 o'clock P. M. Still very weak, but continues to
improve. Tongue not so red. moister and softer : reaction of
saliva alkaline up to this time it has been decidedly acid.
Pulse 56: respiration 22. Temperature of atmosphere, 71=5F. ;
temp, of hand, 96: temp, under tongue. 93*75.

Urine light straw-color, becomes alkaline, and throws down
a light yellow deposit, after standing a few hours ; amount pas
during the last 24 hours. 29.000 grains : sp. gr. of the urine pass-
ed during the evening and night, 1010 Sp. gr. of the urine
passed this morning, 1005. 100 parts of the urine passed this
morning contained, urea, 8*636 ; uric acid, a trace, a few small
crystals: fixed saline constituent- This examination

shows that the elimination of uric acid has greatly diminished in
the course of a few hours.

Oct. 17th. Has been walking about the hospital grounds.
Pulse 60: respiration. 26. Temperature of atmosphere. 64F.;
temp, of hand, 94*75 ; temp, under tongue. 99. The exercise
will account for the acceleration of the pulse and respiration,
and the free exposure of the hands to the cool morning air will
account for the slight diminution of temperature. Reaction of
saliva acid. The acidity, however, was not so intense as in the
paroxysms. Yesterday the reaction of the saliva was alkaline.
During the a- f malarial fever, the saliva, according

to my observation as decidedly acid : whilst during con-

valescence it is generally alkaline, but may vary from alkaline
to slightly acid. This change in the intensity of the acidity of
the saliva, corresponds, in a general way, with the diminution
of acid in the urine, ft. Quassia and soda. Full nutritions
diet. Amount of urine passed during the last 24 hours, grai

y.s. vol. xv. >o. in. 13

172 Clark, on African Fevers. [March,

21,000. Urine passed during the last afternoon, evening and
night, orange colored ; sp. gr. 1014. After standing a few hours,
the reaction changed from the acid to the alkaline, and a heavy
light yellow deposit was thrown down. Urine passed this
morning of a light straw color ; sp. gr. 1004.

Oct. 19th. Says that he feels as well as he ever did in his life.
Has been walking about the hospital grounds. Pulse 60 ; respi-
ration, 24. Tongue, skin and temperature normal; blister
almost entirely healed. This patient had no return of fever, and
was discharged from the hospital a few days after this observa-
tion.

(To be continued.)

ARTICLE VII.

African Fevers Intermittent and Remittent By Eev. William
H. Clark,* returned Missionary from Africa, attending Lec-
tures in the Medical College of Georgia.

I herein submit a report of a few cases of Intermittent and Ee-
mittent fevers, that came under my observation in Yoruba,
Southern Soudan Africa, the notes of which are taken down
from memory, after a lapse of one, two and three years, with the
intention of showing the similarity of such diseases, to those so
familiar to the Profession in the Southern portions of our own
country. . I might number cases 1, 2, 3, 4, 5, 6 all precisely the
same in symptoms, progress and termination, with the common
intermittent, the perfect cure of which is made by a free use of
our specific Quinine.

E. GL Case I. white. Morning cloudy and damp ; sudden
change in the weather; patient becomes chilly avoids the
wind ; finally seeks his bed, and suffers from a hard chill. This
stage is followed by a burning fever, headache, pain and tight-
ness over the epigastrium. Symptoms all 'disappear with the
sweating stage, which now becomes profuse. The bowels are
costive and tender on pressure. Slight laxative administered
quinine freely given, during intermission. Paroxysm prevent-

* Mr. Clark designs returning to Africa during the coming season to resume his
missionary labors. [Edts. S. M. &, S. J.

1859.] Clark, on African Fevers. 173

ed. Patient convalescent within a few days, recovery being
in all cases of this kind very rapid.

Case II. Patient has complained for the last twenty -four
hours of general debility, some pain in the head, aching of the
bones over the whole system. Breakfasted moderately. Within
an hour had a chill. Yomited freely some relief. Put to bed
hot bottles to the feet. Severe pain in the head application of
cold water. Patient drank freely of warm tea, an infusion of a
leaf, something like peppermint. Sweating soon followed hot
stage. Patient much relieved, becomes cheerful and free from
pain. Quinine freely administered paroxysm prevented re-
covery speedy.

In some cases fever persists, and, without due caution, the
second paroxysm supervenes.

Case III. Female, white. "When first seen, was in bed, jo-
vial and free from fever, during intermission. Second paroxysm
prevented. Bowels became deranged, marked by symptoms of
dysentery several bloody discharges, that yielded to a few
opiate doses. Patient seemed to be doing well fifth or sixth
day was walking about the room one or two days following;
seemed to have had fever previous night. Quinine, in small
doses, was administered through the day. Fever supervened
suddenly, without chill it assumed continued form. Skin now
dry ; pulse about one hundred ; tongue tolerably clean ; com-
plains of no pain. About 8th or 9th, had hopes patient would
soon be up ; but the fever continues, though not very high ;
skin dry; no pain. About 12 o'clock, noticed anxiety inpa-
tient wished me to be with her seemed in good spirits, but
anxious. Did not complain of pain ; spoke favorably of herself.
Quinine given in small doses. Early in afternoon stepped into
an adjoining room. Within a short time I was called by at-
tendant. Patient was delirious recognized no one became
almost uncontrolable ; had then burning fever; inspirations
strong and deep. Within a few moments after entering the
room, she began to sink, and expired within a quarter of an hour.
I had not recognized any very alarming symptoms heretofore
in the patient. Death must have resulted from congestion of
the brain.

174 Clark, on African Fevers. [March,

Case IY. Patient, man, white; two hundred miles from the
coast ; country open rolling no malaria ; swamps unknown.
Patient had a chill, with intermission. When called to him, I
ascertained a fact, not known before, that his fever was continu-
ed. Found him haggard, bilious and stupid ; very little rest
during the night. Bowels costive ; pulse quick and small ; skin
dry ; tongue of rather a brown color. Gave nine grs. calomel.
The skin becoming slightly moist, administered a dose of calo-
mel and Dover's powders. Within a few hours, free bilious
discharges. Then administered quinine,, very freely, for twent}^-
four hours. Patient rested well during the night. In the
morning free from fever. Quinine continued. In a few days
the patient was convalescent.

Case V. Subject the writer. Had been suffering from indi-
gestion, costiveness and derangement of the liver, for several
weeks ; was thin, pale, and suffering hourly with a throbbing,
acute pain in the head. Took exercise very freely sometimes
very early in the morning, before breakfast, but without any
increase of appetite. Felt very dull and sluggish sometimes
even to stupor. Pain in head became insupportable, attended
with something like a chill or ague. Went to bed. Had taken
qninine very freely sweated profusely very much relieved
by a cathartic discharged bile copiously. Arose on the follow-
ing morning much refreshed, though sluggish, with some pain
in head ; no fever. Within a few days, was called to see a sick
friend, sixty miles distant. Went to bed early ; suffered from
pain in the head ; rested badly ; arose unrefreshed. Still suf-
fering from pain and oppressed with more or less stupor. Start-
ed on my journey by four o'clock, on horse back.

Early in the morning, had a natural stool, though fasces was
hard and scanty. By 12 o'clock, had travelled thirty-five miles.
Kested one hour. Took a cup of tea and a little refreshment.
One o'clock, ordered my horse. Before mounting, was astonish-
ed to find my urine very highly colored, like blood. After
riding four or five miles, was compelled to dismount to dischage
urine, it was more highly colored. I became sick at my stomach,
and weak. For eight or ten miles, alternated riding and walk-
ing, making water every few hundred yards sometimes com-
pelled to rest from weakness and pain. After sunset reached a

1859.] Clark, on African i 175

town, and retired to rest, without a grain or drop of medicine,
my chest being miles behind me. I ordered a little infusion of
the African peppermint ; could not drink it, because very sick
at the stomach. Vomited continually, with a discharge, hard,
natural, and a rigor simultaneously. Again vomited thought
I could taste blood. Burning fever. Death seemed almost in-
evitable. Ordered my hammock, and told the men to take me
to Ijaye. Now, late in the night, no attendant but my little
boy, while thus vomiting, took a teaspoonful or more of tea. It
seemed to act like a charm: vomiting ceased, pain subsided, and
I lived through the night, contrary to my expectation. Early
next morning, in a very weak state, was borne on a hammock
about twelve or fifteen miles. Eeaching the station, and finding
the crisis of my friend's disease had passed, I took myself 7 grs.
of calomel, and went to bed. Had a chill, followed by good
reaction and fever. Calomel gave several bDious discharges.
Took no more calomel, but took quinine very freely. On the
third day I was very weak, and could not get up. During an
entire week, my urine was like blood gradually, however, it
changed its color under a very free use of quinine. During this
time I had slight fever through the day and night My rest
was very bad, and anything but refreshing. I was now pale and
corpse-like, and scarcely able to put one foot before the other.
Took no medicine but quinine, and an occasional laxative
once or twice a little wine as a tonic recovering very slowly,
and as yet no apppetite. Ten days after this, I could walk a
few hundred yards, with difficulty; unceasing pain in the head;
bowels costive, and ringing in the ears, from the quinine. Af-
ter the lapse of two weeks, I started for my home rode twenty
miles first day, and thirty -five on the second da}7, by 2 o'clock-
Regained my strength, gradually, for several weeks. This attack
was in the dry season, and one of several similar cases.

The country in which these cases occurred, is from 120 miles
to 200 miles from the coast open, undulating and well water-
ed, and in the dry season, very dry. Around one of the places
is a heavy wood, and a branch running through and near it,
and it is swampy. Near it, on one side, the natives say it is
haunted, because no one can live there. On two other sides the
ground is covered by heavy woods, but the country generally

176 Dugas, on Treatment of Fractures. [March,

is open and rolling. The other locality is on the water-shed
that divides the waters that flow respectively to the Niger and
Atlantic it is high, dry and open, with no swamp, no woods,
and to all appearances healthy the general range of the ther-
mometer being from 80 to 85 deg. Fah. No excessive heat
no excessive rains.

ARTICLE VIII.

The Treatment of Fractures of the Femur below its Neck. By
L. A. Dugas, M. D., Professor of Surgery in the Medical
College of Georgia.

In the treatment of fractures of the thigh and leg we have not
only to retain the fragments in their normal relation to each
other, but we must do so with the least possible inconvenience
to the patient, and with the greatest surety of success. The
unruly action of the muscles must be controlled, the tendency
to shortening or other deformity of the limb overcome, and
abrasion of the heel effectually prevented. In order to accom-
plish these purposes and, at the. same time, to allow the patient
the privilege of changing his position, so as to answer the calls
of nature, and to add otherwise to his comfort during the pro-
tracted treatment usually necessary in such cases, I have been
for many years in the habit of resorting to the plan I am about
to describe. I will not attempt an array of objections to the
apparatus of Desault, as originally devised, and subsequently
variously modified ; nor will I urge any aversion to the more
approved expedients which are necessarily restricted to well
endowed hospitals and to special practitioners of surgery, be-
cause they cannot be in the possession of the great mass of
physicians. The apparatus I use consists of materials readily
obtained anywhere, upon the occurrence of the accident.

In fractures of the os femoris, below its neck, the patient should
be placed horizontally, upon a hard bed, and an assistant should
seize the foot so as to make the necessary traction while the
surgeon is bringing the fractured ends in their proper relation
to each other, and until the completion of the dressing. I then

1859.] Dugas, on Treatment of Fractures. 177

apply around the thigh from four to six wooden splints, about
a fourth of an inch thick, and of the length of the shaft of the
bone. These are laid upon suitable compresses, and well secured
with two many-tailed bandages, of sufficient width to extend
over the whole length of the splints, and with the knots tied in
front. A two pound weight should then be attached to the foot,
as follows: Get a bandage, or tape, an inch wide and two and a
half yards long ; apply the middle of this across the sole of the
foot ; bring the ends up over the ankles and along the sides of
the leg ; secure them in this position by means of a two inch
roller-bandage carried several times around the limb just above
the ankles ; turn down the ends of the tape and tie them in a
knot at the sole of the foot; attach the weight (a bit of stone
will do) to the united ends of the tape, and finally, carry the
weight over the foot-board of the bed, so that by thus hanging
it may keep up the traction after the assistant releases his hold
upon the foot. The upper edge of the foot-board should be on
a level with ankles in order that the tapes whieh bear the
weight should pass horizontally from their attachment to the
board. It is evident that if the foot-board were too high
or too low the effect would be to elevate or to depress the heel,
instead of making the traction alone in the direction of the axis
of thelimb, as should be done.

We should now apply to the outer side of the limb a splint
half inch thick and four inches wide, extending from the waist
of the patient to six inches below the sole of the foot. This
splint may be secured by separate ties around the trunk, thigh
and leg, and will serve the double purpose of ^preventing any
displacement of the bones and of supporting the foot in its pro-
per position, toes up. A compress being placed between the
foot and this splint so as to prevent chafing, a narrow bandage
should secure the foot to it Finally, an arch, made with hoops
tied together, should be placed over the foot to protect it from
the weight of the bed-clothes.

It is obvious that with this apparatus the patient may change
his position in bed, either from side to side or from above below
without incurring any risk of displacing the bones, and without
lessening the traction necessary to overcome the contraction of
the muscles. The weight will rise or fall as he moves up or

178 Dug AS, on Treatment of Fractures. [March,

down, and when he desires to move to one side the nurse may
at the same time carry the tape correspondingly so as to continue
the traction in the proper direction. The weight, although
apparently small, will be found amply sufficient, and indeed as
great as the patient will tolerate without inconvenience. The
weight of the body will serve the purpose of counter-extension.

I have already said that the patient should be upon a hard
bed. This will keep his body and limb in a horizontal position
and prevent any bending at the seat of fracture. By this plan
of treatment we effectually avoid the abrasions or chafing which
so often attend the use of splints that bear upon the perineum
and axilla. This apparatus has also the advantage that it may
be loosened or tightened without difficulty, according to the
exigencies of the case. If it be desirable, at any time, to place
the limb upon a double inclined plane, this may be done by re-
moving the long splint without interfering with the short ones.

No roller-bandage is used, for reasons fully set forth in this
journal, vols, for 1850, p. 80, and 1854, p. 69. The annexed
Plates will explain themselves but I should observe that in
Fig. 1, the long splint is omitted, in order not to mask the limb,
and that the short ones are not represented quite long enough.
These plates are similar to those which appeared in the Transac-
tions of the American Medical Association, vol. x., 1857.

*

1859.]

Dugas, on Treatment of Fractures.

179

Fig. 1.

Fig. 2.

180 Lecture on Asthma. [March,

Lecture on Asthma. Delivered at Hotel Dieu, by Prof. Trous-
seau. Translated from the Gazette des Hopitaux of August
26th, 1858, (for the Boston Med. and Surg. Journal.)

Asthma is a disease which manifests itself bj attacks of dys-
pnoea and oppressed breathing, returning at more or less regu-
lar periods, after a longer or shorter intermission, and in the
intervals of which the respiratory functions are performed with
their accustomed regularity.

Whether these attacks come on from the influence of material
causes or not, whether they are related or not to the existence
of appreciable organic lesions, asthma is a complaint in which
the spasmodic element prevails over all others, in which the
nervous system plays a capital part.

An individual in the full enjoyment of health, not having
indulged in any excess of eating or drinking, not suffering from
dissipation or exhaustion, retires at night as well as usual and
sleeps quietly. An hour or two after, he is suddenly aroused
by an attack of the most distressing dyspnoea. He feels within
the chest a sense of compression and tightness, great uneasiness ;
his respiration is difficult and accompanied by a laryngo-bron-
chial wheezing, particularly during inspiration. This dyspnoea,
this anxiety increasing, the patient rises to a sitting posture.
Supported on his hands, with his arms thrown out behind, his
face swollen, sometimes livid, or of a purple hue, his eyes start-
ing, his skin covered with sweat, he is soon obliged to spring
from the bed ; and if the apartment which he occupies has not a
sufficiently lofty ceiling, he hastens to open the window and
seeks from without the air which he needs. This fresh air re-
lieves him. The attack lasts one or two hours, and sometimes
more ; then comes a calm. His face resumes its normal color,
and loses its swollen appearance. The urine, at first clear and
rather abundant, diminishes in quantity. The patient finally
lies down and resumes his interrupted sleep.

The following day he goes about his business, leads his usual
life, retaining sometimes a sensation, more or less vague, of con-
striction about the chest ; often, however, having nothing but
the recollection of his past sufferings. At night, almost at the
same hour, the attack is repeated, precisely like the first one,
37ielding, like that, to return again the next night, and returning
thus for three, four, five, ten, twenty, and even thirty nights
constituting a genuine attack of asthma. This attack, the return
of which is not governed by any rule, is not renewed, in some
persons, under four or five years, and is repeated in others every
year, and in others oftener still.

This is the ordinary form of pure asthma, coming on without

1859.] Lecture on Asil una. 181

any appreciable exciting cause, without any material agency
that can be seized upon, without being related to any organic
lesion susceptible of demonstration.

Let us now look at it as produced under the influence of a
determinate cause. I will take my own case for an example,
subject as I have been for a long time to this complaint ; for
always, in my case, the attacks are repeated under peculiar cir-
cumstances.

The most violent attack that I ever experieuced came on
under the following circumstances.

I suspected my coachman of stealing the fodder of my horses.
To ascertain the fact, I mounted, one night, to the granary,
where I measured the stock of oats. After finishing this opera-
tion, I was suddenly seized with such an attack of oppression
and dyspnoea that I had hardly strength to reach my apartment ;
my eyes protruded from their sockets : my face, pale and swol-
len, expressed the greatest anxiety; I had just time to tear off
my cravat, to rush to the window, to throw it open for a little
air, to avoid suffocation. Although I did not habitually use
tobacco, I begged, or rather by my signs I made those about
me understand that I wanted a cigar, of which I took several
whiffs ; eight or ten minutes after, the attack was over.

^Vhat had caused this ? Certainly the dust of the oats by
which I had been surrounded, some grains of which had pene-
trated my bronchia. But most certainly, also, the dust would
not have been sufficient, of itself, to cause so violent an attack,
for this cause was quite out of proportion to the effect produced.
A hundred times in the streets of Paris or on the boulevards, a
hundred times on the public roads, I had been surrounded by
an atmosphere of dust much heavier than that of the oats of
which I had breathed only a few grains, but I had never suffered
anything of the kind ; it must be, then, that this cause had sur-
prised me under peculiar conditions. Under the influence of
the moral emotion which guided me every one will understand
me the idea of this domestic theft, trivial as it was my nervous
system was excited, and under these conditions a cause, which
under ordinary circumstances, would not have had any such
effect, even if it had been increased fifty fold, acted, in this par-
ticular case, although hardly deserving to be represented by the
power of one. This cause was the spark, which, falling upon
the dry straw, was alone sufficient to kindle a great fire.

I have three more curious cases of the same kind, and an analo-
gous one has been reported, as well as I can recollect, by Muret,
in his Apparatus niedicaminum.

An apothecary of Tours, slightly asthmatic, always had an
attack when powdered ipecacuanha was disturbed in his presence.
It was not merely when this root was pulverized, it was only

182 Lecture on Asthma. [March,

necessary to weigh it in his shop to bring on an attack of fearful
distress, which lasted half an hour. Things came to such a pass
that he made them notify him whenever ipecac was to be used,
that he might retire to his own room. No other powder or dust
produced in him such effects.

I know another apothecary, established at /Sfc. Germain en
Laye, in whom the attacks of asthma, to which he was subject
all his life, were produced under precisely the same circumstan-
ces, and also from the influence of powdered ipecacuanha.

Finally you may interrogate a woman who entered the hos-
pital for rheumatic pains, who occupies bed No. 6, in St. Ber-
nard's ward. She is 43 years old, and remarkably stout.
She will tell you that, born of a father perfectly healthy up to
the present time, of a mother who died of a dropsy, probably
symptomatic of a disease of the heart, if we believe all the details
which she gives us, she always enjoyed perfect health up to the
age of 2-3 years. Married at that time, she was taken with
asthma, of which the attacks returned at intervals during two
years, ceased after the nursing of her children, and never return-
ed. The attacks came on about two or three o'clock at night,
lasted all night, and left the patient until mid-day in a painful
state of exhaustion and oppression ; the rest of the day she ap-
plied herself to her usual occupations. What I wish to call
your attention to particularly, is, that these attacks were never
more violent than when they were produced under the influence
of a cause designated by many asthmatics ; I have not, myself,
alluded to it in speaking with this patient, but she herself told
me that she was immediately seized with an attack whenever
she happened to be in her chamber at the time her feather-bed
was shaken up. These facts it was important to mention.

In the first case, then, which I have given you, asthma came
on without any known or appreciable cause ; in the last three,
the attack was produced by an influence from without ; but in all
of them the disease was purely spasmodic.

To proceed. A man is taken, without exposure to any of the
causes of catarrh, with a violent coryza; he sneezes twenty,
thirty, forty times in an hour, he looks pinched, his nose runs
profusely, a clear, liquid mucus; this coryza lasts a day or two,
and the patient seems to have a regular catarrh ; he has at first
a, nasal catarrh, then a laryngitis, and then a bronchitis ; he
coughs a little ; toward evening an attack of asthma comes on.
I say toward evening, for ordinarily asthma comes on at night,
although there are cases in which it comes on in the day, as
there are others in which the attacks are both diurnal and noc-
turnal, the former being remittent, the latter intermittent.

We here have the organic affection, the catarrh, the bronchi-
tis, to which the spasmodic affection seems evidently to be at-

1859.] Lecture an Asthma, 183

tacbed; so decidedly does it appear that this is the case, and
even that it is dependent upon it. that in this instance the asthma
will be regarded as a symptom. Nevertheless, it is not so. The
spasmodic affection is so little dependent on the inflammatory
one, that the same individual who has had an attack on the
occasion of a slight cold, on being taken with a more serious
bronchitis, or even pneumonia, this patient will not have asthma.

I am in the habit of attending a rich capitalist, who lias been
subject to fearful attacks since the age of 25 years. These at-
tacks are so violent, that for fifteen years, he certainly has not
slept seven months in his bed ; he can only sleep upright, lean-
ing against the chimney-piece. Fifteen years ago he caught a
broncho-pneumonia of the most serious character, on going out
of the theatre; he was so seriously ill, that fears were entertained
for his life. During the whole course of his sickness, he had
not one attack of asthma. He who could not sleep in his bed
until it was arranged as an arm chair so that he was sitting, not
lying rested during the whole time of his pulmonary attack,
stretched out full length on his back. Often, since then, he has
had colds, but never at those times has suffered from asthma.

The organic lesion, then, is not the disease ; undoubtedly the
bronchitis plays its part in the production of asthma under these
circumstances, but it only plays it because it has found the scene
prepared ; because it has found the patient placed under pecu-
liar conditions, without which, its influence would have been
entirely insufficient. The effect produced is not in proportion
to the cause; other more powerful causes would have acted in
vain, unless they had found, like this, the economy in the con-
dition necessary for the evolution of the malady they were to
produce. Asthma has, then, its personality ; it has also its eccen-
tricities, like all other nervous disorders.

Let us see now how it appears, according to the individuals
affected, and the period of life.

In childrenT its Avays are so peculiar that often it may be mis
understood, and perhaps I was one of the first to point out its
existence in youthful subjects. If there have been children who
have had asthma precisely after the manner of adults, it is rare,
and, for my part, I do not remember to have seen it so decided-
ly characterized except in a single instance. It was in a child
five years old, a young Moldavian ; he had very decided attacks
of asthma, very well characterized, which were associated with
pulmonary emphysema. On inquiring about the influences
which might be acting in his case, I found no trace of any here-
ditary affection,, either gout or rheumatism.

Two years after his first visit, they brought me the little
patient writh a great red, swollen, painful great toe ; he had an
attack of acute gout, of the most decided, legitimate character.

18i Lecture on Asthma. [March,

This is also the only case of gout which I ever saw in a child ;
I have never seen one since. The arthritis attacked the knees,
and nothing resembled less acute articular rheumatism. During
this attack of gout, the patient had not a single attack of asthma ;
these things took place according to rule, for, as I shall tell you,
gout and asthma are often two manifestations of the same diathe-
sis, and their attacks may alternate in the same person. It was
so in my little Moldavian ; he had attacks of asthma alternately
with attacks of articular gout.

This form of asthma is, I repeat, that of adults; in the child,
it follows quite a different course. Cases will teach you more
than the best description ; and besides, this last is impossible
from the variety of its forms.

One of my associates, of vigorous constitution, had two child-
ren whose health was very delicate. Their mother was one of
those reasonable hysteric persons, in whom the disease affects
more the trisplanchnic nervous system than that of the life of
relation.

One of these children was taken, one day, with symptoms of
capillary pneumonia ; the systems manifested themselves, so to
speak, in a terrible manner, and assumed, subsequently, a grave
form. An hour after the commencement of the attack, I was
summoned. I found very abundant sub-crepitant rales, great
embarrassment of the respiration, exciting apprehension of im-
minent suffocation. I directed a large fly blister to be immedi-
ately applied to the chest. Three days after, recovery was com-
plete. My treatment had had a success too marvelous, and
above all too rapid, for me to assign to it all the honor of the
cure. I was considering myself only too happy at the result
obtained, when a few days after, the same symptoms re-appear-
ed ; they lasted but forty-eight hours. But this time, even more
than the first, I was convinced that in this case I had something
else to deal with than a pneumonic catarrh.

I called to mind what the lobular pneumonia of children is ;
while my experience showed me that, both in hospital and pri-
vate practice, I had never lost a child affected with pure lobular
pneumonia that this malady yielded generally, not to say al-
ways, under the intervention of art the same experience had '
also taught me that it is not always so with lobular pneumonia.
Of little importance when the subject of it has passed his second
year, during the first period of infancy it is so formidable that,
out of forty-two cases, I had seen forty die, whatever the treat-
ment had been.

Then, on considering that the son of my friend had been
cured of so terrible a disease, the first time in three days, the
second in two, I doubted my diagnosis, or at least I completed
it by looking back to his hereditary antecedents and thinking

1859.] Lecture on Asthma, 185

what his mothor was. I said to myself that in this case the nerv-
ous element must have played an important part, if it had not
occupied the whole stage. Therefore, when, three months after,
I was again called to see this little patient) who, after playing
as usual, was seized in an instant, about ten or eleven o'clock
at night, with an attack as formidable in appearance as the first
I advised burning in the room datura stramonium, in order to
combat the spasmodic element. The following morning the
child was on his feet.

This complaint had been, then, a true neurosis of the pulmo-
nary apparatus, complicated with a bronchial secretion, acting,
in this respect, in the same way as the neuroses which are so
often accompanied by secretion, as I have had reason to tell you
on many occasions.

I had been dealing with an attack of asthma. It was the first
time that I had witnessed such symptoms in a child, or rather
the first time that I had recognized their significance ; for, on
looking back, I could recall twenty cases, perhaps, which I had
witnessed without understanding them. How often has this
happened to the most attentive, intelligent and best educated
physicians, to look at, without seeing, diseases, which another,
more attentive and better observer yet, has discovered and
seized upon after them !

Before Bright, cases of albuminuria has been seen, but no one
before him had known how to draw the consequences from the
facts observed; before Yirchow, before Bennett, before Magnus-
Hus, before M. Vidal, patients with leucocythsemia* had been
seen, but they alone had regarded them sufficiently to under-
stand them. Before M. Bouillaud, the existence of heart diseases
in rheumatic patients had been recognized, possibly, but no one
before the eminent professor of La Charite had known how to
see the relation existing between these affections and rheuma-
tism.

Thus, in my own case, it was the first time that I comprehen-
ded the fact which I had witnessed twenty times before.

I once knew a magistrate whose wife and niece were of a
most marked nervous temperament. His child, subject to
catarrhal affections, was taken to Nice, where he passed the
winter. In the month of May, he was taken with a most violent
catarrh ; his family alarmed, took him to Paris, as soon as he

*M. Vidal, in an excellent monoghaph on LeucocythsDmia published in the
Gazette Ilebdotnadaire, 1856, has taken care to cite a considerable number of
authors, who, since the time of Hippocrates, have mentioned, under the name of
engorgements, obstructions, hypertrophies of the spleen, facts, which, being con-
founded one with the other, present an evident resemblance, a remarkable identity
with those observations of leucocythaemia published in our day, and with those
which he had collected himself.

180 Lecture on Asthma, [March,

was able to bear the journey. On his arrival, he was taken with
the same symptoms; I was called to see him, in company with
M. Blaehe, and found him in such a state that asphyxia seemed
imminent. Nevertheless, recalling the facts which I have told
you, and regarding his hereditary antecedents (I have told you
that his mother was excessively nervous), I was not alarmed,
and prophesied that this violent conflagration would be easily
extinguished. We ordered fumigations with datura, and rather
to quiet the apprehensions of the parents than to benefit the
child, we ordered a portion of which the effect would be very
insignificant, a veritable homoeopathic portion. Two hours
after, the symptoms were relieved; the following day the child
was well, and the family received us with manifestations of joy,
attributing, without doubt, the whole of the relief to the medicine
which we had given. Since that time the little patient has had
similar attacks, and each time the datura has calmed them in
the same way.

My attention once fixed on this form of asthma, it has not es-
caped me whenever I have had occasion to meet with it, and I
have seen it often often at least, considering the rareness of
this disease in children ; that is, I have met with one or two
cases every year. Now asthma always presents itself under the
forms which I have described; only in my young Moldavian it
took on that of adult age.

In the cases which I have cited to you, the progress of the
disease has been very rapid ; nevertheless, the symptoms may
sometimes continue for seven, eight, ten and twelve days. The
affection is none the less the same ; the catarrhal element predom-
inates, and finishes by establishing itself and this, perhaps, be-
cause we do not interfere sufficiently soon or with sufficient
activity to prevent it but it is always the same disease. The
nervous affection is the capital, essential element of it, doubled
by the inflammatory catarrhal affection. This is so true, that if
you arrive in season with therapeutic means capable of combat-
ing the spasmodic element, even when the catarrhal element
shows itself, the attack goes on uno tenore and yields more easily
than a regular pulmonary catarrh ; even although in the first
case the catarrh assumes more intensity, and presents characters
in appearance more formidable than in the second.

Without doubt, when the catarrhal element has continued
for a longer period, the true nature of the disease is more diffi-
cult to be recognized ; but still it is characterized by these
strange symptoms, by these attacks of oppression, of suffocation,
returning after an intermission, principally at night, and persist-
ing often, even when the catarrh has yielded, with an intensity
which bears no sort of proportion to the inflammatory affection.
On the other hand, the general troubles, the febrile phenomena,

1859.] Hydrochlorate of Ammonia. 187

are but slightly pronounced, and also are no way related to the
intensity of the thoracic symptoms.

Finally, with regard to the prognosis, the attacks, however
fearful they may have appeared, yield, to return after a longer
or shorter interval; is this true of pneumonic catarrh, sufficient-
ly severe to cause symptomatic phenomena of such a decided
character ? Most certainly not ; for this disease does not often
attack the same person twice, because generally, not to say al-
ways, it kills him the first time.

I have cited cases to show you what may be the conditions
of the development of asthma ; I have given you my own case.
I have spoken of catarrh as an exciting cause. Among these
exciting causes of asthma, there is one to be mentioned which is
the most important and the most curious; I propose to speak
of the conditions of residence and climate. This will be the
subject of my second lecture. S. L. A.

On the Hydrochlorate of Ammonia. By M. J. Rae, M. D., Black-
burn. Late Physician to the Fever Hospital, and Dispensary,
Carlisle.

Although the value of new remedial agents, which are from
time to time added to the pharmacopoeias, may often admit of
question, there can be no doubt of the great practical importance
of ascertaining the therapeutic action of those medicines which
have long held a place in the materia medica ; and of determin-
ing the diseases which they have the power either of mitigating
or curing, and also of determining their comparative value over
other and similar remedies in the treatment of such affections.
There are medicines possessing considerable and even great
curative virtues which are seldom employed by practitioners ;
and this may be attributed partly to prejudice, to the rage for
new remedies, to want of knowledge respecting them, and to
other causes. The muriate of ammonia appears to me to be one
of these ; for although it has long formed part of the materia
medica, it has been little used by practitioners in this country,
except as an external application. Amongst continental physi-
cians, however, it has been long esteemed as a valuable internal
remedy in the treatment of many chronic and febrile disorders.
Entertaining a very high opinion of its curative powers, I have
prescribed it pretty extensively, in various diseases, for the last
eight years in private and for the last four years in dispensary
practice, and with satisfactory results. The hydrochlorate of
ammonia, besides being liquifacient and resolvent, as mentioned
by Sundelin, Wibmer, and others, appears also to possess con-
siderable neurotic action, as is shown by its curative power in

N. S. VOL. XT. KO. III. 14

188 Hydrochlorate of Ammonia. [5farchr

neuralgia and other nervous disorders. Its remedial influence
is often so rapidly manifested in these affections as to preclude
the idea of the effect being owing to any alterative or resolvent
action ; it seems more rational to refer it to a direct or peculiar
influence of the salt on the nerves or their centres.

I have used the salt with marked success in goitre, and am
not aware of its ever having been tried before in the treatment
of that deformity. In several cases, where the local application
of the muriate was conjoined with its internal administration,
the tumors some of which were very large rapidly diminish-
ed in size, and were soon reduced to the normal condition..
It cured the whole of the cases (ten in number) in which it was
tried, the period of cure extending from a fortnight to two months.
The subjects of treatment were mostly factory girls, of ages vary-
ing from fourteen 1x> twenty. To test the powers of the muriate
fairly, it was given alone in mucilage,, or infusion of quassia, and
combined with soap liniment for external use.

As goitre, from some unknown cause, prevailed here last year
to a considerable extent, opportunities were thus afforded of con-
trasting the curative power of the muriate with iodine in this
affection. Cases were selected where the tumors were nearly of.
equal size and duration, and where the age, temperament, gene-
ral health,, and sanitary condition of the individuals corresponded-
as nearly as possible ; and in the cases treated wi'th the muriate, .
which was: -used internally and locally,, the tumors generally
yielded as readily, and sometimes more quickly, than in those
subjected to the trial with iodine similarly employed, and ap-
parently quite as- permanently. The muriate appears to be a
safe and efficient substitute for iodine in the cure of broncho-
cele, and worthy of further trial. The hydrochlorate of ammo-
nia is also a valuable remedy in hooping- cough. I was first
led to make trial of it in the treatment of pertussis, from a belief
that if the disorder was dependent as it is considered to be by
some pathologists on an enlarged or morbid condition of the
lymphatic glands, or that the exciting cause of the paroxysm
was owing, as is very probable, to the presence of irritating-
glairy mucus in the bronchial passages, the muriate, on account
of its alterative power in glandular enlargements and diseased
mucous structures, and its effect in promoting the healthy secre-
tion of the mucous membrane in cases-of bronchitisr accompani-
ed with the discharge of tenacious, glairy muousr ought to prove
an excellent remedy in the treatment of that often troublesome
affection. The result was most satisfactory. It was tried in
thirty-seven cases, ten of which were private patients, and the
rest home patients at the dispensary, which were, for the most
part, under the charge of Mr. Langsford, house-surgeon to the-
institution, to whom I am indebted for the efficient eanring out

1859.] Hydrochlorate of Ammonia. 189

of the treatment, and for a report of the cases. Of the number,
two died one, a weakly nurse-child, aged three months and a
half, on the third day of treatment, and fifteenth of the attack ;
the other, which had been under the druggists for a month pre-
vious to being brought to the dispensary, and was then almost
moribund, died shortly after the commencement of the treatment.
Both these were hopeless cases, and unfavorable for a fair trial
of the medicine. There were two doubtful cases, the patients
having been removed from town before the cure was completed.
In the thirty-three remaining cases, the majority of which were
of more than ordinary severity, the average period of cure was
about twenty days. But, in most instances, when the patient
was at all favorably placed, and came early under treatment,
the disorder yielded in from nine to fifteen days.

The remedial influence of the muriate in the disorder is
immediate and decided. Under its use the expectoration soon
loses its irritating, glairy character, becoming bland and less
tenacious and the paroxysms are rendered milder, less frequent,
and of shorter duration ; in fact, by its influence the little patient
seems to be carried more easily, quickly, if not at the same time
more safely through the attack than by the agency of any other
remedy with which I am acquainted. In most cases, the muri-
ate was given in mucilage, or with liquorice water, combined
with an aromatic, and in doses of one to five grains, according
to the age of the child, and repeated every four or six hours.

When pneumonic or bronchial complications existed, or were
threatened, an timonial or ipecacuanha, with morphia or hyoscya-
mus, were added to the ordinary mixture. The only inconve-
nience observed to result from the use of the muriate was the
occasional supervention of a slight mucous diarrhoea, which was
easily checked, and did not interfere with the treatment.

I can confirm the favorable opinion of other observers as to
the efficacy of the muriate in enlarged ljTmphatic glands, and in
indolent bubo, and can confidently recommend it in scrofulous
ulceration of the lymphatic glands. There are few more intracta-
ble cases to be met with in dispensary practice than those of
extensive ulceration of the cervical lymphatic glands, which fre-
quently occur in weak, under-fed, and badly -lodged children.
In several aggravated cases of this sort which have come under
my own observation, some of which presented a chain of foul,
ragged ulceration extending from ear to ear, the muriate acted
with great rapidity ; and in some instances, where iodine, syrup
of iodide of iron, and other medicines, had no effect, the ulcera-
tions quickly healed under its employment.

It is also a very excellent remedy in many forms of cutaneous
affections, more especially in the scaly variety. I have seen
cases of psoriasis inveterata which had resisted the long-contin-

190 Diagnosis of Ovarian Dropsy and Ascites. [March,

ued use of arsenic, iodine, and other remedies, quickly yield to
its influence. It seems to me to have the most decided effect in
those cases of psoriasis occurring in patients of dissipated habits,
or when complicated with enlarged liver. It is also very useful
in eczema and syphilitic squamae. Drs. Watson, Ebden, and
others, recommend the muriate in tic and facial neuralgia, and
it certainly possesses very considerable curative power over
these painful affections, and particularly over that form of neu-
ralgia mentioned by Dr. Watson, which is confined chiefly to
the lower part of the face, and in a very troublesome variety
affecting one or other side of the neck, and probably connected
with a morbid condition of the cervical lymphatic glands.

The muriate like other remedies in neuralgia, does not suc-
ceed in every case ; but in those cases in which it proves success-
ful, the beneficial effect generally follows soon after its admin-
istration. In my hands the best results were obtained with it
in neuralgia when it was given in the ordinary dose, and re-
peated every half hour or hour.

My experience of the muriate in catarrhus vesicas, enlarged
prostate, muscular rheumatism, sciatica, and other analogous
affections, has as yet been too limited to enable me to report
with confidence on its value in their treatment ; but judging
from the result of the trials which I have made already with it
in these disorders, I think it deserves the high opinion enter-
tained of it by Rene, Vaneye, Dr. Fuller, and others. Never
having occasion to prescribe the salt in the large doses recom-
mended by some- authorities, I have not observed any irritant
or injurions effects on the stomach, intestines, or other organs
to follow its employment. When given to adults, in from five
grain to scruple doses in mucilage or bitter infusion, with aroma-
tics and anodynes, it may be continued for a considerable time
without producing any unpleasant results. The ordinary dose
to adults was from five to ten grains three or four times daily.
It was seldom necessary to increase the dose beyond the latter
quantity.

The muriate of ammonia is unquestionably a valuable medi-
cine, possessing active curative powers; and having a wide
range of action, and being cheap, and therefore the more likely
to be pure, it is well fitted for hospital and dispensary practice
and deserves more of the attention of the profession generally
in this country than has hitherto been given to it. [Lond. Lancet

The Differential Diagnosis of Ovarian Dropsy and Ascites.
No fewer than four cases have recently come under our notice
in which patients suffering from ovarian dropsy had been sub-
jected to prolonged diuretic and mercurial medication r in the

1859.] Treatment of Puerperal Affections. 191

belief that the disease was hepatic ascites. In one case, a short
time ago, in a large metropolitan hospital, the reverse mistake
was made, and the peritoneal cavity injected, with iodine, in the
hope of obliterating an ovarian cyst, which, as the autopsy a few
days afterwards proved, did not exist. Rumor states that one
or two other accidents of the same kind have occurred since the
iodine injection plan came into vogue, but we are not in a posi-
tion to substantiate them. Facts like these prove that the differ-
ential diagnosis between these two affections is either not so
generally understood as it ought to be, or else that it is a matter
of extreme difficulty. Xow, there is one sign which hitherto
we have never found to fail, but which is, we believe, as com-
pared with its value, but little known. In more than one work
on the diseases of women we find no mention of this symptom,
although, in extreme cases it is the only one which is available.
The sign referred to is percussion of the lumbo-lateral re-
gion. If in a case of ascites in which the distension is so
great that the hydrostatic line of level in front is not changed by
posture and it must be remembered that only in ovarian cases
in which the cyst is so large as to simulate this extreme condi-
tion ought any difficulty to occur if, in such a case, the patient
be made to sit up in bed, and the loins be percussed, it will be
found that the note is the same (usually dull) on both sides. If
an ovarian case, no matter how great the distention, be treated
in the same way, one loin will be found to be clear, and the
other quite dull. The explanation is obvious ; in ascites the
air containing coils of gut float as far forwards as their mesente-
ric attachment will permit, while in the case of an ovarian cyst,
they are pushed over to the healthy side. It is not easy to con-
ceive any condition of things, excepting entire exclusion of air
from the whole tract of intestines, which could diminish the
trust-worthiness of this symptom. It indicates also, with unfail-
ing accuracy, on which side the ovarian cyst, if it exist, has
originated. [Medical Times and Gazette.

Use of the Essential Oil of Turpentine and Opium, in Large Doses
in the Treatment of Severe Puerperal Affections.

In the discussion going on for the last three months at the
Academy of Medicine in Paris, and which has attracted so much
public attention, puerperal fever has been considered by the
most competent authorities as a disease almost universally be-
yond the resource of i rt, at least in the present state of our
knowledge; all the means hitherto employed have, almost with-
out exception, proved useless. This melancholy confession of
the inefficacy of medicine to subdue an affection which carries

192 Treatment of Puerperal Affections. [March,

off so many women in the flower of their age, is unfortunately
but too well founded when we speak of the severe epidemic
form, but ought not, however, to be adopted as literally true.
We have lately seen a case of very severe puerperal peritonitis,
which M. Antoine has cured by the method above mentioned,
and which Velpeau introduced many years ago. We have since
seen two cases in Yelpeau's wards, both cured in the same way.
This plan of treatment is by no means new, for we remember
to have used it with success some twenty years ago, but it is not
the less worthy of notice. It is the plan of Graves (of Dublin)
which Trousseau has long employed with advantage in the
treatment of puerperal illnesses; it consists in giving to lying-in
women attacked with metro-ovaritis, or phlegmonous inflamma-
tion of the broad ligaments, or peritonitis, or uterine phlebitis,
&c, &c, opium and essential oil of turpentine in large doses.

Dr. Bonflls has just published, in extenso, in the "Bulletin
Therapeutique," two very interesting cases of this kind. In the
first the patient was attacked after her confinement with perito-
nitis and double pleuro-pneumonia, and was cured of this for-
midable complication after seven weeks' treatment. The other
patient was attacked under similar circumstances, with a very
severe general peritonitis, all the puerperal complications were
rapidly checked by the plan of treatment recommended, but
after the most marked improvement, which promised to end in a
perfect recovery, she was seized with symptoms of hectic, which
closely resembled that of pulmonary phthisis, and she finally
sunk, owing, in all probability, to a purulent infection.

Opium and turpentine were administered in both cases in the
following manner :

In the first case Trousseau prescribed opium in pills, and tur-
pentine in enemata ; he gave at first 5 centigrammes of opium,
in five pills, in the day ; then the dose was raised to 8 centigram-
mes, in eight pills ; then 10 centigrammes, in ten pills. The
opium was continued for thirteen days.

Turpentine was administered at first in doses of 10 grammes,*
divided into two enemata ; one was given morning and evening ;
then it was gradually increased to 20 grammes, 25 grammes, 30
grammes ; this last dose was continued for fifteen days. The
following was the formula adopted ; essential oil of turpentine,
10, 20, 25, 30 grammes ; yolk of an egg ; water, 100 grammes ;
to be divided into two enemata ; add to each enema five or six
spoonfuls of gum water or linseed. The enema to be retained
as long as possible.

In the second case the opium was likewise given in pills, in
the dose of five centigrammes continued for three days. The

* Gramme*** 15*4325 grains Troy. Centigramme (100th of a gramme = 0*15432
grain.

IS 59.] Scarlatina and its Treatment 193

essential oil of turpentine was administered by the mouth, in
capsules, for six days ; the patient took every day six capsules,
each containing 1 gramme of the essential oil ; she took two,
morning, noon, and night.

M. Bonfils details the following as the physiological phenome-
na which were noted as occurring in both cases :

In the second case, immediately after taking the capsules, the
patient felt a sensation of intense heat at the pit of the stomach ;
a few minutes afterwards there was a very complete general
reaction, characterised by heat of surface; general perspirations,
increase in the volume and frequency of the pulse; then follow-
ed in succession confusion of vision, vertigo, stupefaction, and
drowsiness, and after some time, itchiness of the skin.

The physiological phenomena were less pronounced when the
turpentine was administered in enemata ; they consisted in an
immediate sensation of heat in the abdomen, a general but mo-
derate reaction, slight vertigo, some confusion of ideas, slight
disturbance of vision, and slight itchiness of the skin. Such
were the phenomena which existed in the first case. [Dublin
Hospital Gaz., and Braiihwaite 's Retrospect.

On ScaHatina and its Treatment. By K Bishop, M. D., Devon-
port.

If we would have a science and the art founded thereon, to be-
come more and more pure, we must direct our studies in the
way which our present acquaintance with the science points out
to us. If the way be one of theory, we must theorize ; if it be
one of practice and observation, we must observe and investi-
gate. Medicine is essentially a science of facts. The store of
facts is gradually accumulating, and has already, indeed, increas-
ed to such an extent as to render the teaching necessarily more
and more practical, and to show that things, not words en masse1
form the material with which the practitioner's mind must be
supplied. The more medicine is made to partake of the real,
the more prominent and brightly will it shine.

The foregoing I saw in print some time since, and the re-
marks appear applicable to the following. It is desirable that
contributions to the medical press, however trifling they may
appear to some, should be published, especially respecting any
new or successful treatment in serious diseases. It is the duty
of the practitioner to record his method of treating disease even
if it does not appear strictly orthodox, or in accordance with the
prescribed methods. If we had to rest entirety upon the authori-
ty of even our best authors, we should fall miserably short ; for
the numerous opinions giyen as to the nature and treatment of

194 Scarlatina and its Treatment. [March,

this and other diseases are so contradictory and conflicting as to
mislead the matured as well as the juvenile practitioner. Or,,
to quote the language of Dr. Gilmour, " My young brethren in
medicine must not trust implicitly to what they read in books
many of them are truly valuable and trustworthy, but others
(and of these there is a large number) are written to suit a pur-
pose, and contain trash."

I beg to state as briefly as possible the treatment I have adopt-
ed in this disease during the last nine months. There is noth-
ing original in it, so far as it relates to myself. I know friends
who have tried it with marked success. Scarlatina has been
rife in this town for the last nine months, and has proved fatal
to a large number of children belonging to all classes of society.
In many families, one, two, and even three have succumbed to
it. I applied to the Registrar for the exact number of deaths
from this disease in the three quarters ending March, June, and
September, 1858, and he has been kind enough to supply me
with a return, by permission of the Registrar- General. In the
first quarter of the present year, the deaths from scarlatina
reached 23 ; in the second, 44; and in the third, 27, in children
under ten years of age.

In fifty-one cases of scarlatina scattered over the town, in child-
ren varying from two to ten years of age, my plan of treatment
has been tonics from the commencement (i.e., from my first
visit) either the citrate of iron, or the tincture of the sesquich-
loride, in the usual full doses ; and I have every reason to be sa-
tisfied with the result, having lost but one case. I made no diffier-
ence in the plan of treatment even when serious complications pre-
sented. In many the fever was intense, the inflammation of the
throat severe, and pain in swallowing very considerable. Four
children in one house, in Cannon-street, had scarlatina anginosa
in an aggravated form, being attended with an acrid discharge
from the ears and nostrils. In one case deafness has remained
nearly permanent. I entirely discarded the application of strong
caustics to the throat and tonsils, which many years' experience
has taught me is injurious in very young children, and calcula-
ted to do more harm than good, to say nothing of the injury
and difficulty attending the operation. External applications
to the throat I found most beneficial either the compound cam-
phor liniment, oil and hartshorn, or turpentine sprinkled on a
strip of flannel, previously wrung out of hot water, and applied
several times during the twenty-four hours. Inhaling the steam
of hot water gave much relief; as it generally does. The child-
ren I have been called upon to treat have belonged to the poorer
class ; the diet necessarily simple ; in severe cases, broths, beef-
tea, milk, jelly, and wine were recommended, and procured if
possible. One gratifying result in the treatment of scarlatina

1859.] Scarlatina and its Treatment. 195

with iron, as far as my experience carries me, is that the child-
ren, with few exceptions, escaped that serious and frequent se-
quel anasarca.

I have seen two cases of diphtheria following scarlatina during
the epidemic, in children lour and six years of age. The first
child had been convalescent a week or ten days, and I must
confess, I could not understand the cause of the relapse. After
a few days, I suspected diphtheria ; the child would never allow
me nor the parents to examine the state of the throat, although
rough usage was resorted to more than once or twice. During
the time it suffered extreme prostration, and was supported by
wine and beef-tea ; it also took a mixture containing the tinc-
ture of the sesquichloride of iron. This child ultimately coughed
up the membrane characteristic of diphtheria. A fit of vomiting
and coughing came on at a time when it appeared beyond hope;
but when the membrane was released, the child was relieved
and gradually rallied.

A remarkable case under my care was that of a boy aged
four yeras, belonging to the Koyal Naval and Military tree
Schools. I first saw him twelve weeks ago from the date of this
communication ; he had then scarlatina anginosa, from which
he recovered sufficiently to enjoy a walk. About a fortnight
after his recovery his mother requested me to see him, as he had
(to use her own words) " pimples coming out over his face and
body." On visiting him, this proved to be variola discreta. He
had been successfully vaccinated, judging from the cicatrices in
his arm. The little fellow suffered severely ; he had not regain-
ed his strength from the debilitating consequences of the previ-
ous illness. He was kept up by wine, beef-tea, ammonia and
bark, as maturation of the pustules went on but slowly. He re-
covered from this attack, but not sufficiently to return to school,
when I was requested to visit him, as he had hooping-cough,
which was and is now epidemic in this town ; and this being
complicated with pneumonia, terminated his existence a few
days ago. There was something remarkable in the fact of this
child having three of the most serious and fatal diseases of child-
hood in the short period of three months. One little girl who
was in the habit of going to the house of the deceased is now
under treatment for variola.

I trust the tonic treatment of scarlatina with iron may have a
trial elsewhere, and prove as efficacious and successful as it has
been with me. I conceive it is far better to prove by facts than
to judge and condemn without a trial, simply because the treat-
ment does not harmonize with the doctrine laid down by our
popular authors and preceptors. [London Lancet.

196 Abuse of Mercury in Ophthalmic Diseases. [March,

On the Abuse of Mercury in Ophthalmic Diseases. By Dr.. Al-
fred Poland, Surgeon to Guy's Hospital.

The chief aim of the author is to draw the attention of the pro-
fession generally to the above subject, and more especially when
practised by those not over-conversant with these affections.
He is sorry to say that the study of eye-diseases has considerably
declined, and that it is more and more becoming an isolated
branch of the profession. In former years, every hospital and
general surgeon undertook the treatment of this class of cases,
and the lectures on surgery at the several schools duly elucidated
the principles and practice thereof. Now-a-days, on the contra-
ry, with the exception of one or two leading medical schools,
ophthalmic surgery had become isolated, and rendered perfectly
distinct and separate ; there are separate wards and separate
lectures, which are, moreover, unrecognized by the examining
boards. The author hopes that this state of affairs might be
remedied, and that persons before entering on practice should
show some evidence of having studied, and become practically
acquainted with the treatment of diseases of the eye. With
these strictures the author cursorily surveys the general diseases
of the eye, pointing out that in the majority of them mercury
was not required. In the conjunctival inflammation, including
also gonorrhceal ophthalmia, mercury was admissible, inasmuch
as they could be cured without its administration. So, also, in
so-called strumous diseases, comprising ophthalmia and corneitis,
it was a remedy that did no good, as attention to the secretions
and excretions, with due regard to diet and the powers of the
patient, sufficed to eradicate the complaint. It would hardly be
credited that, in the year 1858, mercury was administered for
penetrating wounds of the eye, yet, he (Mr. Poland) was sorry
to say such was the case ; and, he remarked, what would be the
results of operation for extraction were this line of treatment to
be adopted ? In adverting to sclerotitis and iritis, mercury came
to our aid, more so in the latter than in the former disease ; yet
even in these affections more attention ought to be paid to the
condition and constitution of the patient than the nature of the
disease. It was too much the fashion to consider that because a
part or organ had taken on inflammation, and in consequence,
had appended to its name the dreaded term "itis" it was to be
cambated by calomel, leeches, low diet, &c. Many an eye, and,
perhaps, life, had been lost by this unfortunate appendage. As
for amaurosis, the author naively stated that all the mercury in
the world would not replace a cupped condition of the entrance
of the optic nerve, nor would it remove a detached retina, nor
promote the absorption of dirty white pigment on the retina, nor
restore the lost transparency of the retina, nor such other organic

1859.] Gallic Acid in Fungous Iltematode*. 197

changes pointed out by the use of the ophthalmoscope. Yet
mercury was, and is still, administered by some, for days, weeks,
and even months. Space will not allow us to enter more fully
into each of the topies brought forward, as the principles and
treatment advocated are those generally practiced and taught
by the several leading surgeons who have studied eye-diseases.
It was the author's endeavor in his few loose remarks, to call
attention to the simple fact, that an improvement had taken
place in the last few years, by a more guarded abstinence from
the use of the drug mercury in ophthalmic practice, and that
such should be made known to the profession generally, so that
they may avoid resorting to the remedy as a specific in inflam-
mations generally. Lancet, and Rankin's Abstract.

Gallic Acid in Fungous Hcematodes. Under the care of Thos.
Tattjm, Esq., at St. George's Hospital. (Case and remarks
by C. Hunter, Esq., House Surgeon.)

[The following instance of the effects of an internal remedy on
malignant growth, is interesting. The patient was only eight
years of age, and was admitted with, a tumour about the size of
the eye itself, and situated behind, and consequently protruding
forward that organ. It had only been apparent two or three
weeks, and after his admission to the hospital rapidly increased
no operative measures being had recourse to owing to its situa-
tion.]

As it grew larger, the eye, being pushed before it, gradually
dwindled, and became at last a shrivelled:up and hardened ex-
crescence on the outer part of the protruding mass.

In the course of four months (from time of admission) the
tumour had become as large as the head of a seven months foetus,
and of such a size as to overlap the mouth, so that he had to be
fed by a pipe at the further corner of it.

At this period (beginning of August), the surface of the tumour
was irregular but rounded, the greater part of the surface was
in a raw ulcerated condition, exceedingly vascular and con-
stantly bleeding, often to such an extent that every attack ap-
peared likely to be the last.

These hemorrhagic attacks were generally treated by cold, by
pressure, and by the local application of blue lint. The boy
was living on generous diet and wine. On the 2nd of August,
after one of these attacks more serious than usual, which quite
bleached the face, and much weakened the pulse (always weak
and rapid), I gave him gallic acid in four grain doses,in infusion
of bark, to try, if possible, to arrest the bleeding.

August 30, one month afterwards. Curious as it may appear,

198 Inhalation of Carbonic Acid. [March,

the gallic acid bad been productive of the most marked effect,
the tumour from that time had never bled once, nor even had
there been the least oozing of blood. The surface of the mass
became more healthy, less vascular, more solid, and considerable
diminution of the tumour had taken place. After this, for a few
days, increase of the tumour again occurred, but no bleeding
took place from it. The increase in size was met with an in-
creased dose of the gallic acid, which was again productive of
benefit.

Present State, Sept. 25. 1st, The tumour is about nine inches
measured over the longest diameter, and eight and a quarter
over the shortest ; this is much less than it was two months ago,
so that the boy can now feed himself easily, the mouth not being
at all overlapped, whereas before he required feeding. 2nd, Not
the least bleeding has occurred since the first dose of the gallic
acid, which was given now nearly two months ago. 3rd, The
health, strength and appetite of the boy appeared improved.

In recording this case, it is only meant as an instance of the
palliative effect of a remedy on malignant disease ; it is the more
curious that the gallic acid has had the striking effect it had,
because of the exceedingly vascular and raw state of the surface.
The least movement, the least cry before the administration of
the acid, used to occasion a sudden rush of blood from several
parts of the tumour. That the tumour should have decreased
in size is not less remarkable than that all hemorrhage for so
long a time should have ceased. [Med. Times and Gazette.

On the Inhalation of Carbonic Acid as a safe and efficacious Anaes-
thetic. By M. Ozanam.

The inhalation of this gas, Mr. Ozanam tells us, produces effects
which are very analogous to those of ether, only more transitory ;
and these effects he considers as belonging to four periods.

1. The prodromic period. In this period the animal experi-
mented upon is sometimes calm, sometimes rigid. The duration
is from one to four minutes, according to the strength of the
subject and the dilution of the gas with the atmospheric air.

2. The period of excitement. This is almost absent, and at
most it consists in some agitation and voluntary movement.
The respiration is quickened and so are the beats of the heart
then, in about a minute, the muscles relax.

3. The period of Anaesthesia. In this period the animal lies
stretched on its side, breathing slowly and profoundly, and with
the pupil moderately dilated, and with the heart beating slowly
and more feebly. The anaasthesia is complete. M. Ozanam
tells us that this state of complete anaesthesia may be kept up

1859.] Ophthalmia Tarsi treated with Iodine and Glycerine. 199

by continuing the inhalation, without any danger to life, for
ten, twenty, thirty minutes, or more, and that the animal recov-
ers almost immediately when it is allowed to breathe atmospheric
air.

4. The period of waking, which is very transitory, appears to
be somewhat like a state of drunken nc-

One curious fact transpires in connection with these experi-
ments, and this is, that animals which have been frequently
submitted to them, at length become so habituated to the gas,
that they cannot be rendered anaesthetic by it. [Archiu. Gen.
de Med., and Banking's Abstract.

Obstinate Ophthalmia Tarsi treated by the Application of Tincture
of Iodine and Glycerine. By Dr. ANGUS MAOMELLAN, Hull.

M. A., aged twelve years, five years ago had a severe attack of
scrofulous ophthalmia. On examination we observed specks on
both cornea?, and considerable conjunctival vascularity. Edges
of eyelids much inflamed, hardened, and considerably thickened;
eyelashes agglutinated together. Partial obliteration of Meibom-
ian apertures in right lower eyelid. General health evidently
much impaired; skin and digestive organs disordered, and un-
doubted marks of a scrofulous constitution present.

On being questioned, stated she had been under treatment
more or less since the attack of scrofulous ophthalmia, that gen-
eral and local means had been employed, but with no perma-
nent benefit.

The edges of the eyelids were washed carefully, and any ad-
herent matter removed from the roots of the eyelashes and Mei-
bomian apertures. The edge of each eyelid being carefully
everted, the tr. iodine was then applied to the whole edge by the
aid of a fine camel's-hair brush, which was passed over two or
three times, so that the tr. iodine might enter the Meibomian
apertures, and be diffused among the cilia. During the day and
night frequent applications of the glycerine by the aid of a com-
mon camel's-hair brush. In the course of two or three days a
decided improvement was manifest. Three more applications
of the tr. iodine at intervals of three or four days sufficed to cure
the case. Quinine and sulphuric acid were administered inter-
nally.

Many more cases followed by the same success could be re-
ported, but the above will be sufficient to direct attention to
this mode of treatment of an affection of the eyelids, which in a
majority of cases may be considered incurable. I am not aware
that this method has ever been previously suggested ; and should
any of your readers feel disposed to give it a trial, it is to be

SaO Method of Excising the Eyeball [March,

hoped they will communicate the result of their experience, so
that its true value may be ascertained. The tr. iodine is a more
convenient and effectual application than the ordinary salves,
inasmuch as its stimulating properties can be brought to bear
more directly on the Meibomian apertures. [Med. Times and
'Gezette.

Mr. Dixon's Meilwd of Excising the Eyeball.

(Mb. Dixon's method of excising the ball, though similar in
plan, differs in some of its details from that practised by his col-
leagues.]

Mr. Critchett, to whom the credit is due of having been the
first to supersede the old and most clumsy method with the
scalpel by the admirable operation now in general use, employs
the strabismus hook and scissors in the dissection. Mr. Dixon
has for some time past dispensed altogether with the hook and
employs curved instead of straight scissors. The wire speculum
having been introduced, the conjunctiva, elevated by dissecting
forceps, is divided all round at the margin of the cornea with
scissors curved on the flat and slightly rounded at their points.
The tendon of the external rectus and the adjacent areolar tissue
are next seized in the forceps and snipped through. An assist-
ant now fixes the globe and draws it forcibly inwards by hold-
ing in forceps the insertion of the just divided muscle, and the
superior rectus, the oblique and the inferior rectus, are in order
snipped through. The globe now starts forwards, and the optic
nerve having been easily reached and cut through, it is turned
hind part before, and a few more touches suffice to divide the
last remaining muscle, and to complete the operation. [Medical
Times and Gazette.

Inhalation of Carbonic Acid as an Anaesthetic. (From the French
of Dr. Ozanam).

The effects of carbonic acid resemble those of ether, according
to the author, but are more fugitive ; and while it is necessary
in the case of ether to interrupt the inhalations after short inter-
vals, an opposite procedure is required for carbonic acid.

a. As long as one wishes the sleep to be prolonged, the inha-
lations must be continued.

b. These can be prolonged ten, twenty, thirty minutes and
more, without danger to life.

c. When the inhalations are stopped, the waking is almost
always immediate.

The experiments of Ozanam and Faure have never resulted

1859.] Ncevus in the left Cheek cured by Tannic Acid. 201

in death. When death does take place, it is slow, progressive,
and one can predict for some time in advance the moment of its
arrival, by considering, as Fan re has done, the condition of the
heart and the pupils. The following experiment, related by
Ozanam, is most interesting.

I had prepared by Mons. Fontaine a gas bag containing abont
100 litres of carbonic acid, being resolved to prolong the anaes-
thesia as far as possible. The animal was put to sleep in three
minutes, without convulsions, and remained on its side in a quiet
sleep without being held. The inhalations were continued for
87 minutes, and the apparatus was then withdrawn ; full sleep
lasted five minutes more; towards the tenth minute the paws
began to be agitated; at the fifteenth the animal arose. One
hundred and two minutes were thus consumed in the experi-
ment a time much longer than is required by the longest opera-
tions.

We believe that Faure and Ozanam purpose the use of as-
phyxiated anaesthesia, or anaesthesia produced by carbonic acid, for
man. Faure and Ozanam say, that they have respired the gas,
if not to the point of producing sleep, at least until they felt the
first effects. Its taste is slightly piquant, about as pleasant as
that of ether, and it is an excitor of the saliva. Ozanam says
that the ethers, chloroform, and carbonic oxide determine anaes-
thesia by robbing the arterial blood of its oxygen, so as to pro-
duce carbonic acid, and thus making the blood venous. Carbo-
nic acid itself does not decompose the blood ; it removes no vital
principle from it, but contributes progressively, and so that it
can be graduated at will, the necessary quantity of carbon to
determine the insensibility. [American Med. Monthly.

Case of Xcevus in the Left Cheek cured by Hie Injection of Tannic
Acid. By Dr. Quinlaxd, Surgeon to St. Vincent's Hospital,
Dublin.

Case. Eliza B , set. 9 months, has a subcutaneous naevus on
the left cheek, about midway between the angles of the mouth
and jaw. Her mother states that she observed this immediately
after birth ; it was then almost imperceptible, but has gradually
increased, until it is now somewhat larger than a shilling. It
can be almost emptied by pressure. The skin covering it is
healthy. Two veins of considerable size lead from it.

Saturday, August 21. I introduced a cataract- needle into the
upper portion of the nasvus, and broke up its structure. I then
inserted a very fine platinum canula, and, by means of a small
platinum screw-action syringe, constructed for this purpose, in-
jected a scruple of solution of tannic acid, of the strength of a
drachm of the acid to the ounce of distilled water. I repeated

202 Extirpation of tJie Parotid. [March,

the same manoeuvre in the two other most prominent parts,
until the naevus became well distended. Congulation quickly
ensued, as was shown by the almost stony hardness which the
navus assumed.

Eight, P. M., same day. Left side of the face considerably
swelled; nsevus somewhat inflamed. Ordered the part to be
fomented with cloths wrung out of hot water. To take a little
hydrarg. c. creta.

August 23d. The swelling of the face is quite gone down ;
thenaevus appears to be undergoing a kind of chronic inflamma-
tion ; the epidermis over it is desquamating.

Friday, September 3d. The site of the nsevus is occuppid by
a tumor resembling the induration left after a boiL There is no
trace of dilated vessels. The two veins before alluded to have
almost disappeared.

September 7th. The induration appears to be undergoing
gradual absorption ; the three openings made by the canula are
healed up. [Dublin Hospital Gaz., and Banking's Abstract.

On Extirpation of the Parotid. By Dr. J. M. Warren.

In a paper on " Tumors in the Parotid Kegion," Dr. Warren
states his experience upon this subject in the following para-
graphs :

u As to the practical question which is often raised, whether
the gland can be removed without the ligature of the carotid,
the result of my experience is this. The parotid gland has been
removed by me in six instances, which are given below : three
for scirrhous disease, one for erectile tissue, one for melanosis,
and one for hypertrophy ; in none of these was the great artery
tied. The experiment of dissecting out the parotid gland in the
dead subject has been frequently made by me, and with a little
care this can be done in most instances, leaving the great vessels
behind, although sometimes a small backward-projecting bit of
the gland is left, and this has been observed to escape disease.
But in scirrhous affections, where the gland undergoes a gradu-
al induration, the vessels are frequently pushed backward, as
they were in one or two of the cases here given. The above
observation is confirmed by my friend and colleague at the hos-
pital, Dr. Gay, who made similar dissections on the dead body
to ascertain this point.

" In a case mentioned by Dr. J. C. Warren the carotid was cut
at the end of the operation, and the jet of blood struck the wall.
The vessel was secured, the carotid being compressed below,
and the patient did well. In the second case for the removal of
a scirrhous parotid, in which I assisted Dr. Warren, the carotid

1859.] Diagnostical and Prognostical value of Haemoptysis. 203

was divided and tied. Three days after, as the patient was strain-
ing at stool, the vessels gave way, and the blood struck the ceil-
ing. He almost at once fainted, and the friends were fortunate-
ly sufficiently cool to place a sponge in the wound, and to check
the flow partially. I was called, and at once cut down upon the
carotid in the neck, tied it, and stopped the further effusion of
blood. Berard, in his monograph on this subject, mentions
many instances of removal of this gland without ligature of the
carotid."

The paper is completed by the history of the six cases above
aluded to. [Boston Med. and Surg. Journal, and North American
Med. Chir. Review.

Diagnostical and Prognostical value of Haemoptysis. By Dr.
Trousseau, Physician to the Hotel Dieu, Paris.

Prof. Trousseau states that, on finding an individual spit-
ting blood, the first idea that presents itself is the existence of
pulmonary tubercle ; but if we note all the cases that present
themselves, not in private, but in hospital practice, we shall
find the haemoptysis as often dependent upon other causes as
upon tubercular disease. This statement, paradoxical as it may
seem, is quite true when confined to hospital patients.

A form of haemoptysis that is rarely met with in hospitals, is
due to hemorrhagic deviations. We meet with women who,
without suffering from any notable disturbance of menstruation,
but who are the subjects of nervous symptoms, spit blood fre-
quently in considerable quantity. Neither the symptoms nor
attentive exploration of the chest, indicate any affection of the
heart or lungs ; and when the period of menopausis arrives, the
haemoptysis becomes arrested, and does not return. Other
women spit blood during pregnancy or lactation, and cease
doing so when these conditions are terminated. These nervous
women are also sometimes the subject of menorrhagia, seeming
to be under the influence of a hemorrhagic diathesis; and when
the critical discharge does not take place by the uterine mucous
membrane, it does so by the bronchial membrane. Although
these haemoptyses are not of the importance that might be sup-
posed, and may be reproduced at longer or shorter intervals
during several years, it must be borne in mind that this frequent
repetition may induce a congested state of the respiratory ap-
paratus, during which even a slight accessory cause may give
rise to a more or less dangerous phlegmasia. Independently
of abnormal circumstances, we may meet with haemoptysis oc-
curring, so to speak, as a physiological accident, supplying the
place of a natural or accidental discharge of blood, which, from

n. s. VOL. xv. NO. III. 15

204 Diagnostical and Prognostical value of Haemoptysis. [March,

some cause or other, does not take place by the ordinary chan-
nel. Thus, in women with obstructed menstruation, it is one of
the most frequent forms of hemorrhage supplementary to menstrua-
tion. It will be readily understood that when with this peculiar
disposition of the economy there is combined another dependent
upon a local predisposing condition of the pulmonary apparatus,
these haemoptyses are still more readily produced. Under such
circumstances the prognosis of haemoptysis is far more serious
than when it arises from hemorrhagic deviations unconnected
with local occasional causes. Here, in fact, the accidents become
complicated with the loc/il lesion which has led to these manifes-
tations, just as this itself is necessarily complicated by the fact of
the fluxionary hemorrhagic movement, which, at each return,
accelerates the evolution of such lesion.

As already observed, these varieties of pulmonary hemor-
rhage are rare in hospital practice. The form of the affection,
however, there most commonly met with, is not haemoptysis de-
pendent upon phthisis, but haemoptysis dependent upon disease
of the heart. It is not meant by this to declare in an absolute
manner, that tubercular haemoptysis is of rarer occurrence than
haemoptysis dependent upon disease of the heart, but only to
state that in phthisis, haemoptysis being in general a transitory
condition, occurring early in the affection, the patients do not
come to the hospital, while haemoptysis dependent upon heart-
disease occurs principally when the disease is much advanced,
and, consequently, at the period when patients are obliged to
resort to the hospitals. Proceeding to consider some of the points
of diagnosis between these two forms, we find that in youth,
adolescence, and the early period of mature life, from the six-
teenth to the fortieth year, haemoptysis most generally is depen-
dent upon pulmonary tubercle, and that whether it is met with
in hospital or private practice ; but after the fortieth year, and
still more after the fiftieth, it is no longer, generally at least, a
sign of phthisis, but of disease of the heart. There are excep-
tions to this rule, but they do not invalidate its general truth.
In phthisis bloody expectoration may either precede any other
manifestion of the disease of which it may then be considered the
earliest symptom, or it may appear in the course of the. affection.
Laennec indicated its slight quantity as a characteristic, and re-
garded very abundant haemoptysis as almost always due to pul-
monary apoplexy. But he had little opportunity of observa-
tion in private practice. It is true that, in general, haemoptysis
is not abundant, but still there are cases in which it is over-
whelmingly so, causing death by the sole fact of the loss of an
enormous quantity of blood. Haemoptysis, consequent on
disease of the heart, is, notwithstanding, still seldomer over-
whelming (foudroyante) than bronchial hemorrhage. It may

1859.] Diagnostical and Prognostical value of Hcemoptysis. 205

recur fifteen, twenty, forty, or fifty days in succession, without
at once proving fatal. Of course, when dependent upon the
rupture of an aneurismatic vessel into the bronchi, it may prove
still more rapidly fatal than haemoptysis supervening on
phthisis. Besides the age of the patient and the progress of the
symptoms as elements in the differential diagnosis, there is an
important point in regard to the seat of the hemorrhage, viz.,
that while in phthisis it takes place generally at the bronchial
surface, in diseases of the heart it is most often parenchymatous,
first occurring in the pulmonary vesicles.

As to the question of the characteristics of bronchial and pul-
monary sanguineous expectoration, it is said that bronchial
hemorrhage is observed under the form of spumous, semi-fluid
sputa, resembling blood beat up with air, and having a bright
redness, deemed characteristic. The quantity discharged is said
to be sometimes very slight, and sometimes very abundant, not
being mingled with the debris of alimentary substances or muco-
sities. But this is far from being always the case, as the sputa,
may be as viscous as those seen in the first stage of pneumonia,
or in pulmonary apoplexy, an appearance, probably, due to the
slight accompanying inflammatory action, or to the accumula-
tion and detention of the blood in the lungs. So. too, we may
find the discharges mixed with alimentary substances when the
haemoptysis is undoubtedly connected with phthisis. Stethosco-
pic signs are often at default, or indicate as much, or even more,
the pulmonary lesion upon which the haemoptysis depends.
Generally at the autopsy of persons who have been the subjects
of bronchial hemorrhage, we only find, besides the lesions proper
to phthisis, redness of the pulmonary mucous membrane, which,
indeed, may be due to imbibition. If cavities exist, they may
contain a certain amount of coagulated blood, and that usually
when vascular ruptures take place within these : otherwise we
only find a little blood accumulated in the bronchi.

With respect to pulmonary hemorrhage, we may advert to the
erroneous term, " pulmonary apoplexy,"' which has been be-
stowed upon it, giving, as it does, no idea of the nature of the
affection. It occurs in general during the course of an affection
of the heart; and at the autopsy kernels of engorgement are
found of as deep a color as the spleen, and as hard as those of
pneumonia in its second stage. The tissue of the lung is friable,
and presents the grauular aspect of hepatized tissue, except that
while in the latter the vessels and lobular intersections are visible,
the haemoptycal engorgement presents a uniform blackish, or
very deep brown color. This lesion, which would be better
termed sanguineous infiltration, bears no analogy to cerebral
apoplexy, the term apoplexy always implying the idea of sud-
denness and active fluxion, a condition rather belonging to bron-

206 New Operation for Inguinal Hernia. [March,

chial than pulmonary hemorrhage, which is ordinarily, to a cer-
tain extent, passive. There are, indeed, cases of true pulmona-
ry apoplexy giving rise to sudden death, and characterized by
the effusion of more or less blood amidst the lacerated lung.
The term apoplexy would be much better applied to cases of
active congestion of the lung, a not very rare disease, but which
is rarely accompanied by haemoptysis, properly so called. Gren-
drin proposes to substitute for the term pulmonary apoplexy,
pneumo-hemorrhage, indicating without ambiguity an extravasa-
tion of blood into the tissues of the lungs. As to the distinctive
signs in these cases of pulmonary sanguineous infiltration, the
expectoration is generally viscous, sometimes red, and some-
times black, and even deep black. But, as in bronchial hem-
orrhage, the blood discharged is also sometimes black, so in
the pulmonary it is sometimes spumous, and that especially
when it is quickly and abundantly discharged.

While lesions of the heart are the usual causes of pulmonary
hemorrhage, contraction and insufficiency of the mitral valve is
the most common of these lesions, and especially when, as is
commonly the case, it is conjoined with ventricular hypertro-
phy. These hemorrhages are sometimes very considerable, and
may recur three, foury six, eight, or ten times in the course of
the disease of the heart ; at other times, though rarely, they are
slight and transitory, and do not re-appear. When the lesion
is much advanced, the patients may spit blood for one or two
months, and sometimes until their death. The disposition of
these hemorrhages is, in fact, to increase in frequency and in
quantity as the disease of the heart an effect of which they
are approaches its fatal termination. {I? Union Medicate, and
Banking's Abstract.

A New Operation for the Radical Cure of Direct Inguinal Hernia.
By Mr. Wood, House-Surgeon to King's College Hospital.

The main features of this operation consist: 1st, in its being
conducted subcutaneously, insuring a more ready and less pain-
ful healing ; 2d, in the introduction into the canal of the two
layers of superficial and intercolumnar fasciae, which are "un-
usually abundant and strong under the condition of hernia, and
which are made to cohere into a solid plug by adhesion of their
opposed surfaces, made raw by the subcutaneous separation from
the skin, and are also supported and kept in position in the
canal by the new adhesions contracted below by the skin from
which they were separated ; 3d, in the drawing together and
close union of the sides of the enlarged external ring by the
lateral traction of the ligature upon them, caused by its passing

1859.] New Operation for Inguinal Hernia. 207

through the same opening in the skin and in the compress upon
it, and tying them down by consequent permanent adhesion to
the invaginated plug of fasciae behind them ; and 4th, in the firm
compression made upon the part during the formation of the
adhesions, and their consequent greater extent and firmness, by
the traction of the ligature upon the boxwood compress.

Mr. Wood is of opinion that the distinct evidence as to the
position of the hernial sac of peritoneum and of the cord through
the opening in the skin, and the great certainty that the feel of
the tube gives, that its position at the extremity is close behind
the aponeurosis of the external oblique, and has no intervening
structure to be voided between it and the surface, remove almost
entirely the danger of puncturing the sac in this operation ;
while he supposes that the succeeding pressure may operate
after a while in producing adhesions of the opposed surfaces of
the doubled-up sac. The operation leaves no dimple or defor-
mity whatever ; the cicatrices are very small and slight, and
after a time will become nearly imperceptible.

Case. John C , set. 25, a printer, applied at the hospital

with a direct inguinal hernia on the right side, to which he had
been subjected eighteen months, with frequent obstruction and
constipation of the bowels, and after meals had suffered from
great pain and distress in the part. He has tried several trusses
none of which had power to retain the bowel. The last he tried
produced such irritation as to give rise to a series of abscesses in
the groin, which was the direct cause of his application. The
abcesses being healed, and the patient disposed to submit to an
operation for permanent cure, the following was performed:

On examination, he was found to have a hernia projecting into
the scrotum, producing a tumor, which he said sometimes reached
the size of his two fists. On reducing it, the external ring and
the internal opening were found to be enlarged, so as to admit
the ends of three fingers, the margin being lax and loose. On
the slightest cough or exertion the bowel immediately dropped
down into the scrotum.

Description of the Instruments. The instruments used in this
operation consists of : 1st, a tube two inches and a half long,
mounted on a strong handle, about three inches and a half in
length, curved in a circle of an inch and a half radius, and flat-
tened into an oval at one end, and forming a linear aperture a
quarter of an inch wide at the point ; 2d, a strong needle having
a corresponding curve, with a perforated point, projecting a full
inch beyond the end of the tube when passed through it, and
mounted on a strong handle ; 3d, a box-wood pad or compress,
two inches by one and a quarter, perforated by a hole at half
an inch from one end, and crossed longitudinally by a bar of
iron-wire screwed on to the upper surface ; 4th, a subcutaneous

208 New Operation for Inguinal Hernia. [March,

section -knife, with a sharp point, a narrow blade, and an inch
of cutting edge.

Operation. The patient being laid on his back, with the legs
a little drawn up, and the hernia returned, an incision, about
three-eighths of an inch long, was made through the skin only,
over the cord, about an inch and a half below the external ring,
with the subcutaneous knife, which was then carried close under
the skin, so as to separate a circle of the superficial fascia around
the opening of two inches in diameter. The detached fascia was
pushed up into the inguinal canal by means of the curved tube,
the end being placed through the opening in the skin. The
extremity of the tube was then carried behind and close to Pou-
part's ligament, or the external pillar, to the extent of an inch
and a half from the pubic spine. It was then felt, by depres-
sing the handle, to raise the external pillar upon the extremity.
The needle carrying the thickest silk ligature was then protru-
ded through the tube, and pushed through the external pillar
and the skin, the latter being previously drawn considerably
downwards and outwards. The needle was then withdrawn,
leaving one end of the ligature on the surface. The end of the
tube was next shifted upwards and inwards, and made to pro-
trude behind the internal pillar, as far as possible from its margin.
Through this the needle was then passed, and the skin moved
upwards and inwards till the point appeared at the opening
previously made. The ligature was then freed, and the needle
withdrawn, the tube being still held firmly in its position. The
ends of the ligature were next passed through the hole in the
box-wood compress, one on each side of the wire bar, over
which they were then drawn close and tied firmly, so as to re-
tain the pad closedown to the end of the tube in the canal,
which was then withdrawn. It will thus be seen that the first
passing of the needle pierces not only through the external pillar
of the external ring, but through the origin of the internal
oblique and cremaster muscles, from Poupart's ligament behind
it; and at the second passing it goes through not only the inter-
nal pillar, but also the conjoined tendon of the internal oblique
and transversalis muscles, which is placed behind it, so that the
sides of the inguinal canal are drawn together from end to end
by the ligature. The wound in the skin of the scrotum was
drawn firmly together by plaster, a fold of linen placed upon it,
and the Whole secured by a spica bandage ; the patient being
ordered \b remain in bed, and to use no exertion whatever.

The bandage was removed on the third day, when the sub-
cutaneous juncture was found completely healed by the first
intention. ^The compressed ligatures were retained till the fifth
day, some ceaema and suppuration having by this time appeared
around them, 'with considerable soreness and pain in the groin.

1859.] Diagnosis of Ascites and Ovarian Dropsy. 209

The opening for the ligature looked red, healthy, and suppura-
ting. It was dressed with wet lint, oil-silk, a large compress,
and spica bandage. In a fortnight it was completely healed.
No irritation or swelling of the testicle occurred in the course of
treatment, nor any symptom of peritonitis.

At present, three weeks after the operation, the external ring
is felt by the finger, pushed up beside the cord, to be completely
blocked up by a broad band of fascia passing across it and up
along the canal, with the cord passing by the lower part. The
sides of the canal are felt adherent and consolidated. There is
no ballotternent whatever felt on coughing; the groin of the side
operated upon being more firm and resistant, in fact, than the
opposite, which has always been a little weak. The patient was
ordered to wear a truss for some months, to consolidate the part
and protect the newly-formed tissues. The skin is firmly adhe-
rent to the subjacent structures at the point of the punctures and
subcutaneous separation. He has since undergone a severe test
as to the efficacy of the cure, in an attack of bronchitis, from
which he has completely recovered, without in the least affecting
the site of the hernia. [London Lancet, and Ibid.

Preparation of Anti- Asthmatic Cigarettes. By M. Dahnecy, Phar-
macien of Bordeaux. Some of the properties of stramonium and bella-
donna which plants, when smoked, justly eDJoy the reputation of re-
lieving asthma, and which are employed with the most undoubted suc-
eess in the treatment of neuralgia exist also in plants abounding in
nitrates. Thus I have seen patients who had experienced great relief
from the use of the leaves of borage pellitory plants containing, as is well
knowu, much nitrate of lime.

The fault which almost all patients find with narcotic plants, smoked
in pipes or in the form of cigarettes, is a copious production of smoke,
which fatigues them and sometimes excite cough a symptom they are,
on the contrary, employed to allay.

In order to obviate this inconvenience, I have added nitre to the
leaves of belladonna and of stramonium, by watering the?7e plants, dried
and conveniently spread out, with a solution of nitrate of potash, in the
proportion of three ounces of the salt to rather more than two pounds
avoirdupois of the plants. It will be easily understood, that as this solu-
tion penetrates the entire vegetable tissue, the latter will, when dry, burn
completely, without the formation of the pyrogeneous products above
alluded to.

I have for many years prepared cigarettes according to this formula,
and the benefit derived from their use by a great number of patients in-
duces me to publish it, and to call the attention of practitioners to this
mode of treatment, consisting in the smoking of narcotic plants combined
with nitre. [Journal of Materia Medico.

210

Editorial.

[March,

EDITORIAL AND MISCELLANEOUS.

Medical College of Georgia. The Dean's Report, which we give be-
low, developes a most encouraging condition in the affairs of the Medical
College of Georgia. While such continued prosperity is well calculated
to strengthen the resources and extend the influence of the Institution,
we are certain that, each member of the faculty feels that a yearly in-
creasing responsibility devolves upon him by the unvarying confidence
reposed in the College as a reliable and efficient centre for the promulga-
tion of sound medical doctrine. How fully they have discharged these
responsibilities, during a period of nearly thirty years, can be more pro-
perly answered by their numerous and influential alumni now to be found
in every portion of the South and West.

ANNUAL REPORT OF THE DEA.N.

To the President and Members of the Board of Trustees of the Medical
College of Georgia :
Gentlemen By direction of the Faculty of the Medical College of
Georgia, I herewith present to you the names of the following gentle-
men, who having complied with all the regulations of the College, and
having undergone satisfactory examinations, are hereby recommended to
you for the Degree of Doctor of Medicine, viz :

H. H. Hodges,

of Alabama.

J. R. Slayton,

Alabama.

W.W.Peel,

Georgia.

M. M. T. Huchingson,

Florida.

R. T. Cochran,

it -

J. W. Linn,

Georgia.

W. L. Graves,

Alabama.

J. T. Moore,

tt

D. W. Patton,

S. Carolina.

J. R. Knox,

ti

Ralph Davis,

Alabama.

W. F. Thomason,

it

E. R. Young,

Georgia.

W. R.McRee,

it

N. S. McCants,

S. Carolina.

D. C. Young,

Tennessee.

P. 0. Sullivan,

it

F. M. Matthews,

Georgia.

L. A. Purvis,
W. L Burton,

m

T. S. Matthews,

ti

Alabama.

H. H. Matthews,

ti

R. M. Sharpe,

Georgia.

Geo. S. Orr,

ti

W. E. Link,

S. Carolina.

W. H. McClure,

tt

W. W. Johnson,

Florida.

J. J. Stephens,

Alabama,

W. L. Mills,

Georgia.

W.W. Hearndon,

Georgia.

J. T. Mann,

ti

L. D. Johnson,

ti

C. W. Duggan,
D.J. Williams,

u

J. H. Glover,

S. Carolina.

u

J. S. Blain,

Georgia.

J. F. Baggot?

M

E. F. Sharp,

Alabama.

B. McD. Daniel,

It

J. H. Hall,

Georgia.

B.R. Hildretk.
M. M. Pitts, \

S. Carolina.

J. L. Brockman,

it

tt

A. T. Rowe,

it

C. A Bates,

Georgia.

J. T. Andrews,

ii

1859.] Editorial 211

A. 11 Settle,

S. Carolina

E. M. Roberts,

Georgia.

D. R. dimming,

Georgia.

L. D. Matthews,

u

Wm. Clark,

u

H. W. Cogburn,

u

C. D. Snipes,

Alabama.

J. A. Vigal,

M

B. S. Isbell,

u

A. J. Matthews,

n

W. C. M. McConnell,

u

W. A. Greene.

u

They also recommend that the Honorary Degree of M. D. be conferred
upon Rev. "W. H. Clark, Missionary to Central Africa, and Dr. Wm. B.
Gilbert, of Clay county, Georgia.

The Faculty report, th^t there were in attendance upon the Course of
Lectures which has just terminated One Hundred and Sixty-five Students,
of whom One hundred and twelve were from Georgia, Twenty-one from
Alabama, Twenty-six from South Carolina, Two from Florida, One from
Tennessee, One from North Carolina, One from Texas, and One from
Mississippi. The general deportment of the Students, and their attention
to the Lectures have been highly satisfactory.

Respectfully submitted in behalf of the Faculty.

(Signed,) I. P. GARVIN, Dean.

Medical College of Georgia, )
t, 1859. J

Augusta, March 1st,

Medical Society of the State of Georgia. The Atlanta Medical
and Surgical Journal calls attention to the approaching meeting of this
highly important Body, and we here take occasion to second the call,
and to urge a full attendance of members. " It would be a work of
supererogation," says the Editor, " to go into an argument to prove the
advantages of Medical Associations, and this is not our object ; but we
feel that something ought to be done to arouse the medical men of the
State from their apparent forgetfulness of the great interests which they
have involved in the question, whether the State Medica? Society shall
be the instrument of the incalculable amount of good, it may be made
to accomplish."

Nothing will so fully subserve the object for which our State Society
was instituted as the punctual and full attendance of its members ; then,
the two-fold object of the association is accomplished; 1st, scientific ad-
vancement, and 2ndly, the establishment of, and the promotion of kind
and harmonious relations between the Physicians in distant portions of the
State. There is little encouragement to make extensive research and
to prepare elaborate Essays when they are to be read to but a handful,
however intelligent they may be, and hence the members who are delin-
quent in their attendance, do much injury to the society, by depriving
it both of its interest and its usefulness. In order to refresh the memory
of all concerned, we here re-publish from the minutes of the last meeting,

212 Editorial [March

the names and assigned duties of the various appointees, whose compli-
ance with the request of the Society, is to give interest and profitable
discussion to the approaching session.

" Dr. E. W. Hunter, of Louisville, was, by ballot, elected to deliver the
oration at the next annual meeting. Dr. G. L. McClesky, as his alter-
nate."

The Committee on Essays reported the names of the following gen-
tlemen as Essayists, for the next Annual Session of the Society :*

Drs. H. W.' D. Ford, H. F. Campbell, Robert Campbell ; Dr. Smith,
of Griffln ; Dr. E. Hillyer ; Dr. Stewart, of Pike county ; Dr. G. B. Knight ;
Dr. S. H. Dean ; Dr. W. F. Westmoreland ; Dr. W. H. Doughty, of
Augusta ; Dr. Juriah Harris ; Dr. J. G. Howard ; Dr. R. D. Arnold ; Dr.
V. H. Taliaferro ; Dr. Joseph A. Eve ; Dr. A. M. Boyd ; Dr. Joseph P.
Logan ; Dr. H. W. Burns ; Dr. J. M. Green ; Dr. T. B. Ford, and Dr. G.
L. McClesky.

The day for the next meeting of the Society, is the Second Wednesday
of April 1859, (next month). Place of meeting, the City of Atlanta.
We earnestly hope for a full attendance, which always secures an inter-
esting meeting.

Diseases of the Urinary Organs. A Compendium of their Diagnosis,
Pathology and Treatment. By William Wallace Morland, M. D.,
Fellow of the Massachusetts Medical Society, etc., etc. With Illustra-
tions. Philadelphia : Blanchard & Lea, 8vo., pp. 579. (For sale by
Messrs. Thos. Richards & Son, Augusta, Ga.)

It is seldom that we have to complain that an author does not do himself
justice in his title page, and still less frequently do we find him claiming
too little in his preface. In both these particulars we find Dr. Morland
deficient to an extent, even calculated to injure the sale of his excellent
work. Any one reading the title of the book would never suspect its
comprehensive scope, that instead of being a work which "treats simply
of the Diseases of the Urinary Organs, it also comprehends a most parti-
cular and complete account of the most approved methods, both medical
and surgical, of treating each one of these diseases. Stricture, in ks
multifarious forms, Enlarged Prostate, every variety of Calculous disease,
with the various operative procedures necessary for their cure, are all
fully and judiciously discussed and the operations carefully described.
This work is a valuable addition to the library of Practitioners, as it fur-
nishes a very useful manual for convenient reference in a class of diseases
which, while they are very common, are, unfortunately, but little under-
stood by most Practitioners. In typographical execution the work com-
pares well with all others issued from the excellent establishment of

1859.] Editorial 213

Messrs. Blanchard <fe Lea. "We cordially recommend it to our readers
as one of the best monographs upon the important subjects of which it
professes to treat.

Concentrated Organic Medicines ; being a practical exposition of the
Therapeutic Properties and Clinical Employment of the Combined
Proximate Constituents of Indigenous and Foreign Plants, to which is
added a brief history of Crude Organic Remedies, Constituents of
Plants, Concentrated Medicines, Officinal Preparations, etc., etc. By
Grover Coe, M. D. New York: B. Keith & Co. 1858. pp. 422,
8vo.

This is doubtless a useful book to those particularly interested in the
subjects of wrhich it treats. We have not read the work, but in many
places upon wrhich our eye has fallen the Text smacks somewhat of the
advertising tendency, while the Illustrations indicate that penchant even
more decidedly. The frontice-piece is a picture of the Author, and oppo-
site page 109, is a picture of the Publisher. From this exhibition of the
fine arts, we are led to suspect that the work has been both written and
published more for the benefit of B. Keith & Coe, the Publisher and Au-
thor, than for that of its readers. Doubtless our readers may find it ad-
vantageous to buy their medicines, but we cannot consistently advise
them to buy their book.

Diphtheritis. In an article on this truly appalling disease of children,
Dr. Richard Cammack, jr., says that the disease is of recent growth in
England, and has never been fully treated upon in books ; but he has no
doubt, isolated cases had occurred in England before its specific nature
had been discovered. The Pathology of the disease rests with the
French. M. Bettonneau, of Tours, is the first to give a full and accu-
rate account of it. It often comes on suddenly like Influenza, Cholera,
and Erysipelas, without warning symptoms. In the mildest forms even,
there is a tendency to ulceration beneath a white, loosely attached epithe-
lium, coagulated with viscid mucus and lymph. (This tendency has not
been observed, even in the severer forms in this country.) The specific
cause is atmospheric " as in typhus, cholera, and potato-rot." Debili-
ty, cess-pools, and all nuisances, predispose to it. Taking cold drinks
when overheated, sudden changes of temperature and over exertion are
exciting causes.

Treatment, he thinks, shonld be antiseptic, tonic, stimulating and nu-
tritious, to which we would add, as indispensably necessary in this coun-
try, anti-periodic, with efficient doses*of Quinine.

He recommends a well ventilated room, the exclusion of cold drinks,
a calomel purgative in the beginning, and in some cases, continued in

21-i Editorial. [March,

small, repeated doses. He thinks teething children are most liable to
inflammatory symptoms.

He advises hydrochloric acid, from 1 to 10 minims, every three or
four hours, in a decoction ef cinchona. Common salt and vinegar, a
tablespoonful of each, in a teacupful of hot water, he says, " excels all
other gargles." He applies the stick of nitrate of silver over the whole
surface on which the white exudation appears rubs the external fauces
with comp. ointment of iodine night and morning gives beef-tea, rich
gruels and boiled milk, and hot Port-wine Sanger, with lemon and sugar,
for all above ten years. Every thing should be taken warm, as cold drinks
often excite the disease.

He says the disease is not infectious unless, perhaps, under extraordin-
ary circumstances.

Scraps of Practice.
Remedy for Asthma. We have used the following for years, as a
convenient remedy in a great many cases ol Asthma : indeed, there are
but few circumstances under which it will not be found applicable. The
urgent symptoms yield to it in a few hours, and when promptly adminis-
tered on the first appearance of the symptoms the attack is often pre-
vented.

ft. Of ^Etherial Tinct. of Lobelia (Whitehall's) ij.
Tincture of Assafcetida, )

Laudanum, J ^'

Syrup of Tolu or Simple Syrup, giv.

Mix. Dose, for adult, from a teaspoonful to a tablespoonful every one
or two hours, according to the urgency of the symptoms.

The laudanum obtunds the nervous excitability upon which the attack
often depends, while the lobelia relaxes the spasm, and promotes the
free secretion from the mucous membrane. If necessary, the amount of
laudanum may be reduced to avoid narcotism. We usually advise each
patient to keep the remedy prepared, and to begin taking it on the ap-
proach of the attack. h. f. c.

Iodine and Glycerine in Scrofulous Ozcena. This remedy has been
suggested for Scaly Eruptions on the skin. In an obstinate case of Ozcena,
which applied to us recently, we recommended it in the following pro-
portions :

ft. Of Iodine, . . . grs. ij.
Glycerine, * . ij.

Mix, and apply to affected Schneiderian membrane three or four times
a-day. The case was cured in less than a month. During the time that

1859.] Editorial 215

the above external application was used, the following was taken inter-
nally :

ft. Of Iodide of Potassium, 3ij.

Huxham's Tincture of Cinchona, . . . gviij.
Mix. Dose, one tablespoonful three times a-day, in sweetened water.

H. F. C.

Turpentine externally applied in Puerperal Peritoneal Tenderness.
In a recent case of labour, which was under our care, extreme tenderness
in the hypogastric and iliac regions was presented on the eighth day.
The patient had fever at night and suffered with thirst. The tenderness
extended in a slighter degree up to the umbilical region. The bowels
were moved by a wine-glassful of Olive oil, and the following external
application made :

ft. Of Spts. of Turpentine, . . . gij.
Olive oil, 5vj.

Mix. Heat the mixture in a sand or water bath. A woollen flannel
was then dipped into the liniment and applied, as warm as the patient
could bear, in several folds, over the entire tender region. The patient
obtained the most conspicuous relief from the application, though we
deemed it safe subsequently to resort to a blister in the same case.

Turpentine stupes were strongly recommended in chronic pneumonia
some years ago, by a writer in'the London Lancet. Flannel was used in
the application. The folds were confined to the chest by a many-tailed
bandage, and the liniment renewed every night at bed-time. We have
much confidence in the external application of turpentine in a variety of
cases. h. f. c.

Lime Water for Boih. Some one, under the impression that these
troublesome and often obstinate nuisances are of an acid origin, has re-
commended the free use of alkalies. The English practitioners use " liquor
potassae " for a great many diseases, but in the case of boils we have
used Lime water, i oz. three times a-day, in a tumbler of either milk or
water, for years. We find it the only remedy which exerts any control
over the furunculous diathesis ; whether it be acid or not, certain it is
that under the use of Lime water the boils often dry up even when con-
siderably advanced, and succeeding crops are prevented by continuing
the use of the remedy. Milk and Lime water are by no means unpleas-
ant. This is more than can be said of the boils. h. f. c.

Artificial Pupil and Pectination of Lens. Mr. Critchett ( Ophthalmic
Hospital Reports) suggests that the operation f artificial pupil be per-

216 Editorial and Miscellaneous. [March,

formed by including a portion of the Iris in a ligature, and Mr. Solomon,
in the same periodical, proposes that inclination of cateract should be
done with two needles instead of one, as formerly.

American Medical Association. The twelfth annual meeting of this
Association, will be held in Louisville, Kentucky, on Monday, May 3d,
1859. The Secretaries of all Societies and other bodies entitled to rep-
resentation in the Association, are requested to forward to the Secretary,
S. M. Bemiss, at Louisville, correct lists of their delegations so soon as
they may be appointed. The Convention of Teachers, invoked by a res-
olution of the National Association, for the purpose of a general confer-
ence upon the best means of elevating the standard of Medical Education
in this country, will meet in. the same city on Monday, the 2nd of April.

Medical Journals throughout the United States are requested to insert
the above. S. M. BEMISS, M. D.

Sec'y American Med. Association.

Elixir Cinchona, or Elixir of Calisaya Bark. By Alfred B. Taylor.
[The following is one of the most beautiful preparations of Cinchonse
we have ever seen. It will probably replace the ordinary tinctures at
present in use. We are glad to be able to present the formula to our
readers. Edts. So. Med. & Surg. Jour.]

ft. Best calisaya bark, $\v.

Fresh orange peel, ij.

Ceylon cinnamon,

Coriander seed, aa j.

Anise seed,

Caraway Seed,

Cardamon seed,

Cochineal, aa ij.

Brandy Oiiss.

Having bruised the articles well, and allowed them to macerate for
twenty-four hours in sufficient of the brandy to moisten thoroughly,
transfer to a displacement apparatus, and add the rest of the brandy ;
then displace carefully with a mixture of three parts of water and one
part of alchohol, until six and a half pints of tincture are obtained ; to
this add two and one-half pints of simple syrup, and mix thoroughly.

[American Journal of Pharmacy.

Improvement in the Plastic Execution of the Hare-Lip Operation.
[We have ourself, acted upon the following suggestion, in the operation
for Hare-lip in two cases, with the most satisfactory results. The central
notch, so common with the ordinary operation, was entirely avoided. The
operation, as described below, however, is not correctly represented a

1359.] Miscellaneous. 217

portion of the vertical border is retained in paring the hare-lip and eon-
verted into horizontal, and not the horizontal converted into vertical as
here described. II. F. C]

"Sedillot suggests, warranted by his own succe s, to convert a portion
of the horizontal^ border of the hare-lip into vertical, procuring thereby
the natural prominence of the middle of the upper lip, which by the
method hitherto pursued, remained thin and left the teeth visible. Even
the most successful operations by the present mode, have a deficiency in
this respect, which is entirely avoided by his method. How much
of the horizontal border is to be excised to make the desired bulging
edge, must be determined by the operator, according to the individual
case."

Nature's Great Disinfectant. Monsieur Sroutteten,head physician of
the Military Hospital at Metz, has published a book on the new-found
body called by chemists azone, which probably contains the newest as
well as the most reliable facts in reference to this interesting subject. A
very careful analysis of this work was published in a recent number of
"Household Words,'' and we gather from this source a few points of
interest, which we believe are not generally known.

The latest and most accurate experiments of French chemists have
proved that ozone, at first supposed to be an odorous principle, emanating
from a simple elementary body, and afterwards a compound of oxygen and
hydrogen, is nothing more nor less than oxygen electrified. It is color-
less, of a penetrating nauseabund smell, and is the most powerful agent
of oxydation known. It oxydizes cold silver and mercury, when both are
moist, destroys organic coloring matters, as well as ligneous and albu-
minous matters. It is produced naturally in the air whenever an elec-
tric discharge takes place; and it may be prepared artificially in the lab-
oratory, the simplest mode being to plunge a stick of phosphorus half in
air and half in water. It is a little curious that the odor given off by
artificially prepared ozone, is identical with the odor which spreads itself
around a spot stricken with lightning ; and it is believed that the odor of
the air traversed by lightning is owing to the formation of ozone.

Passing over all that has been said in reference to what this new found
substance is expected to accomplish in the arts, in chemistry and in
agriculture, we come to the main fact that it has the power to. destroy
sulphuretted hydrogen ; that it is readily absorbed by a great number of
vegetable and animal substances ; that it extirpates all oxydable miasms,
and is the most powerful disinfecting agent yet discovered. Stranger still,
this invisible fluid pervades the whole earth ; it is manifested in very
decided quantities over sheets of water, and the air, in its normal state,
contains one ten-thousandth part of ozone. It has been found that when
the proportion is raised to one two-thousandth part, it is powerful enough
to kill small animals. So delicate are the calculations in the mammoth
laboratories of Nature !

Although the study of ozone has scarcely advanced beyond its rudi-
ments, the facts already known are curious and interesting. By the
means of slips of paper, impregnated with iodide of potassium and starch,
some of the chemists have carried on a series of experiments by which

218 Miscellaneous.

they can measure the quantity of ozone in the atmosphere at any given
time. The prepared paper is called an ozonometer ; and there is an ozo-
nometer scale, running from one to ten. These tests are not always satis-
factory, but it has been found that ozone is more abundant in the upper
regions of (he air than in the lower strata, an observation which is justi-
fied by experience in reference to the healthy effects of mountain air.
It has also been ascertained that ozone is found to be absent in inhabited
dwellings, upon which the writer whose statements we are collating, re-
marks that " a clue is thus given to the different effects upon the health
produced by indoor exercise and out door exercise, by town life and coun-
try life, by labor in a metropolitan workshop, and labor in the open fields."
Experiments were made in the hospitals at Versailes and Metz, for days
together, without showing the slightest trace of ozone, while slips hung
outside of the windows gave seven, eight and even ten degrees of the
ozonometric scale.

We shall not go any further into the facts and theories of these 'French
chemists, nor follow them in their speculations and experiments as to the
effects of the deficiency or excess (for there can be too much of a good
thing) of ozone in breeding miasmatic fevers, epidemies, and influenzas.
It is sufficient for us to know that a kind Providence has provided a vast
disinfecting agent which constantly sweetens the polluted air and destroys
the noxious gases which spread themselves around the manufactories and
haunts of men. Nature is constantly ventilating herself; it is only man
who shuts himself off from the wholesome influences of the fresh, Heaven-
sent air. The all pervading ozone comes to us continually from the
thunder storm, or the invisible electric current, or from the surface of the
rivers and seas; but from the owners of the overcrowded tenement house
to the whole race of sextons, janitors and car-conductors, no one seems
to take the hint given by nature's great disinfectant, although the best
physicians have asserted, and dinned it into the ears of the public for
years, that scrofula, consumption, and other malignant forms of disease,
are produced and perpetuated by a neglect of a proper system of venti-
lation. [Newspaper.

Mode of Growth and Increase of Muscular Fibre. M. Budge, by a
new method of dissection, which consists in dissolving out the areolar
tissue between the fibres, so that the muscular fibres alone remain, has
been able to follow out the different conditions of their development in
animals of different sizes. He has satisfied himself that the increase of
muscles arises both from augmentation in thickness and in length of each
existing fibres, and also from the formation of new fibres ; and that under
the influence of rest, or of absence of nutrition, the fibres diminish in
volume, and that some of them disappear. [Academie des Sciences and
Virginia Med. Journal.

Dr. Thomas Watson has been appointed Physician Extraordinary to
Her Majesty, Queen Victoria, in place of the lamented Dr. Richard Bright.
Dr. Watson is well known to the profession for his high character and
distinguished attainments, and as the author of the " Principles and Prac-
tice of Physic." [Boston Med. <fb Surg. Jour.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XV.] AUGUSTA, GEORGIA, APRIL, 180, [No. 4.

ORIGINAL AND ECLECTIC.

AKTICLE IX.

Observations on Malarial Fever. By Joseph Joxes, A.M., M.D.,
Professor of Medical Chemistry in the Medical College of
Georgia, at Augusta.

[Continued from page 172 of March So.]

Case LI. Grerman, aged 40 : height 5 feet 9 inches ; weight
150 lbs. ; black eyes, black hair, sallow complexion ; occupation,
bar-keeper.

October 16th. 1857, 8 o'clock P. M. Has just entered the
hospital. Is unable to give coherent answers, and is either stu-
pid, or unable to speak the English language. His companion
states that this patient has been in Savannah for two months,
and has been sick with chill and fever for two weeks. He is
exceedingly weak, and his intellect wanders. Pulse 112, rather
feeble.

$. Calomel, grs. xii. ; sulphate of quinia, grs. vi. Mix: ad-
minister, and follow with castor oil in four hours.

ty. As soon as the calomel has acted once, commence with
sulph. of quinia, grs. v. every three hours, up to grs. xx.

October 17th, 11 o'clock A. M. When I saw this patient last
night, I supposed that the stupidity, and difficulty of speech,
were due, in great measure, to the fact that he was a foreigner,
imperfectly acquainted with our language. Careful examina-
tion this morning, however, shows that the difficulty of speech,
and torpor of intellect, is dependent upon the effects of the ma-
larial poison, (either directly or indirectly.) upon the brain.
When questioned, endeavors to converse commences sentences,
but is unable to finish them.

Pulse 124, very feeble ; respiration 28. Tongue, dry, hard
and rough, and coated with dry, brownish-yellow fur. The

n. s. VOL. XV. NO. iv. 16

220 Jones, on Malarial Fever. [April,

tongue feels very hard and rough. There is not moisture enough
in his mouth to produce any sensible effect upon a bit of paper
pressed against the tongue. Skin, warm and dry. The tem-
perature of the skin corresponds to the feebleness of the pulse,
but not to its frequency, and not to the frequency of respiration.
Says that he feels well.

ty. Mustards to extremities; cut-cups to temples and back of
neck.

ty. Administer freely, brandy, infusion of Virginia snake-root,
spirit of Mindererus, and sulphate of quinia.

8 o'clock P.M. The cut-cups and mustards aroused him for
a short time, but he has relapsed into the state of partial stupor,
in spite of the action of the sulphate of quinia and stimulants.

$. Continue stimulants, infusion of Virginia snake-root and
sulphate of quinia.

Oct. 18th, 11 o'clock A. M. No improvement. Tongue very
red at edges and tip, which are free from fur. Surface of tongue
coated with dry, yellow fur, and presents the same dry, rough
feeling and appearance. Teeth coated with sordes. The pulse
is so rapid and feeble that it is almost impossible to ascertain
accurately its number of beats it feels like the delicate pulsa-
tions of a minute capillary filled with water. The pulsations
cease, as soon as the slightest pressure is made. Pulse 155 to
minute. The heart merely thumps (flutters). The two sounds
are merged into one, and cannot be distinguished. The sounds
of the heart correspond in number to the beating of the pulse
155 to the minute. The correspondence of the two was examin-
ed, not only by separate calculation, but also by applying the ear
over the region of the chest, and the hand over the pulse, at the
wrist. Eespiration 34, spasmodic. Skin covered with cold,
clammy sweat. Extremities are at least 20 degrees below the
normal standard. Trunk and head feel cold they are several
degrees below the normal standard.

The action of the heart is feeble the capillary circulation is
exceedingly feeble and sluggish the distributton of the nutri-
tive and force elements is correspondingly retarded, and as a
necessary consequence, the chemical changes are diminished and
altered both in quantity and kind.

The patient is very restless, tosses about the bed, and is with
the greatest difficulty retained in bed. Passes his water and
feces in bed. Intellect wandering talks incoherently says
that he is perfectly well and wishes nothing but water. When
aroused, his eye looks bright, and there is no expression of pain
or uneasiness upon his countenance.

During the last thirty-six hours, has taken 50 grains of the
sulphate of quinia, together with large quantities of stimulants.
Mustards have been frequently applied. The effect of these

1859.] Joxes, on Malarial Fever. 221

remedies appear to be only palliative, they have produced no
permanent beneficial effect. Whenever the mustards and stimu-
lants were withheld, the forces diminished rapidly and the patient
would relapse almost inlo a profound stupor. The action of the
mustards was very slow, on account of the sluggish capillary
circulation.

#. Continue stimulants apply bottles of hot water to the
extremities administer 10 grains of the sulphate of quinia, im-
mediately, and repeat every three hours.

ft. Blister to back of neck.

9i o'clock P. M. The mustards and stimulants aroused him,
and at 6 o'clock P. M., this evening, his pulse was fuller, his
tongue was moister, his intellect clearer, and the restlessness had
in a great measure disappeared. The patient, during the mo-
mentary absence of the nurse, got out of bed, and attempted to
walk across the floor, to the bucket of water at the other end of
the ward. He had not proceeded more than five steps, before
he fell upon the floor, completely exhausted. Almost immedi-
ately, his pulse became more frequent and feeble, in fact, almost
entirely disappeared, and his extremities became much colder.
Mustards were again applied and stimulants administered. Un-
der the action of these, his circulation, both general and capilla-
ry, was increased somewhat in force, and his exhausted forces
revived.

Now, his pulse is 135, and his respiration 32. The sordes on
the teeth, which were this morning perfectly dry, are moister
the tongue is moister the pulse is fuller (although still exceed-
ingly feeble and flickering) than it was this morning.

There is an unnatural brilliancy about his eye, and excitement
about his intellect. He converses freely for the first time says
that he feels perfectly well, and wishes to go immediately home
to the hotel, and take the place of the bar-keeper, who, he savs,
is sick. Complains bitterly of being confined to bed, when
nothing is the matter with him, and when he feels as strong and
as well as he ever did in his life. Has been quarreling with the
nurse, and threatens vengeance, because he confines him to bed
and will not allow him to dress himself and go and drink freely
of water. Complains greatly of thirst keeps his eye fixed on
the vessel containing water, notwithstanding that he is liberally
supplied. Has vomited several times. The blister is acting,
and the serum is of a golden color. Has taken 30 grains of the
sulphate of quinia since 11 o'clock this morning.

Has just passed urine: it is perfectly clear and amber-colored.
The color of the urine is in striking contrast to that of patients
who are able to resist the effects of the malarial poison to the
extent of the production of the febrile excitement. AVhen the
constitution is able to cope with the malarial poison, we have a

Jones, on Malarial Fever. [April,

rapid pulse, rapid respiration, high temperature, rapid chemical
change, and high colored concentrated urine. Specific gravity
of urine, 1015*3 reaction strongly acid. The urine changed
the litmus blue paper to as bright a red as a strong mineral acid.
The rapidity of the change also corresponded to the action of a
powerful acid. After standing 70 hours, the reaction was still
decidedly acid, and there was no deposit of any kind. When
the urine was evaporated, the residue was a dark reddish-brown
viscous mass, resembling tar. After prolonged, tedious and
careful evaporation, it was found to be impossible to reduce it
to a solid state. When the urine, concentrated to the consist-
ence of a syrup, was treated with nitric acid, there was a slight
effervescence, and a few crystals, appeared. These crystals
were transparent, and resembled rather crystals of saltpetre than
the silvery crystals of nitrate of urea. After standing for a
short time these crystals disappeared, and did not again appear
even when the fluid was concentrated by evaporation. If these
crystals were nitrate of urea, the whole amount existing in 1000
grains of urine must have been less than 2 grains. In a fluid
ounce of urine, not more than a trace of uric acid could be detect-
ed after careful examination. Under the microscope, a few
small crystals could be detected, which were invisible to the
naked eye.
Analysis of 1000 parts of urine contain

Solid Matters, 34.482

Water, 965.518

Urea, a trace.

Uric Acid, a trace.

Ext. and Color 'g and Organic Matters, 24.805
Fixed Saline Constituents principally ) 0 ^^
Phosphates, - - . . - f *bob
The fixed saline constituents were principally the phosphates.

A short time after this observation, the excitement and rest-
lessness of this patient disappeared, and he went into a profound
sleep, and died at 1 o'clock, A.M.

(14.) Autopsy twelve hours after Death.

Exterior Limbs and trunk round and full, and apparently
in full flesh ; the skin, over the whole surface except the face,
presented a fair white color. There was no settling of the blood
in the capillaries of the most dependant portions of the skin,
producing the mottled appearance previously noticed. This
may be due to the fact, that the patient was under the action of
stimulants at the time of death.

Head. Dura-mater normal. Arachnoid membrane opales-
cent (pearl-colored) in many spots. Serum was effused between
the arachnoid membrane and pia-mater. Blood-vessels of pia-

1859.] Jones, on Malarial Fever. 223

mater filled with blood. Substance of brain was firm, and was
altered neither in consistency nor in appearance. Blood-vessels
of the substance of the brain not more distinct than normal.
Ventricles of the brain were almost entirely filled with light
yellow serum. Light-yellow serum was effused around the me-
dulla oblongata, and superior portion of spinal cord. The
effused serum appeared to fill completely the space between the
spinal cord and its membranes, and the surrounding vertebral
cavity. When the medulla oblongata, and superior portion of
the spinal cord were removed, the serum flowed in (the should-
ers being slightly depressed), and filled the vertebral canal.

Chest. Lungs normal. Blood-vessels of the dependent por-
tions engorged with blood.

Heart, normal in size and structure. The ventricles and auri-
cles contained clots ; portions of these clots were free from col-
ored corpuscles, and presented the yellow color of whipped
fibrin. Surrounding and attached to these were ordinary coag-
ula of blood. The vena cava and all the large venous trunks
in the abdominal cavity, were filled with dark, almost black,
coagulated blood.

Abdominal Cavity. Liver, somewhat enlarged, presented
a singular mottled appearance ; at a distance, it presented a light
bronzed color; upon nearer inspection, the lobules were found
to be distinct, elevated, and of a light bronze color, whilst the
spaces between the lobules inclined to a slate color. There
were several spots, varying from two inches to half an inch in di-
ameter, of a uniform slate color. The structure of the liver 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, and forming a
sheath for the large vessels lying in the portal canals, was thick-
ened, and the individual lobules of the liver were surrounded
with fibrous tissue. These facts which were demonstrated, not
only by the touch and naked eye, but also by the microscope,
show that this liver was in a cirrhosed condition. Cirrhosis of
the liver, in this case, was not caused by the action of the
malarial poison, but in all probability by the habitual use of
ardent spirits. This patient was a bar-keeper. Men in this
occupation are, as a general rule, addicted to the free use of
ardent spirits. The liquors drank in this country, at the
hotels and bar-rooms, contain much alcohol, which acts upon
the secreting structures of the liver, and upon the blood-
vessels, and excite adhesive inflammation in the areolar tissue,
about the small twigs of the portal vein, and in the areolar tis-
sue of the portal canals, by which serous fluid and coagulable
lymph are thrown out Under the microscope, the substance

224 Jones, on Malarial Fever. [April,

of the liver contained many dark looking masses, resembling
the altered blood corpuscles of the spleen, and the black gran-
nies and flakes of black vomit. These dark masses were not
sufficiently numerous to have any marked effect upon the or-
gan. When the fibrous capsule was torn off, it presented a
light slate color, and yet, when magnified and carefully exam-
ined, but few of these dark masses were seen in the meshes.
The structures of the liver, and the liver cells, contained num-
erous oil globules. These oil globules existed in sufficient
numbers to induce the belief that the liver was in a state, not
only of cirrhosis, but also of fatty degeneration. The blood-
vessels of the liver were filled with dark blood, which did not
change to the arterial hue upon exposure to the atmosphere.

The mottled appearance of the liver, and the want of that
decided slate and bronze color, characteristic of malarial fever,
were due, not to any peculiarity of the effects of the malarial
poison, but rather to the pathological conditions of cirrhosis and
fatty degeneration. Allowing clue weight to these pathological
changes, 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. The
change in the color of the liver during 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 the physical
and chemical changes in the bile, and the contents of the secre-
tory apparatus; and not to the deposition of black granules in
the structures of the liver. I have seen the slate and bronze
color as well marked in the liver, when these dark masses were
absent, as in the liver where they were most abundant. The
peculiar color of the liver is due in a great measure to changes
in the coloring matter (haematin) of the blood. The blood will
not change to the arterial hue when exposed in the atmosphere.
This altered coloring matter, resulting from the destroyed disin-
tegrated blood-corpuscles, or from the blood-corpuscles acted on
by the malarial poison without actual disintegration, escapes
and permeates the surrounding tissues, and imparts the peculiar
color to the liver. The color is also due to the altered color of
the bile. In all the cases of malarial fever which I have thus
far examined, I have found the bile to be of high specific gravi-
tythick, concentrated and of a greenish black color when seen
in mass, and of a gamboge yellow when spread in thin layers.
The altered bile also infiltrates the surrounding tissues, and gives
this peculiar color to the liver. This peculiar color can be, to
a certain extent, abstracted from the liver by boiling with water.
I have always found the filtered decoction of malarial fever
livers to be of a brownish-yellow color, whilst the decoction of
yellow fever livers is of a bright golden color, whilst that of

1859.] Jones, on Malarial Fever. 225

normal livers is of a light-yellow. After the altered coloring
matters of the blood and bile have infiltrated the structures of
the liver, they will sometimes remain for a considerable length
of time without being absorbed, and communicate the peculiar
bronzed color to the liver, long after the restoration of its nor-
mal functions, and the disappearance of the malarial fever. I
have observed, however, that the intensity of the color of the
liver, bears a marked relation to the time of convalescence : as
convalescence advances, the color diminishes in depth.

The liver contained animal starch. Several of the hepatic
ducts were isolated and treated with tincture of iodine, and
carefully observed under the microscope. Their color, with the
exception of a few small spots, was simply changed to that of
the tincture of iodine. In these spots, the color was changed to
a bright-blue. In other cases of malarial fever, I have seen long
portions of the hepatic ducts changed to a bright-blue color un-
der the action of the tincture of iodine. These facts would show
that they do sometimes contain animal starch.

The gall-bladder was filled with concentrated bile of the con-
sistency of molasses, and of the color (when seen in mass) of a
saturated solution of iodine. When spread in thin layers the
bile presented a gamboge color.

Spleen, enlarged: it was at least three times the normal size.
The structures of the spleen were so much disorganized, that, in
attempting to remove it from the abdominal cavity, the capsule
and trabeculae gave way under a slight pressure, and the fingers
plunged into its soft substance. Dark brownish-purple, almost
black, mud flowed from the rupture. After thirty-six hours'
exposure to the atmosphere, the color of the mud of the spleen
remained unchanged. Under the microscope, the mud of the
spleen contained a great number of dark, reddish-brown, and
reddish-black granules, and conglomerations of granules. These
granules and black masses, composed of conglomerated granules,
resembled the bodies found in the liver, and also the black sed-
iment of the black vomit of yellow fever. Similar granules and
masses have been observed in normal spleens. They appear,
however, to be most abundant in the malarial fever spleens of
long standing. In cases which have terminated fatally, after
only a short illness of two or three days, I have observed that
these granules were not so numerous as in cases of longer dura-
tion, and in some very recent cases they were not more numer-
ous than in the spleen of health. These masses appear to be
derived from the disintegrating blood-corpuscles.

Alimentary and Intestinal Canal. Stomach. Blood-
vessels upon its exterior filled with blood. Mucous membrane
bore no marks of inflammation, and was not more congested
with blood than usual The exterior and mucous membrane of

226 Jones, on Malarial Fever. [April,

the jejunum presented the usual appearance. There was no
unusual appearance either of congestion, irritation or inflamma-
tion. The mucous membrane of the ileum, especially at the
lower portion, was more coagested, and of a darker color than
usual.

The intestinal canal throughout its entire length was empty.
The mucous membrane presented a yellowish appearance, pro-
bably due to the presence of bile.

The solitary glands of the ileum, especially in the neighbor-
hood of the ileo-csecal valve, were numerous, enlarged, elevated,
distinct, and of a brown color. When the intestines were held
up to the light, the blood-vessels, filled with blood, could be dis-
tinctly seen sending off branches to each gland. The glands of
Peyer were large, distinct and elevated. Several of these glands
in the lower portion of the ileum were three inches in length.
These glands, however, were not inflamed, as in typhoid fever,
but presented the usual pale appearance.

Kidneys. Each kidney had upon its inferior surface a spot
about one inch in diameter, of a slate color, resembling in all
respects the color of the exterior of the malarial fever liver and
spleen. When these portions of the kidney were cut, they pre-
sented a bronzed color, for the depth of jth of an inch. Micro-
scopical examination showed the absence from these portions
of the kidney of those granules and brownish-red and reddish-
black masses, so abundant in the spleen and liver. Microscopical
examination showed that the excretory structures of the kidney
was not altered in these discolored portions. These facts sustain
the assertion that I have previously made, that the color of the
liver in malarial fever does not depend upon the diffusion
through its substance of dark granules and granular masses.
The bladder was empty. The scrotum was reddened, and ap-
peared to be blistered and excoriated. This was due to the
action of the intensely acid urine.

CONCLUSIONS.

1. This case corresponds to the congestive fever of American
writers. The prominent symptoms of this case were rapid,
feeble pulse ; rapid, thoracic respiration ; relaxed skin, with cold,
clammy sweat ; sluggish capillary circulation ; deficient and per-
verted chemical action ; reduced temperature ; deranged physical,
muscular and nervous forces ; and aberrated intellectual action.

2. The rapid, feeble action of the heart the rapid, feeble
pulse the almost entire arrest of the circulation and chemical
changes in the capillaries; were attended by a reduction of tem-
perature, and loss of muscular and nervous force, and aberration
of the actions of the sympathetic and cerebro-spinal nervous
sjTstems. These disturbances of the chemical changes, and physi-

1859.] Jones, on Malarial Fever. 227

cal, muscular and nervous forces, were reflected in the urine.
The appearance and chemical constitution of the urine, were
strikingly different from the urine of those cases of intermittent,
and remittent fever, where the action of the poison is attended
by an excitement of the general and capillary circulation, and
of the respiration, and corresponding rapid chemical changes, and
high temperature. In those cases of malarial fever, where there
is a rapid full pulse moderately accelerated respiration rapid
introduction and distribution of oxygen and corresponding high
temperature the urine is invariably high colored, concentrated,
and rich in solid matters. If we examine the analyses of the
urine of those cases of intermittent and remittent fever, which I
have recorded in previous numbers of this journal, and at the
same time, bear in mind, the fact, that the urine was excreted
during the summer season, and during starvation, it is evident
that during the febrile excitement, the urea is greatly increased.
When the febrile excitement (rapid distribution of oxygen, and
rapid chemical change, and high temperature) subsides, the urea
and other solid constituents of the urine decrease. After the es-
tablishment of convalescence, when the patient is able to take
food freely, the solid constituents of the urine again rise, not-
withstanding that the temperature is the same, or a few degrees
above that of the intermission. The urea during convalescence,
is probably derived partly from the food and partly from the
metamorphoses of the tissues. In this case, on the other hand,
the arrest of the circulation and chemical changes of the capilla-
ries and the reduction of temperature, was attended by a com-
plete alteration of the physical and chemical constitution of the
products resulting from the metamorphoses of the blood, organs
and tissues. The urea and uric acid were absent, the acid of the
urine was greatly increased and the physical properties of the
urine altered.

Whether the disappearance of the urea and uric acid resulted
from the arrest of the metamorphoses of the muscular tissue, Or
of the blood corpuscles and nitrogenized elements of the blood;
or from the disturbance of the normal chemical changes, by the
introduction of the malarial poison, amongst the substances un-
dergoing chemical change ; or from the primary action of the
malarial poison upon the sympathetic and cerebro-spinal nervous
systems, and the perversion of the chemical changes of the or-
ganized elements, by the consequent aberrated nervous action ;
cannot be definitely answered in the present state of chemical,
physical, physiological and pathological science, because the fun-
damental facts are wanting. It has not as yet been definitely
settled, whether urea and uric acid* results from the metamor-

*The following observations throw some light upon the origin of uric acid. I
kept a large Indigo snake (coluber couperi) in a cold dry room, during the winter

228 Jones, on Malarial Fever. [April,

phoses of the blood corpuscles, or of the other nitrogenized con-
stituents of the blood, or of the muscular tissue ; or from all these
sources. The chemical, physical, physiological and pathologi-
cal properties and relations of the malarial poison, are unknown.
What relations, chemical, physical, physiological and pathologi-
cal, do the metamorphoses of the organized bodies which result
in the formation of urea and uric acid, and of the extractive and
coloring matters, bear to the metamorphoses induced by the
malarial poison ? It is impossible to give any answer to this
important question, which lies at the foundation of the solution
of the problem. Neither would the answer of this important
fundamental question, clear up the difficulty, for we have here,
complicated phenomena and numerous complicated actions and
reactions. So complicated and involved are the phenomena
that the solution of one necessarily demands the solution of all.

Such questions as these demand an answer.

What is the chemical, physical, physiological and pathologi-
cal relations of the malarial poison to the sympathetic and cere-
brospinal nervous systems ?

What is the effect of derangement of the sympathetic nervous
system upon secretion and excretion, in fact, upon all the chemi-
cal changes of the elements of the human organism?

season, without food and drink. This serpent remained in a partially torpid state
for three months. He was never entirely without the power of motion, and
would, when aroused, show considerable power. At the end of this time, the
serpent died. When the heart was exposed after death, its surface was covered
with a chalky, granular substance, which was demonstrated both by microsco-
pical and chemical analysis, to be the urate of ammonia. The external surface
of the aorta, and its largest branches, were in like manner covered with the urate
of ammonia. When the substance of the heart was cut, numerous particles of the
urate of ammonia were found along the course of the blood-vessels and amongst
the muscular fibres. Numerous particles of the urate of ammonia were also dis-
covered amongst the fibres of the muscular coat of the aorta and its largest branch-
es. When a portion of the muscle of the heart or of the muscular coat of the
aorta was treated with acetic or hydrochloric acid under the microscope, thous-
ands of small lozenge shape crystals of uric acid were discovered lying around
the muscular fibrillse. The urate of ammonia was deposited in no other organ
or tissue except the heart and the aorta and its largest branches. The following
appears to be the explanation of this singular phenomenon :

The heart was the only portion of the muscular system in continual action
during the season of hybernation. Muscular force is developed by chemical
change. The heart therefore was the only portion of the muscular system un-
dergoing chemical change. The blood was concentrated, deficient in water.
There was not sufficient water to dissolve the urate of ammonia, resulting from
the chemical changes of the blood and muscles of the heart, by which the muscu-
lar force was developed. The urate of ammonia, consequently remained just
where it was formed. This observation not only points to the origin of uric acid
and ammonia in the animal economy, but also demonstrates that the muscular
force is developed during the chemical changes of the elements of the blood and
muscles. If these conclusions be legitimate, true and universal, it follows as a
necessary consequence that any alteration in amount, or kind, of the chemical
changes of the blood and muscular tissue must be attended by corresponding
alterations in the amount and kind of the products resulting from those chemical
changes.

1859.] Jones, on Malarial Fever. 229

Will the derangement of the secretions and excretions differ
with different poisons, when the actions of those poisons are
limited, simply to the sympathetic nervous system ?

What is the effect of derangement of the sympathetic nervoms
system npon the cerebrospinal nervous system f

Can the sympathetic nervous system induce alterations in the
actions of the organs and tissues, in the secretions and excretions,,
independent entirely of any direct action, but by communicating
or reflecting its aberrated action to the cerebro-spinal nervous
system ?

What is the effect of derangement of the cerebro-spinal nervous
system, upon secretion and excretion, in fact, upon all the chemi-
cal changes of the elements of the human organism?

Will the derangements of the secretions and excretfons differ
with different poisons, when the actions of those poisons are
limited simply to the cerebro-spinal nervous system f

What is the effect of derangement of the cerebro-spinal nervous
system, upon the sympathetic nervous system ?

Can the cerebro-spinal nervous system induce alterations in
the actions of the organs and tissues, in the secretions and ex-
cretions, independent entirety of any direct action, but by com-
municating or reflecting its aberrated action to the sgmpathetic
nervous system?

Would the phenomena of nervous and muscular action and
of secretion and excretion vary, if the action of the poison or
poisons were primarily upon the blood, rendering it unsuited to
the healthy action of the cerebro-spinal and sympathetic nervous
systems and of the muscular system rendering it unsuitable
for the formation of the secretions and excretions?

Notwithstanding the absence of the facts necessary for the
solution of these complicated phenomena and problems ; still the
present observation, that arrest of capillary circulation and chemi-
cal change due to the action of the malarial poison, was at-
tended by a reduction of the temperature, aberrated muscular and
nervous action, and a marked alteration of the properties of the
urine ; is of great interest, in its bearing upon the treatment of
congestive fever.

3. In the treatment of that form of malarial fever called con-
gestive fever, those remedies should be employed, which excite
the general and capillary circulation promote the introduction
and distribution of oxygen increase the chemical changes and
excite the development of the muscular and nervous forces. Sul-
phate of quinia and diffusible stimulants, brandy and carbonate
of ammonia, should be freely and promptly administered and
sinapisms freely applied. Bottles of hot water, or better still, the
hot water bath, should be used to impart heat and stimulate the
capillary circulation, and relieve the engorgement of the large

230 JONES, on Malarial Fever. [April,

organs. Brandy and red pepper may be applied to the surface
with advantage. The sulphate of quinia may be administered
in doses of 10 to 30 grains, every one, two or three hours, accord-
ing to the urgency of the symptoms, up to 60 or 100 grains during
the 24 hours. The best method of administering the sulphate
of quinia is dissolved in a weak solution of citric acids or in
lemon j uice. It is perfectly soluble in this, and is much more
readily absorbed, when in this soluble form. If the stomach
rejects the sulphate of quinia, it should be administered in solu-
tion with starch, by the rectum. The stimulants will in many
cases be the means of prolonging life until the sulphate of quinia
can be absorbed and act. Whilst therefore the stimulants do
not cure the disease, they often preserve life, by supporting the
patient until the sulphate of quinia can act.

The carbonate of ammonia is peculiarly valuable in that form
of malarial fever, where there is a rapid, feeble pulse, and corres-
ponding rapid, feeble action of the heart. The observations
which I hove recorded in the previous numbers of this journal,
prove that heart clots are almost always formed previously to
death from malarial fever. It is probable that cases often oc-
cur where the sudden and distressing symptoms are due, in a
great measure, to the formation of these heart clots during life.
The feeble action of the heart, and the sluggish circulation of
the blood are very favorable to the formation of these heart clots.
The researches of Benjamin Ward Richardson* have establish-
ed the fact, that the fibrin of the blood is held in solution in
the blood-vessels by ammonia. The free administration of the
carbonate of ammonia, then, in congestive fever, would fulfil
two indications. 1st. Stimulation ; 2d, Prevention of the for-
mation of fibrinous clots in the heart and large blood-vessels.

4. The failure of this mode of treatment to prevent a fatal
termination in this case, was due to several causes. The disease
had been allowed to progress, without any opposition, for at least
ten days before this plan of treatment was instituted. During
this time, such profound alterations of the blood, spleen and
liver, had taken place, and the chemical changes so perverted,
and the correlation of the physical, vital, nervous and muscular
forces, so disturbed, that no plan of treatment, however vigorous,
however appropriate, could arrest the progress of the disease.

The symptoms were, without doubt, aggravated by the cir-
rhosed condition of the liver. The alterations of the color of the
blood and of the secretions of the liver in malarial fever, point
to profound alterations. The cirrhosed condition of the liver
would necessarily increase these morbid effects. The cirrhosed
condition of the liver, also points to the former intemperate

*The cause of the coagulation of the blood, by Benjamin Ward Richardson,
M. D., London, 1858.

1859.] JoXES, on Malarial Fever. 231

habits of the patient, and the effects of these upon the constitu-
tion, no doubt, influenced materially the course of the disc
As far as my observations upon malarial fever extends, I can
assert that this disease most frequently proves fatal in those who
have been addicted to the intemperate use of ardent spirits, and
especially in those, in whom a cirrhosed condition of the liver,
has been induced by the free use of ardent spirits. This state-
ment is worthy of the attentive examination and consideration
of the profession.

It is probable that the fibrinous clots found in the heart
were formed some time before death, and if they did not deter-
mine, they at least hastened the fatal termination.

5. In this case, the marked reduction of the temperature of
the trunk and extremities, was unattended by the shivering and
sensations of cold, characteristic of the chill of intermittent and
remittent fever. The observations which I have recorded, in
previous numbers of this journal* have established, that in the
chill of intermittent and remittent fevers, the temperature of the
trunk is actually elevated several degrees above the normal
standard, whilst the temperature of the extremities is depressed
many degrees below the normal standard. In this state of things,
we find a feeble pulse ; feeble circulation of the blood in the
capillaries of the extremities ; diminished chemical action in the
capillaries of the extremities ; accumulation of blood in the large
organs of the trunk; and increased chemical change in the blood
and large organs of the trunk. This state of things is attended
by shivering of the muscles, and a sensation of cold, just as a
similar reduction of the temperature of the extremities in cold
weather, would be attended by shivering of the muscles, and a
sensation of cold. On the other hand, in that form of malarial
fever, called congestive fever, where the temperature of both the
trunk and extremities is depressed, the patient often complains
of no sensation of cold, and in some instances, even says, that
he feels perfectly well, and there is no shivering of the muscles.
Here we find a feeble, general and capillary circulation, and an
arrest and perversion of chemical action, both in the trunk and
in the extremities.

Whence this difference ?

Without attempting to decide dogmatically upon the solution
of these complicated phenomena, we would simply state, that in
congestive fever, the chemical changes in all parts of the body,
are so diminished and perverted, and the correlation of the forces
so disturbed, that the muscular system ceases to indicate by
shivering and aberrated action, and the nervous system ceases
to indicate by the sensation of cold, the depression of tempera-

* Cases I to VIII, June number. 1848, pp. 377-396.

232 Jones, on Malarial Fever. [April,

ture, consequent upon the arrest of capillary circulation and
chemical change. As muscular and nervous force, and even
sensation, depend upon chemical change, it is but reasonable to
s*uppose, that a marked perversion and diminution of chemical
change should be attended by an arrest of muscular and nervous
action, and even of sensation. In congestive fever, whether
from peculiarities of constitution, or from the overwhelming
amount of the poison introduced, those chemical changes are
not excited, which result in the breaking up and removal of
the malarial poison. The febrile excitement following the chill
of intermittent and remittent fever, appears to be due to the
equalization of the general and capillary circulations, and to
the distribution through the blood-vessels and capillaries of
all parts of the body, of the active chemical changes, and high
temperature, which during the chill were confined to the trunk.
It is highly probable, that during the febrile excitement, the
malarial poison is drawn into the round of chemical changes,
and so altered, that its action is for a time suspended. Hence
the intermission or remission.

The fever then is a favorable symptom, and the want of fever, a
most unfavorable symptom.

The manifest duty of the physician in congestive fever, (if these
views which have been suggested by the results of actual obser-
vation and experiment, be correct,) is to administer those reme-
dies which will excite the general and capillary circulations
excite chemical change excite fever and destroy, or counter-
act, or paralyze the action, or eliminate the malarial poison.

If these views be true, the paroxysms of malarial fever, are
due to the alterations and partial destruction of the poison,
during the active chemical changes of the febrile excitement.
To the question, why should the blood be accumulated in the
large blood-vessels, and capillaries of the organs of the trunk,
during the chill, I can, in the present state of physiological and
pathological science, give no satisfactory answer.

Case LII. Irish seaman, aged 24; light hair, light blue eyes,
fair complexion ; height 5 feet 7 inches stout, well built ;
weight 150 lbs.

October 12th, 1857, 12 o'clock M. Entered the hospital two
hours ago. Now, he is out of his head and can give no history
of his case. A companion states that he has been watching at
night on board a brig, lying in the river, below the ship-yard,
along the low marshy shore, and that he was taken sick with
chill and fever one week ago, but did not, until two nights ago,
discontinue watching at night. He is said to have used ardent
spirits freely. Pulse 137, rapid and feeble ; respiration 32 ; skin
hot and dry. Tip of tongue clean and of a bright red color

1859.] JoNES, on Malarial Fever. 233

the remaining portion of the tongue is coated with yellow fur.
The tongue is dry and harsh, to the touch, and feels, when the
fingers are passed over it, like sand-paper. The patient mutters
to himself, continually, half-formed sentences and imperfect
words. Continues to mutter in the same incoherent manner,
notwithstanding strenuous efforts to arouse and attract his at-
tention. It is with the greatest difficulty he can be made to
open his mouth for the inspection of his tongue.

About one hour ago his extremities felt cooler, and his pulse
was more feeble than it is now. Mustards were applied to the
extremities they increased the temperature and rendered the
pulse somewhat fuller, and aroused his intellect for a moment,
but he again relapsed into the state of delirium.

3. Cut-cups to the temples and back of neck. Apply cloths,
wet with ice water, around the head.

$. Calomel, grs. xij. ; follow with castor oil in four hours.

$. Mustards to the epigastrium and extremities.

$. Brandy, infusion of Virginia snake-root, sulph. of quinia,
and spirit of Mindererus.

8 o'clock P. M. The mustards and free use of stimulants fail-
ed to arouse him. He is in a profound stupor, from which it is
impossible to arouse him. Pulse 124, full and strong. His pulse
has increased in force and volume under the action of the stimu-
lants. Skin hot and dry. Tongue presents the same dry and
rough appearance.

3. Apply blisters to back of neck and over epigastric region.

Oct. 13th, 11 o'clock A. M. The cut-cups to the head, the
sinapisms upon the extremities, the blisters upon the back of
the neck and epigastric region, and the diffusible stimulants and
the cathartic, have all failed to arouse this patient, and he now
lies in a comatose state, and passes his urine and feces in the
bed. The nurse states that, during the night he was much more
restless than at the present time, and it was necessary to give
constant attention that he did not fall out of the bed. The medi-
cine has operated freely, and the blister has drawn well. The
serum from the blistered surface is of a golden color.

Kespiration 30, stertorous. The patient lies in a stupor, with
his eyes shut and mouth open, and emits a suppressed groan, or
whine, at every breath his appearance, and the sounds which
he emits, are similar to those of the patient described in Case
XL., page 78*. These groans appear to be entirely involunta-
ry, and depend upon the state of the organ of voice and the
mode in which the air passes through it.

Pulse 144, feeble. The sounds of the heart cannot be distin-
guished they are both united into one, and the heart makes a

* Southern Medical and Surgical Journal, February number, 1859.

v 234 Jones, on Malarial Fever. [April,

short, quick, thumping sound. The number of the thumps of
the heart corresponds to the pulse 144 to the minute. Tem-
perature of atmosphere, 77 F.; temp, of hand, 1035; temp, in
axilla, 1045. _ Skin hot and dry ; teeth coated with sordes.
Cannot get a sight of his tongne, as his teeth are tightly closed,
and he is entirely insensible. I have just applied mustards to
his extremities they do not arouse him and after remaining
on one hour they scarcely redden the surface.

I have delayed the administration of the sulphate of quinia
up to the present time, with the hope that the cut-cups and cold
applications to the head, and blisters and sinapisms, and stimu-
lants, would arouse the patient from the state of profound stupor.

Without having any hopes of his recovery, we will administer
the sulphate of quinia, as an experiment.

3. Sulphate of quinia, grs. v. every three hours, up to grs.
xxx. Continue diffusible stimulants, brandy and spirit of Min-
dererus.

9 o'clock P. M. Profound coma. Eespiration 32, spasmodic.
Pulse is gone. Heart merely flutters. Head and trunk warm .
extremities cold. Have again applied mustards to the extremi-
ties and administered diffusible stimulants, but they do not pro-
duce the slighest effect, and he will die in the course of one hour.

The patient died half an hour after this observation.

(15.) Autopsy twelve hours after death.

Body in good condition, apparently not at all reduced ; limbs
full and round, muscular, well developed; complexion very
fair there appeared to be a slight tinge of yellow. Skin of the
dependent portions of the body slightly darker than that of
the superior portions of the body. Eigor mortis remarkably
strong it requirad all the force that I could exert to straighten
his arms, and they would return back to the bent position with
considerable force. After the right arm had been first straight-
ened out at right angles to the body, and while I was standing
between the arm and the body, engaged in opening his abdo-
men and thorax, I felt the pressure of a hand and arm upon my
back. This was the hand of the dead man, which had slowly
returned to its former position by the contraction of the muscles.

Head. Dura-mater, normal in appearance. The longitudin-
al sinus of the dura-mater contained an elongated, flattened,
ribband-like, fibrinous clot, which was free from colored corpus-
cles, of a light yellow color. This, without doubt, was formed
before death. Arachnoid membrane, opalescent, pearl-colored
in many places. Blood-vessels of pia-mater filled with blood.
Substance of brain appeared to be normal in color and texN*re,
as far as an examination with the naked eye extended it was
perhaps a little softer than usual, but this may have been due

1859.] Jones, on Malarial Fever. 285

to post-mortem changes, and at any rate would not account for
the symptoms during life. Ventricles of the brain contained no
serum. Blood-vessels of medulla-oblongata and superior por-
tion of spinal cord, not congested with blood.

Chest. Heart. Exterior surface of the heart adherent at all
points to the pericardium. There was no free space between
the heart and the pericardium hence no fluid lubricated the
heart. Muscles of the heart paler than usual.

The right auricle and ventricle contained a yellow clot, free
from colored blood-corpuscles, which was attached to the colum-
nar carnese and cordar tendinear of the right ventricle, and
extended through the auriculo-ventricular opening into the
auricle. This clot sent off a large branch into the pulmonary
artery. This branch of the yellow fibrinous clot, which almost
completely filled up the pulmonary artery, sub-divided and sent
branches down the right and left pulmonary arteries, and
these branches again divided and sub-divided into numerous
branches, the smallest of which were not larger than fine
threads. These fibrinous threads passed deep into the blood-ves-
sels of the lungs, probably almost to the commencement of the
capillaries.

The left ventricle contained a similar }'ellow fibrinous forma-
tion, almost entirely free from colored blood-corpuscles, which was
attached at one extremity to the columnar earn ear and chordae
tendinear, and extending through the auriculo-ventricular open-
ing into the auricle, sub-divided into branches, which passed up
the pulmonary veins, and sub-divided into numerous smaller
branches which occupied the smaller divisions of the pulmonary
veins. These fibrinous bodies of the pulmonary veins and arte-
ries were very elastic with care they could be drawn out of
the smaller branches of the pulmonarj- veins and arteries, four
and six inches in length, without breaking, notwithstanding
that the smallest branches were very delicate. The aorta con-
tained a similar clot. All these clots were of a bright yellow
color, almost entirely free from colored blood-corpuscles, and pre-
sented almost an organized appearance, and were, without
doubt, formed long before death.

It is worthy of note, that the heart and arteries and pulmona-
ry veins, contained little or no blood. The large venous trunks
were distended with partially coagulated black blood. When
the blood from the large venous trunks was exposed to the at-
mosphere, it assumed slowly and imperfectly the arterial hue.
The blood appeared to have been collected in the capillaries
and veins. If the chemical changes between the blood-corpus-
cles and liquor sanguinis, and between the blood-corpuscles and
the capillaries, and the structures aud fluids surrounding the
capillaries, be arrested, as a necessary consequence the circula-

s. s. vol. xv. no. iv. 17

236 Jones, on Malarial Fever. [April,

tion of the colored corpuscles through the capillaries must be
greatly interfered with.

Lungs Normal in appearance and structure lower (depend-
ent) portions congested with blood. This was due to the action
of gravitation. The trachea and bronchial tubes and aii cells*
contained much froth.

Abdominal Cavity. Liver. The liver presented a much
darker color, upon its exterior,, than normal,, but not the dark
slate color of cases of malarial fever of longer standing. When
incisions were made into the liver the cut surface was different
in appearance from that of the healthy liver, and approached
the bronze color of malarial fever. The color of the cut surface,
however, was several shades lighter than that of malarial fever
of longer standing. On the under surface of the right lobe,
were several spots, of the dark slate color peculiar to malarial
fever. When incisions were made into the liver, through these
spots,, the substance of the liver for one-eighth of an inch, pre-
sented the regular bronze color of malarial fever. The liver
cells presented the usual appearance. In some cases they ap-
peared to contain more oil than normal. The tissues around
the secretory cells contained numerous small and large oil glo-
bules. The presence of this oil may have been due to the action
of the alcoholic stimulants.

The liver contained animal starch, without a trace of grape sugar.
The liver was carefully tested for grape sugar, as soon as it
could be removed from the body. The weather was cool, and
the substance of the liver had not undergone decomposition to
the slightest extent ; and the time which had elapsed since death,
was not of sufficient duration to account for the disappearance
of the grape sugar. Weight of liver, grains 29416 equals ozs.
75 , equals lbs. 4, ozs. 3 \.

Spleen, enlarged, softened,, disorganized, and of a dark slate
malarial color when pressed gently between the fingers, the
trabecule could be felt giving way. The cut surface was of a
dark, purplish-brown color from the cut surface, issued a
dark, purplish-brown mud. After eight hours exposure to the
atmosphere, small streaks, inclining to an arterial hue, appeared
upon the cut surface of the spleen,, and probably were due to*
the change in the blood which issued from the divided vessels.
These streaks of mud, inclining to- the arterial hue, occupied
but an inappreciable fraction of the whole surface. When the
dark mud (effused blood) was examined under the microscope,.
it was found to consist of colored and colorless corpuscles and
dark granules. Some of the colored corpuscles were swollen
and altered in shape the alteration was by no means univer-
sal, or remarkably great. When the splenic mud was spread
upon a glass slide,, and treated with tincture of iodine, and

1859.] Jones, on Malarial Fevers, 237

viewed under the microscope, a few irregular blue particles ap-
peared, resembling animal starch. Weight of spleen, grs. 7562,
equals ozs. 17|, equals lbs. 1, ozs. H.

Alimentary and Intestinal Canal Exterior surface of stomach
and intestines looked pale. Blood-vessels of omentnm and
mesentery were rilled with black blood. The stomach contain-
ed a yellow, mucus-like fluid. The mucous membrane of the
stomach was dyed yellow by the bile. With the exception of
this discoloration, the mucous membrane of the stomach appear-
ed to be normal. There were no marks of inflammation.

The small intestines contained large quantities of yellow mu-
coid matter, mixed with soft fascal matters. When carefully and
completely washed under a gentle stream of cold water, the free
edges of all the valvulse conniventes, presented a bright red and
bistre color, which diminished in intensity towards the attached
portion. The whole surface of the mucous membrane of the
small and large intestines, was of a darker color and indicated
much more congestion than usual. I do not consider the con-
gestion of the blood-vessels of the mucous membrane, as a patho-
logical alteration, due to either the primary or secondary effects
of the malarial poison, because, at the time of his death, the
patient was under the action of a cathartic. Cathartics, as far
as my experiments upon animals have extended, produce en-
gorgements of the vessels of the mucous membrane of the intes-
tines. Glands of Peyer, not enlarged or inflamed, normal in
size and appearance. Solitary glands did not attract attention.

Kidneys. This subject had but one kidney this corres-
ponded to the right kidney. The inferior surface of the kidney
presented a dark slate-colored spot, two inches in diameter the
color of the spot resembled, in all respects, the slate color of the
malarial liver. When an incision was made into the substance
of the kidney through this slate colored spot, the cut surface
presented a bronze color to the depth of about one-sixth of an
inch. The bronze color gradually shaded into the normal color
of the kidney. With the exception of this slate colored spot,
the color of the kidney was normal.

The pelvis of the kidney and superior portion of the ureter,
contained a few drops of a fluid which, to the naked eye, re-
sembled pus. Bladder contracted contained no urine.

Conclusions.

The formation of the heart clots, and the blocking up of the
pulmonary arteries and veins, with tough elastic fibrinous bodies,
demand a careful consideration. Was the formation of these
clots, before death, due to the absence of the volatile alkali of
the blood? or to the abnormal formation of fibrin in the blood?
or to disturbances in the nutritive and excretory processes?

238 Jones, on Malarial Fever, [April,

or to the impeded and sluggish circulation ? It may have been
due to one or all of these causes it was certainly accelerated by
the impeded and sluggish circulation. The acetate of ammo-
nia (spirit of Mindererus) was administered freely in this case
not however with any design of preventing the formation of
heart clots, but rather for its refrigerant and diaphoretic effects.
We cannot say, that the administration of this remedy had no
effect upon the formation of the fibrous bodies because they
may have been formed previous to the admission of the patient
into the hospital. We believe the carbonate of ammonia, to be
far more efficacious in congestive fever than the acetate of ammo-
nia, on account of its general stimulant influence on the circula-
tion and organic nervous system, and its power to increase the
secretions. As far as my observations extend, the formation of
heart clots, during life, is very common in malarial fever. In
the fifteen postmortem examinations which I have recorded
in the previous numbers of this journal* heart clots were found
in ten cases ; and of the remaining five cases, one was a case of
typhoid fever, combined with malarial fever, another was a case
of malarial fever of long standing, where the patient died of ex-
haustion, and in the remaining three, no special examination
for heart clots was instituted. If the formation of fibrous bodies
in the heart and blood-vessels, be common in malarial fever ; and
if the statement of Dr. Benjamin Ward Eichardson of London,
that the fibrin is held in solution in the liquor sanguinis in
the living blood-vessels, by ammonia, be true ; and if the state-
ment which I have endeavored to substantiate by numerous
cases recorded in the previous numbers of this journalf that the
action of the malarial poison is depressing, rather than inflamma-
tory, be true; then carbonate of ammonia should be administered
freely in malarial fever. It should be administered because it
excites the general and capillary circulation excites the chemi-
cal changes in the capillaries necessary for the development of
the muscular and nervous forces arouses the sympathetic and
cerebro-spinal nervous systems promotes secretion and excre-
tion and furnishes the volatile alkali to the blood, which holds
the fibrin in solution.

*Case xxiii, August number, 1858, p. 529. Case xxix, October, 1858, p. 662.
Case xxx, October, 1858, p. 669. Case xxxi, October, 1858, p. 6*74. Case xxxii,
November, 1858, p. 726. Case xxxiii, November, 1858, p. 728. Case xxxv, No-
vember, 1858, p. 737. Casexxxvi, November, 1858, p. 740. Case xxxvii, Novem-
ber, 1858, p. 743. Cases xxxviii. xxxix, xl and xli, February, 1859.

f Case i., June, 1858, pp. 382-884. Case ix., July, 1858, p, 438. Case x.,
p. 441. Case xxiii., September, 1858, pp. 589-592. Case xxviii., October, 1858,
p. 655. Case xxix., p. 664. Case xxx., p. 667. Case xxxv., November, 1858,
p. 732. Case xxxviii., February, 1859, pp. 80-81. Case xxxix., p. 86. Case xl.,
p. 91. Case xli., p. 93. Case xlii., p. 96-100. Case xlvii., March, 1859, pp. 147,
148, 150, 151, 153, 155. Case xlviii., pp. 160-163. Case 1., pp. 165, 166, 168.
Cases li., lii , liii., April, 1859.

1859.] Jones, on Malarial Fever. 239

It should be borne in mind, that we do not for one moment
advocate the carbonate of ammonia, as a substitute for sulphate
of quinia. The carbonate of ammonia does not cure the disease.
The carbonate of ammonia, merely arouses the system, prevents
a distressing and fatal accident and prolongs life until the sul-
phate of quinia can act. Administer then the sulphate of quinia
in full and vigorous doses, in conjunction with the carbonate of
ammonia.

With the exception of the heart clots, we do not discover any
pathological changes of the organs, which of themselves, would
account for either the symptoms or death of the patient. As
far as an examination with the naked eye extended, we did not
find in the brain, any structural alterations, sufficient to account
for the symptoms of delirium and coma. We should not,
however, in the present state of chemical and physiological and
pathological science, decide dogmatically a question of such im-
portance ; for we are wholly ignorant of the chemical, physiolo-
gical and pathological relations of the malarial poison to the ner-
vous elements. Notwithstanding that we have no investigations
bearing upon these questions notwithstanding that I was
anxious to enter upon this untrodden field ; 1 was compelled on
account of the difficulty of the investigation, and on account of
the complete occupation of time, and entire employment and
exhaustion of health and strength, in the researches, imperfect
as they are, now recorded ; and on account of the imperfections
of the methods of physico-chemical, physico-physiological,
chemico-physiological, physico-pathological, and chemico-path-
ological research to abandon, for the present at least, this most
important investigation.

It is evident that a thorough knowledge of the nature and
treatment of malarial fever, demands amongst many other things,
a thorough knowledge, not only of the appearance and chemical
constitution of the structures of the cerebro- spinal and sympa-
thetic nervous systems, but also a thorough knowledge of the
physical, chemical, and pathological alterations of these structures
when acted on by morbific agents. Whatever was the alteration
or alterations of the nervous elements in this case it is evident
that they could not be reached by the most energetic and vigor-
ous treatment. Nothing appeared to arouse the action of the
brain, notwithstanding that there was no congestion and no in-
flammation of this organ. We are unable to determine what
effect the previous habits of the patient had, upon the course of
the disease.

3. We do not think that the condition of the spleen was suf-
ficient to cause death* because we have recorded in previous

* Case xxx., October. 1858, pp. 667-671. Case xxxi, pp. 671-675. CasexxxiL,
November, 1858, pp. 723-727.

t

240 Jones, on Malarial Fever. [April,

numbers of this journal, cases where sudden death occurred from
other diseases during convalescence from malarial fever, in
which the spleen was much more engorged, and apparently in a
worse condition. The same remark applies to the alterations of
the liver they do not appear to have been sufficient to cause
death.

4. The stomach and intestinal canal presented no pathologi-
cal alterations. The slate-colored spot upon the kidney was
curious, especially in its bearing upon a similar change in the
color of the liver, but it was not sufficient to account for even
one of the symptoms.

5. If then, the cause of death was not found in the patholo-
gical alterations of the organs and tissues, what destroyed life ?
In the present state of medical science, we can offer suppositions,
but we can give no decided answer. How difficult would it be
to prove or disprove, that the malarial poison produced death,
by its direct action upon the nervous system, in a manner
analogous to the action of some of the violent alkaloid and me-
tallic poisons ? We know that some of these poisons will pro-
duce almost instantaneous death, without producing a single
pathological alteration which can be recognized by the most
delicate chemical tests, or by the most rigid microscopical exami-
nation. We know that some substances, as chloroform, will pro-
duce sudden death in some cases, where there is no assignable
cause either in the structures and forces of the patient, or in the
pathological alterations produced. This peculiar action is said
to be due to the idiosyncrasy of the patient. May not the fatal
action of the malarial poison be due in some cases to the idiosyn-
crasy of the patient ? Has any one ever determined upon what
an idiosyncrasy depends ? How difficult would it be to prove
or disprove, that the malarial poison acts antagonistically to
the vital principle, which directs the physical forces developed
during the unwinding of the spring, wound up by the forces
of the sun, so that the form, and individuality and definite con-
stitution of every organ and tissue, is preserved amidst unceas-
ing changes.

Case LIH. American seaman, age 25 ; height 5 feet 9 inch-
es weight, 150 lbs.; dark complexion, dark brown hair, brown
eyes.

October 19th, 8 o'clock P.M., 1857. This patient entered the
hospital three hours ago, at 5 o'clock, P. M., in an almost insen-
sible condition. Now he is aroused with great difficulty, and
answers incoherently. Extremities cold. Pulse 80, feeble.
Head and trunk cooler than normal. Tongue, by the gas-light,
appears clean, soft, and normal in color.

$. Cut-cups to each temple and back of neck.

1859.] JoXES, on Malarial Fever. 241

#. Mustards to extremities, and over epigastric region.

$. Sulphate of quinia, grs. v.; camphor, grs. ij. Mix, and
administer every three hours, until fifty grains of the sulphate
of quinia have been taken.

3. Spirit of Mindererus, brandy, and infusion of snake-root,
f?ss. of each, alternately, every half hour.

October 20th, 9 o'clock A. M. Lies in a profound coma.
This came on a short time after the first observation yesterday
evening. The cut-cups aroused him partially for a few moments,
but he soon relapsed. Mustards have been applied to the ex-
tremities and epigastric region, three times during the night
they failed to rouse the brain they excited the capillary circu-
lation and induced an elevation of temperature, but did not
restore reason. The stimulants also failed to arouse the intel-
lect. Whenever the mustards were removed, and the stimulants
withheld, his surface became cool, and the pujse diminished in
volume. It is evident then, that the mustards and stimulants
excite the general and capillary circulation, and induce an
elevation of temperature, but they do not arrest the disease.
During the night, has passed his urine and feces in bed.

Pulse 140, full. The sounds of the heart are not distinct,
they cannot be distinguished, but sound to the ear like one sound.
The beating of the heart sounds stronger, even than in health.
The sounds of the heart correspond in frequency to the beat of
the pulse, 140 to the minute. Eespiration 40, spasmodic,
Temperature of Atmosphere, 70F. ; temp, of hand 104 ; temp.
in axilla, 104,o5. Great tenderness of epigrastrium whilst
neither shaking nor loud talking will arouse him, pressure upon
the epigastrium, causes him to emit a short cry. The epigastrium
and region of the liver, feels to the hand, warmer than the head
or any other part of the body. Complexion very sallow. I ad-
ministered grs. xxx. of sulphate of quinia, in f 5 ij. of brandy. It
was with great difficulty that the spoon was forced between his
clenched teeth. The dose had not been swallowed more than a
few moments, before it was ejected violently, apparently without
any effort or conciousness on the part of the patient. This dose
was again repeated, and his trunk and extremities covered with
mustards, and bottles of hot water applied to the feet, without
producing the slightest effect. This patient died one hour and a
half after tttese observations.

(16). Autopsy twenty- four hours after Death.

Body not emaciated apparently in full flesh has the marks
of a large ulcer over the superior portion of the sternum. Skin
of the dependent parts of the body of a purplish hue. The dis-
coloration of the skin commences about the middle of the body,
and gradually increases downwards, until the most dependent
portions are of a deep purple color.

242 Jokes, on Malarial Fever. [April,

Head. When the skull-cap was removed, much blood flowed
out. Arachnoid membrane opalescent, in a few spots. Blood-
vessels of pia-mater, filled with blood. Bloody serum was effus-
ed between the archnoid and pia-mater. Blood-vessels at the
base of the brain and surrounding the medulla oblongata, and
superior portion of the spinal cord, congested with blood.
Blood was effused upon the base of the brain. This blood was
fluid, and contained no coagula. The substance of the brain
was normal in consistence and appearance.

Chest. Heart normal right auricle and ventricle contained
a small clot ; left heart, empty.

Lungs, normal dependent portions congested with blood
blood-vessels of superior portions almost entirely free of blood.

Abdomen. Liver. A large portion of the surface of the liver
presented the healthy spanish-brown color, and when cut, the
substance presented the usual healthy color. Other portions
however, presented a mottled appearance of spanish-brown and
dark purple, and the blood-vessels of these parts appeared to
be engorged with blood. The right lobe of the liver had upon
its under surface, a spot about two inches in diameter, of a dark
slate (malarial) color. When an incision was made through this
portion of the liver, it presented for the depth of about {th of
an inch, the true bronzed color. Numerous incisions were made
into the liver, in all directions, so as to expose its substance fully
to view ; portions were found, approaching in color the bronze
hue of the malarial fever liver ; the great mass of the liver,
however, resembled more nearly that of a healthy liver engorged
with blood. Portions from different parts of the liver were ex-
amined under the microscope. The liver cells, from the slate
colored and bronzed portions, did not differ in appearance under
the microscope, from those of the normal colored, or from those of
the mottled portions. The colored corpuscles appeared to be
more altered in form in the bronzed portions than in the normal
colored portions. The alterations, however, even in the bronzed
portions, were small and by no means universal, but confined
comparatively to a few, and after all, the difference may have been
imaginary. The determination of comparative alterations of this
kind, is not so easy, as at first sight appears. Did not discover
any of those dark granules in the bronze portion, which have
been said to impart the peculiar color of the liver.* From the
cut surface of the liver, much black blood issued, which assumed,
upon exposure to the atmosphere, the arterial hue. The liver
cells did not appear to be altered in any manner.

Gall bladder, filled with bile. Specific gravity of bile, 1042'5.
Viewed in mass, the bile was of a brownish black color, with
greenish reflexions, and resembled, upon a general view, a satu-

* A. Clark, M. D. Bartlett, on the Fevers of the United States, p. 370. This
subject will be discussed more fully hereafter.

1859.] Jones, on Malarial Fever. 243

rated tincture of iodine. It resembled, and poured like molasses,
being thick and ropy. Upon close inspection, the bile was found
to contain numerous flakes, of a green color, which under the
microscope were found to consist of the conglomerated cells of
the mucous membrane of the gall-bladder. When spread out
in thin layers, the bile presented a gamboge yellow color.

Pancreas , normal.

Spleen, slate colored, softened and enlarged not as much
softened and altered, however, as in cases of malarial fever of
longer standing. The mud of the spleen was of a dark purplish
hue, and appeared to be in transition, to the color and state of
the mud of the spleens, of malarial fever of longer duration.
After exposure for a few hours, to the oxygen of the atmosphere,
a large portion of the mud of the spleen assumed a color, ap-
proaching the arterial hue ; much brighter than the mud of the
spleens, upon which malarial fever had exerted its full effects,
and somewhat darker than the bright arterial hue, assumed by
the splenic mud of healthy normal spleens. When the splenic
mud was spread in thin layers upon a glass slide, the change of
color was much more rapid. Under the microscope, the splenic
mud appeared to consist almost entirely of colored corpuscles,
many of which appeared swollen and altered in appearance.
After careful examination, I was unable to find those conglomera-
tions of black granules, resembling the black sediment of black
vomit, which were discovered in other malarial spleens*.

Kidneys, normal. Bladder, contracted, contained no urine.
Scrotum, red, and apparently scalded. This was due, most pro-
bably, to the acrid urine.

Alimentary and Intestinal Canal. The mucous membrane of
the stomach, presented two well defined portions the mucous
membrane of the lesser curvature of the stomach, was pale and
normal in appearance the mucous membrane of the greater
curvature and pyloric extremity, and of the pylorous, was of a
purplish color, and ecchymosed, in crimson spots. The blood-
vessels of the greater curvature, and of the pylorous were con-
gested with blood. Mucous membrane of the superior portion
of the jejunum, congested with blood valvulae conniventes,
especially at the edges, ecchymosed in spots of a purple and scar-
let color. Mucous membrane of the lower portion of the ileum,
greatly congested with blood. Peyer's glands somewhat enlarg-
ed, more distinct and elevated than usual, but pale and not con-
gested and inflamed, as in typhoid fever. Solitary glands enlarg-
ed and distinct. Mucous membrane of colon, greatly congested
with blood.

* Case xxiv., Autopsy 2, p. 663, October, 1858. Case xxxv., November, 1858,
Autopsy 7, p. 738. Case xxxviii., Autopsy 10, February, 1S59, p. 79. Case xxxix.,
Autopsy 11, p. So.

N. S. VOL. XV. NO. IV. 18

244 Jones, on Malarial Fever. [^Pr1??

Conclusions.

1. The slight alteration of the color of the liver the change
of the blood of the liver, to the arterial hue upon exposure to
the atmosphere the change of the splenic mud to the arterial
hue all prove that this patient had died very soon after the
commencement of the malarial fever. As we have seen, the
patient was unable to answer any inquiries with reference to
the history of his case. So convinced was I, that this was a case
of only one or two days standings that I sought out the captain
of the vessel to which this patient belonged, and made minute
inquiries. The captain stated that this man was the cook on
the vessel. One month ago, whilst the vessel was lying in the
Santee river of South Carolina, this patient was taken with a
fit ; this was relieved in a few hours, and was not followed by
fever, and the patient appeared to suffer no ill effects, and resum-
ed his duties. Two weeks ago, the captain brought his vessel
to Savannah. This patient has been sleeping on board the shipr
at night, up to the time of his entrance into the hospital. He
was well, active, and attentive to his duties, up to 5 o'clock P.
M., October 18th, when he was suddenly seized with vomiting,,
cold extremities, complete prostration and delirium. He had
cooked dinner this day, and was attending to his duties, at the
time of this sudden attack. He had, however, " a singular look
out of his eyes," which attracted the attention of the captain, and
led him to inquire, if he was well ; the patient answered yes, and
complained of nothing. Whilst sick on board the ship, he com-
plained of no pain, and before the complete loss of reason, said,
that he felt well. The next day, the 3 9th inst, he was sent to
the hospital at 5 o'clock P. M. I saw him for the first time at
8 o'clock P. M. He died at 12 o'clock M., the next day. This
patient, thenT died after forty -three hours sickness.

2. The general and capillary circulation was easily aroused
by stimulants the temperature of the body, under the action of
stimulants, was elevated above the normal standard, and there
was a correlation between the temperature of the trunk and ex-
tremities ; and the chemical changes appeared to be amply suffi-
cient for the development of the muscular and nervous forces ;
and the liver and spleen had undergone, comparatively, but
slight alterations. The most prominent apparent cause of death
was the effusion of blood upon the base of the brain. The fit
which occurred one month ago, points to a previous derange-
ment of the cerebro-spinal system. Was the effusion of blood
upon the brain the result of the action of the malarial poison
alone, or the result of the action of the malarial poison upon
the delicate structures of the brain already altered by previous
disease? It is impossible to decide these questions positively ;
but all our observations upon malarial fever, would lead us to

1859.] JoXES, on Malarial Fever. 245

adopt the latter supposition. We regard the action of the mala*
rial poison as depressing, and not inflammatory. Cerebral dis-
turbances in malarial fever, appear to be due, first, to the direct
action of the malarial poison and of the altered blood upon the
nervous structures and secondly, to the stagnation and accumu*
lation of blood in the capillaries and blood-vessels of the brain,
due to the diminished action of the heart, arrest and perversion
of chemical change in the blood of the capillaries, and loss of
power in the capillaries themselves. If by previous disease,
arising of itself, or induced by the intemperate use of ardent
spirits, the capillaries and blood-vessels of the brain and its
membranes, lose their tonicity, elasticity and coherency, the
simple stagnation and accumulation of blood may be attended
by a rupture of the altered vessels, without any inflammatory
action. A strong confirmation of these views, is the fact, that
the vigorous administration of the most active stimulants, con-
joined with sulphate of quinia, is the most efficient mode of pre-
venting, arresting and relieving, the coma and delirium of mala-
rial fever. If the action of the poison was inflammatory, this
would not be the case. The preceding case, shows that we may
have symptoms of inflammation of the brain, in malarial fever,
without a single pathological alteration after death, cognizable
to the senses.

3. A comparison of the autopsy of this case with that of other
cases, shows that in the first stages of malarial fever, the liver
is first engorged with blood, and the slate and bronze color is
not at first universal, but confined to definite portions. It is an
interesting fact, that in the present case, the solitary glands were
found enlarged, even at this early stage of the disease. The mu-
cous membrane of the stomach and intestines presented marks of
congestion, if not of inflammation. This condition of the mucous
membrane is by no means characteristic of malarial fever, even
when there is great tenderness upon pressure of the epigastrium.
Tenderness here may be due rather to the state of the spleen and
liver. The slate-colored spots upon the kidneys in cases xxxviii.,
Autopsy 10 and Hi., Autopsy 15, are interesting in their bearing
upon the peculiar color of the liver. The observation which we
made upon previous cases is also true with regard to this, that
the slate and bronze color of the liver is not due to the formation
and distribution through the liver of peculiar dark colored gran-
ules.

-i. Although the stimulants and sulphate of quinia did not
cure the disease, still they aroused the capillary and general cir-
culation and induced the chemical changes.

This case closes the report of cases, and in the succeeding numbers
ofViis journal, we hope to generaliz all the facts and phenomena
thus far presented.

(To be continued.)

246 Hammond. Case of Lithotomy; [April,

article x.
A Case of Lithotomy. By D. W. Hammond,. M.D., of Macon, Ga,

I was called on the 15th November, 1858, to visit a little boyr
2 1 years of age, son of Mr. Blunt, in the immediate vicinity of
Oglethorpe. The patient, from his earliest infancy up to that
time, had suffered more or less from painful and difficult mictu-
rition. As he grew older, the symptoms became more intense
and distressing. Dr, Oliver, my esteemed friend, under whose
care he had been placed, diagnosed the case to be Calculus of the
Bladder, which the introduction of the sound readily and un~
mistakably revealed.

On consultation with the medical friends present, the operation
was at once decided upon. After securing the little sufferer in
proper position, and other requisite appliances suitably arranged,,
the operation was completed in a few minutes by the lateral
section using Br. Physick's gorget.

The calculus was readily engaged in a small lithotomy spoon
or scoop, and extracted. Its shape, an oblate spheroid the
surface tuberculated with minute, sharp, and semi-transparent
crystals, and weighing 9j.

Eleven days after the operation, I received the following let-
ter from Dr. Oliver, under whose management he was confided ;

" Oglethorpe, Nov. 26thr 1858.
Dr. Hammond;

Dear Sir The child of Mr. Blunt is getting on well has had
no fever for five or six days. The urine is now passing free,,
per vias naturales, though not wholly through the urethra as yet,
some still finding its way through the opening in the perineum.
The wound is closing gradually. The little fellow is quite
cheerful this morning, and has every prospect of a speedy re-
covery,* &c.

Yours truly r

T. F. Oliver.77

The patient was not placed under chloroform,, in consequence
of his age, and other circumstances contra-indicating its admin-
istration. The child being so young, rather deterred me from
the operation, and it would have been postponed but for the

*In a note, dated January 21st, 1859, Dr. Hammond informs us tbat the pa-
tient has entirely recovered now running all about the house and yard.

$59.] Hammond. Case of Lithotomy. 247

increasing intensity of his sufferings for several months prior
to the time I visited liim. He was having "fits of the stone,"
frequently, as often as twice a week, causing violent straining
and persistent tenesmus, the consequence of which was a trou-
blesome diarrhoea, complicated with prolapsus ani, and ulcera-
tion of the neck of the bladder. These enervating consecutives,
together with an exhausting catarrhus vesica?, impelled me,
without further delay, to resort to the " uUimum et unicum rerae-
diumP I had been consulted about twelve months anterior to
this time in regard to the propriety of performing the operation,
and advised it to be deferred as long as possible, as I feared one
so young might doubtless succumb to traumatic convulsions.
And I would here remark that, age has much to do with sub-
jects afflicted with this terrible malady, especially where a resort
is had to the knife.

From long practice and experience in such cases, I am of the
opinion that the most favorable age for cutting for stone, is from
five to ten years. Sir Astley Cooper, in speaking on this branch
of the subject, says, " The age at which there is least danger is
from three to twenty, for death is then a very rare occurrence.'1
I never knew a case terminate fatally when operated upon be-
tween the ages of five and ten years. Including the little boy
now under consideration with nine others, varying in age from
five to ten years, upon whom I have operated, they all, without
a single exception, have had speedy and satisfactory recove-
ries the time occupied ranging usually from ten to fifteen days.
Those farther advanced in life say, from twenty-five to sixty
have, as a general rule, recovered more slowly and less perfectly.
From these facts, the conclusion is irresistible, that those who
are suffering from this ailment should be urged by every possi-
ble argument to submit to the only remedy as early as possible.
Perhaps one less than two years of age would be too young,
although many have been successfully operated upon, much
younger. South says, " The earliest age at which I have known
the operation for Stone performed, with success, was twelve
months : in two instances, successfully, by Keate, at St. George's
Hospital." John Hunter operated on a child eighteen months
old, but the result is not stated. Civiale has collated many in-
stances of infants affected with Stone one of which was cut at
ten weeks : result not stated.

248 Jones, on Retroversion of the Uterus. [April,

On the other hand, although age, cceteris paribus, should not be
a bar to the operation, yet the prognosis in such cases, as a
general rule, is unfavorable for recovery. Mr. Cline, senior,
operated successfully upon a patient eighty-two ; Attenburrow,
at a still more advanced age; and Astley Cooper upon one sev-
enty-six, who lived ten years after. But these may be consider-
ed extreme cases, and exceptions to the rule laid down.

I had intended, before closing this article, to give my views in
relation to the comparative merits of the gorget, and Lithotome
Cache of Dupuytren ; but to do the subject justice, would ex-
tend the essay to an unnecessary length. I must be permitted,
however, to remark, that my decided preference is in favor of
the gorget, as being the best and safest instrument that has yet
been invented for dividing the prostate gland and neck of the
bladder.

ARTICLE XI.

The Horse-Shoe Pessary in Retroversion of the Uterus of long
standing. By Wm. B. Jones, M. D., of Birdsville, Burke Co.,
Georgia.

Messrs. Editors :

The history of the following case is given to the readers of
your valuable Journal, for the interest it possesses in being a
case of exceeding rare occurrence, and of its long existence,
without producing that fatal termination we might anticipate
from so serious an accident.

We can readily conceive how, under favorable circumstances,
an impregnated uterus can become " topsy-turvy" ; but the
retroversion of an unimpregnated uterus in a female who had
not borne children, is an accident of so improbable a nature,
that some authors have doubted whether it could occur at all,
unless from disease of the organ itself, or pressure from some
neighboring diseased structure, or from congenital deformity.
This case affords also another of the many melancholy instances
(particularly) of female maladies, which, simple in themselves,
when first happening, and easily removed when detected and
treated by an intelligent medical practitioner ; but, falling into

1859.] Jones, on Retroversion of the Uterus. 249

the hands of the ignorant pretenders of our art, entail suffering
indescribable, and a life-long martyrdom upon the unfortunate
patient.

On the 19th of June, I was called to see Mrs. EL, in consulta-
tion with her attending physician. I was informed that she had
been suffering about thirteen years with some uterine disorder,
the exact nature of which was supposed not to have been ascer-
tained that now she was nearly bed-ridden, after withstanding
the treatment of innumerable Doctors, and swallowing all the
stuffs and nauseous compounds that ignorance and superstition
could invent and impose, and the hopeful credulity of a suffer-
ing woman could endure passing gradually from bad to worse,
hope had well nigh fled, and life, otherwise desirable, had be-
come almost an intolerable burden.

With her attending physician, I visited the patient, determin-
ed (if a careful examination would reveal the true nature of the
malady) to have the satisfaction of discovering to herself and
friends, of what she was suffering, if I could not extend relief,
or promise a cure.

The Statement of the Patient. That she had been suffering,
more or less, for thirteen years ; that she grew up to womanhood
with scarcely a pain or ache ; that her catamenia appeared at
the usual period of life, and had regularly and healthily reap-
peared, up to the time she dates the commencement of her
trouble. She married at nineteen years of age, and, with her
hjusband, commenced soon after to* keep public house. Priding
herself upon her ladyship's strength and activity, she did much
of the active duties of the house. One day, whilst her catamenia
was upon her, in making up and replacing beds, she attempted
to lift a heavy bedstead from its position. The effort caused
sudden pain in the back, which, continuing, compelled her to
take to her bed for several days. From that time, until now,
she has never recovered from a continual distressing sensation
of weight and pressure about the lower pelvic region, accompa-
nied often with a difficulty at defecation, and a habitual costive-
ness. All these symptoms, much aggravated now during her
menstrual periods she is compelled to take her bed, and scarce-
ly recovers from the suffering of one period, before another
prostrates her.

250 Jones, on Retroversion of the Uterus. [April,

Upon a vaginal examination, the finger, instead of being
directed backwards and upwards, passed upwards and for-
wards where, high up, was distinctly recognized the os tincae
looking towards the neck of the bladder, though not pressing
upon it. Behind the posterior wall of the vagina, and in the
hollow of the sacrum, could be plainly felt a round, firm tumor.
A careful recto-vaginal exploration, determined that this tumor
was the fundus uteri, and that there was continuity between it
and the cervix. I will remark here that the attending physi-
cian, from the strangely altered relation of the parts, had, in the
confusion of his mind, mistaken a fold of the posterior mucous
membrane for the os tineas, and had determined a congenital
deformity and a double uterus.

The case was one of retroverted uterus. The history furnish-
ed satisfactory evidence of the circumstances, and the time the
difficulty commenced, and the abuse of cathartic medicine, and
other causes, had completed the retroversion after the lapse of
so long a time. The treatment could only be paliative. To re-
store the organ to its proper position, and maintain it there, I
could not expect. An effort to dislodge it from its position,
proved that adhesions had doubtless taken place with the sur-
rounding structure, and any serious attempt to lift it from its
bed, might inflict still more serious injury upon the patient.
After the introduction of two or three styles of pessaries, and
finding slight relief afforded, I adopted the Horse-shoe pessary,
as described in a late number of the American Journal of Med.
Sciences. Having at my service an excellent silversmith, I
succeeded in obtaining one made, that, being introduced, put
upon stretch the posterior vaginal wall and thereby support-
ing the organ from farther descent, gave a sensation of comfort
and support to the patient (as she remarked) whilst retaining the
upright position. The patient herself learning to remove and
replace the pessary. With a strict regimen and diet, her gen-
eral health was very much improved, and she has been enabled
to assume again her household duties, to visit her friends, and
participate again in some of the pleasures of life.

1859.] Lecture on Asthma. 251

Lecture on Asthma. Delivered at Hotel Dieu, by Prof. Trous-
seau. Translated from the Gazette des Uopitaux of Septem-
ber 2nd, 1858, (for the Boston Med. and Surg Journal).

LECTURE II. SOME OF THE CAUSES OF ASTHMA.

I said in my last lecture, that among the causes of asthma,
are some which are particularly worthy of notice, on account of
their importance ; such are the circumstances of residence, climate
and temperature. I will give you some examples in illustration.
Five years ago, a young man came from St. Omer to consult
me. Subject to very frequent attacks of asthma, he availed him-
self of an interval of respite to take the journey. After his ar-
rival in Paris, he had some return of his complaint, but less vio-
lent than before, and after two or three days he was cured. His
recovery seemed to me astonishingly rapid, and I attributed it
to the influence of climate, anticipating that sooner or later the
event would confirm my opinion. The patient remained here
three weeks ; during this time he had but a single attack. Final-
ly, he came to take leave of me ; he departed for Versailles, and
this journey was to be the proof that I was waiting for. On the
first night that he passed in that city, at the very gates of Paris,
so to speak, where he had been so well, he had a most terrible
attack ; in the morning, he did not find himself in his habitual
state of health, and in the evening a new attack came on as before.
The following day, he resumed his journey to St. Omer, pas-
sing by the way near the capital.

What had led me to anticipate that this journey to Versailles
would furnish the evidence I expected, was what the patient had
told me. His attacks, he said, had begun in his native town at
the age of 19 ; two years after, his father had taken him to Lon-
don on business, and from that moment, having borne the pas-
sage over which he greatly dreaded, without the slightest attack,
although living in the midst of the fogs of the Thames, which
are blamed, perhaps with some degree of exaggeration, he never
experienced the slightest return of his complaint and notwith-
standing that, during the two years of his life in England, he led
the life of a young man, a life of divided work and pleasure,
exposing himself to all the causes of catarrh. During this time,
although he did not escape colds, he had not a single attack of
asthma, and his colds had left him much more promptly than
they had in France. After his father's death, the young man
returned to St. Omer ; hardly re-established in that town, he had
a renewal of his old attacks ; and at last, after two years of tor-
ment from this complaint, he decided to come to see me. Hav-
ing prescribed a course of active treatment for him, I sent him
back to his own town, and some months afterward he sent me

252 Lecture on Asthma. [April,

word that he remained in the same condition. I tried to induce
him to return here. He replied that it was impossible for him
to undertake the journey, his condition was so serious; I never-
theless insisted upon the necessity of his quitting St. Omer. The
patient was transported, rather than came, by the railroad, and
from the moment of his arrival at the Hotel, where he alighted
in Paris, his oppression became less ; a few days after, his relief
was complete. I had then no other advice to give, but to forbid
a residence at St. Omer, and I persuaded the patient to place
himself at the head of his house in London.

An old advocate, a friend of mine from childhood, passed,
every year, three or four months on his estate of Calvados.
Perfectly well at Paris, he scarcely arrived at his place in the
country, when he had an attack of nocturnal asthma, coming
on, usually, at 10 or 11, P. M. His dyspnoea was such, that he
was obliged to pass his nights at the window, notwithstanding
the cold of the autumn nights. The following morning he was
relieved, and was able to resume the course of his usual occupa-
tions.

A third instance. I have among my patients two brothers,
twins, both very rich, both keepers of famous gambling houses,
and so extraordinarily alike that it is impossible for me to dis-
tinguish one from the other, except on comparing them side by
side. This resemblance was not limited to physical appearance
merely, for they had, allow me to say, a pathological resemblance
even more remarkable. For instance, one of them, whom I
saw at Neothermes, sick with a rheumatic ophthalmia, said to
me, " at this moment, my brother ought to have an ophthalmia
like mine." And as I expressed my surprise, he showed me,
two days after, a letter which he had received from his brother,
then at Vienna, which said, in effect, " I have my ophthalmia,
you ought to have yours". However singular this may appear,
the fact is nevertheless true ; I witnessed it, and I have seen
other analogous cases in my practice. To resume: these twins
were both asthmatic, and asthmatic to a fearful degree. Born
in Marseilles, they had never been able to live there, where
their interests often called them, without experiencing an attack ;
they never had one in Paris. Better still, it was sufficient for
them to go to Toulon to be cured of their Marseilles attacks.
Travelling often, and necessarily in all sorts of places, they had
remarked that certain localities were deadly to them, while in
others they were quite exempt from annoyance.

There is, then, a rule for asthmatics, and it is important that I
should mention it, for I shall make a great account of it when I
come to speak of the nature of this disease.

A young physician, Dr. E. Vidal, has mentioned to me a fact
which he had himself observed, and which properly comes

1859.] Lecture on Asthma. 253

in here. He knew a sea-captain, for a long time affected with
this complaint for many years in fact. Every time he went to
Peru to take in a cargo of guano, his attacks ceased from the
moment of his arrival at the Chincha Islands where he took in
his guano ; and his disease, of which he did not then experience
the least symptom, from which he seemed radically delivered
during the time of his voyage from America to France, returned
as soon as he went on shore and breathed an atmosphere not
charged with guano. This fact is explained to a certain extent,
better by another influence. You know what guano is, and
those who have seen it know also how penetrating the odor is
which it gives off, an odor excessively ammonical. I shall tell
you, in speaking of treatment, the part which ammonia some-
times plays in calming attacks of asthma.

The influences of temperature are not less singular in the pro-
duction of this complaint.

The sufferer from catarrh dreads the cold, which easily influ-
ences him, and becomes the cause of new symptoms ; he keeps
himself habitually well clothed ; in winter he seldom goes out,
but keeps in the chimney corner. The asthmatic, on the con-
trary, seeks for plenty of fresh air, he has a horror of small
apartments, of low ceilings, which seem to weigh upon his chest;
he dreads woollen draperies. However rich he may be, you
will find him usually occupying a chamber either without cur-
tains, or supplied with very light ones ; his bed has none ; thick
draperies and curtains overwhelm, oppress, suffocate him ; in
the very heart of winter, open windows are as necessary to him
as in summer; in a word, he needs a great body of air. That
this want is real, that it may be the effect of the imagination, a
sort of mania, you will often find, as I shall show you.

Among the peculiar eccentricities which show us also the
essentially nervous nature of asthma, there is one which has not
escaped the attention of any observer, namely, that in the space
of twenty-four hours the asthmatic has his attacks at certain
hours, and not at others.

My poor mother whom I had the misfortune to lose twelve
years since, and from whom I inherit the asthma with which
I am affected, my poor mother had her attacks at eight o'clock
in the morning. The rest of the day she came and went with
an activity which never failed her, and her nights were good.

I know the master tailor of a regiment of carbiniers, then in
garrison at Saumur, who was regularly seized at three o'clock in
the afternoon. The attacks were so regular that, on account of
this perfect uniformity of the hour at which they came on, I be-
lieved them due to a marsh miasm, a kind of masked intermit-
tent. I gave him however the sulphate of quinine in vain.

Although there are thus some examples of diurnal asthma,

254 Ligature of the Extremities in Intermittent Fever. [April,

most commonly it is at night that the attacks come on. Gen-
erally, it is from ten to twelve o'clock at night. And the influ-
ence of the bed, of the decubitus in the horizontal position, is
here of slight importance ; whether the individual is a-bed or up,
the attacks return at the same hour of the night ; in some they
occur a little later. Thus, in my own case, they come on about
three o'clock in the morning. Invariably, I am awakened at
that hour, and hear the hammer of my clock strike its three
blows. At the same time these exceptions do not weaken the
general rule.

I have told you that asthmatics seek for nothing so eagerly
as fresh air ; and, singular fact ! nervous asthma is oftener observ-
ed in summer than in winter. The attacks occur much more
often in the months included between May and November than
from November to May. Another thing worthy of remark
asthma is a more common complaint in equatorial regions than
in temperate or frigid zones, and yet every one knows how rare
thoracic affections are in warm countries, where diseases of the
liver and digestive organs predominate over all others. In these
countries, catarrhal affections are observed without doubt, but
as exceptions ; at least so English physicians who have lived in
India have taught us, where, Simms says, asthmatics are very
numerous.

Thus asthma is a disease of warm countries, it is a summer
disease, and when those who are affected with it take cold during
the cold season, they recover much more rapidly from their
catarrhs at that time than they do in summer, other things being
equal. S. L. A.

Ligature of the Extremities in Intermittent Fever. By Drs. J. De
Bratjw and H. J. Brohrs.

According to Drs. De Brauw and Broers, the ligature of the
extremities is a measure which has been already employed by
ancient physicians to aid in the treatment of intermittent fever,
but has unjustly nearly fallen into oblivion. Already Pinius
(Hist. Nat. xxviii., 6) knew this antiperiodic, as Pittschaft (Hufe-
land's Journ., li., 3, pp. 47, 48) states, and in Van Swieten's
Commentaries to Boerhaaves Aphorisms, the "levis brevisque
compressio venarum in artubus," is strongly recommended as a
means to relieve the burning heat of fever. Dr. V. Hildenbrand,
however, declares the remedy, in his Institutiones Practico-Meoli-
cce, to be unreliable, and in many respects unsafe, and recom-
mends caution in the use of it. Jos. Frank (Prax. Med. Univ.
Prsecepta) speaks of it in a very superficial manner, like many
other, particularly more recent authors. One of the most enthu-
siastic commenders of this method is George Kellie, (Duncan's

1859.] Ligature of the Extremities in Intermittent Fever. 255

Medical Commentaries, vol. xix.,)who, during the siege of "Wil-
lemstad by the French army, in 1793, cured many cases of
intermittent fever (which had resisted the use of quinine) com-
pletely, by compression of the extremities. Upon his recom-
mendation several physicians in England for instance, Veiteh
and Wallieh, (Mecliz. Nation alzei tun g, July, 1798,) and in the
Netherlands, (Agemene Vaderl. Lettervefn in gen, 1808, 5,)
tried his method with signal success. Of the more recent com-
munications on this subject, that of Prof. Chladni (Hufeland's
Journal, xlii., p. 133,) is worth particular attention. This cele-
brated savant being attacked in 1813 by an obstinate intermit-
tent fever, used the remedy with much advantage. He describes
it as quite innocuous, and explains its curative influence by the
supposition, that by the ligature of the extremities the return of
blood to the heart, and to the centres in general, is hindered or
partially suspended, and that the full development of one of the
principal symptoms, the chill, being thus interfered with, an
interruption and disturbance of the whole type of fever takes
place.

This method belongs morever to one of the oldest popular
remedies used in Kussia, England, and France. In Canstatfs
Jaliresbericht, (Jaborg., 1848, p. 113,) the cure of a quartan by
application of Junod's boot is mentioned, a fact which seems to
be intimately connected with the subject in question. Accord-
ing to Jolly, (Diet, de Med. et de Chir., tome xi., part i., p. 363,)
who gives a detailed account of the ligatures circularies des mem-
bres, the ligature should be applied to the four extremities at the
same time, but in such a manner that only the circulation in the
superficial vessels is suspended. Martinet, Robinau, Recamier,
and Husson, kept up the compression for not longer than twen-
ty-five to fifty minutes, and commenced with it in the cold stage.

Jolly recommends taking off the ligatures one by one, at
intervals of several minutes, as by the simultaneous removal of
the same too much blood would be at once introduced into the
circulation, which might be attended with evil consequences.

The most complete information on the subject of his investi-
gation the author found in a dissertation of R. v. Bserle : De
valde rrmltiplici ftbrium intermittentium medicatione speciatim de
membrorum majorum circumstrictione tantaminibm in nosocomio
academico explorata" Utrecht, 1809. In this treatise the liga-
ture of the extremities is thoroughly illustrated by the report of
seven cases, and highly recommended. V. Brerle commenced
the treatment with the administration of a gentle purgative; the
patients were kept in bed, and subjected to a rigid diet during
the paroxysm ; shortly before the commencement of the cold
stage, the thighs and upper arms were encircled by ligatures
exercising a moderate pressure, which were removed in from six

266 Action of Certain Vegetable Diuretics. [A^nlf

to fifteen minutes, or later, according to the effect they produced;
after Wallich's example he forbade warm drinks during the
cold stage, but recommended cold drinks in the hot stage. From
observation of this kind the author draws the following conclu-
sions : The ligature of the extremities is a safe and powerful
means of assistance in the treatment of intermittent fever ; it is
not only an adjuvant to other antiperiodics, but also a febrifuge
by itself. It cures the febris intermittens simplex and duplex,
as well as the quotidiana. In regard to the quartana no experi-
ence has been made. The ligatures must be allowed to remain
until the hot stage begins; a longer application does not lessen
their effect. The method seems to owe its curative property to
the disturbance of the usual course of the fever, (Chladni.) Some-
times the paroxysm is transferred under this treatment from the
third day to the second, but generally so that the tertian type is
not interrupted, or that a febris duplex is developed. The com-
pression of the extremities is always followed by some increase
of the heat and perspiration, the signs of an energetic reaction.
After repeated use of this method the fever gradually subsides.
Contra-indications to it never existed, but may be easily inferred
from an examination of the modus operandi of the remedy.

Dr. De Brauw generally applied compression to two extremi-
ties only, but considers the ligature of all four far more effica-
cious in obstinate cases, and recommends the method as being
capable in some cases to substitute the use of quinine.

In cases of relapse of intermittent fever, in which the patients
complain of that characteristic pain in the lumbar region (fifth
lumbar vertebra,) against which cups are used without effect,
Brcers recommends the application of the galvanic current to
the mentioned spot as a highly serviceable, though occasionally
inefficient means. After the second or third application of this
remedy the cachectic appearance, as well as the depressed feel-
ings of the patients, underwent a favorable change. Kelapses of
the fever, consequent upon a return of the patient into the ma-
larious district, yielded quickly to this mode of treatment, even
when quinine was administered without success. [Nederland.
Tijdschr., 1858, and Medizinische Neuigkeiten, 1858, and N. Amer.
Medico- Chir. Review.

On the Action of Certain Vegetable Diuretics. By William A.
Hammond, M.D., Assistant Surgeon, IT. S. Army.

The ensuing investigations consist mainly of repetitions of those
performed some years since by Krahmer, and subsequently by
Bird. They have reference to the appreciation of the influence
of squill, juniper, digitalis, and colchicum, over the quantity of
the urine, its specific gravity and the amount of its solid organ-

1859.] Action of Certain Vegetable Diuretics. 257

ic and inorganic constituents. They were all performed upon
healthy adult males.

The quantity of uriue was determined in cubic centimetres,
and the weight of solids in grammes.

The method employed for the determination of the whole
amount of solid matter was as follows:

Ten cubic centimetres of the urine were evaporated to as com-
plete dryness as possible in vacuo over sulphuric acid, and the
residue accurately weighed. By simple proportion the amount
of solids in the whole quantity of urine was easily ascertained.

Although it is impossible to get rid of all the water by this
process, the quantity remaining is extremely small, and the re-
sults obtained are far more accurate than those-yielded by evap-
orating to dryness in the water-bath as generally practised. Xo
matter how carefully this latter method is conducted, the loss of
urea, by decomposition, is always an important item, and in-
volves far more serious errors than the imperfect desiccation by
the former process.

For the determination of the amounts of organic and inor-
ganic constituents separately, the solid residue obtained as above
was mixed with ten or fifteen drops of moderately strong nitric
acid, and gently heated until the mass was well dried. The
heat was then gradually raised till all the carbon was consumed,
and the mass in consequence became white. It was then cooled
in vacuo over sulphuric acid and weighed. The inorganic mat-
ter was thus determined and the loss showed the proportion of
organic substance.

Digitalis. The subject of the experiments with this substance,
was about twenty-five years of age and in good health. For
the three days immediately preceding the commencement of the
investigations, the average quantity of urine daily excreted by
him was 1474.5 cubic centimetres, the specific gravity was
1024.30, and the average total amount of solid matter was 75.31
grammes, of which 30.17 grammes wrere inorganic, and 45.14
organic constituents. The digitalis was given in the form of
the officinal tincture in doses of 20 minims three times in 24
hours, and was continued for three consecutive days. During
this period the manner of living (food, drink, exercise, etc.) > -
as nearly as possible the same as during the preliminary inves-
tigations.

1st day. The urine passed on this day was of a pale straw-
colour and feeble acid reaction ; quantity 1950 cubic centime-
tres; specific gravity 1013.25; total solids 69.98 grammes, of
which amount 31.27 were inorganic and 38.71 organic matter.
The action of the digitalis was not manifested otherwise than by
its effect upon the urine.

2nd day. The urine passed on this day was of similar physic-

%o8 Action of Certain Vegetable Diuretics. [April,

al character to that above mentioned. The quantity was 1873.6
centimetres, the specific gravity 1014.32, and the total solids
63.74 grammes. The inorganic solids amounted to 30.15
grammes, and the organic to 33.49.

The pulse on this day was somewhat slower and fuller than
on the previous day.

3rd day. The quantity of urine evacuated on this day was
1624.9 cubic centimetres, and of specific gravity 1020.04. The
total amount of solid matter was 67.29 grammes, of which 33.19
were inorganic and 34.10 organic.

The colour, reaction, and odour of the urine were similar to
those of the two previous days.

The characteristic effects of the digitalis upon the action of
the heart were well marked during this day.

The effect of the digitalis in increasing the amount of urine
is seen to have been greatest on the first day. On the second
day it had fallen somewhat, and on the third was but 150 cubic
centimetres greater than when no digitalis was taken. The so-
lids, it is seen, were less than the normal standard from the
commencement, were still further reduced on the second day,
and on the third were slightly increased. This diminution is
perceived to have been owing to the lessened amount of organ-
ic matter excreted. .The inorganic substances were somewhat
increased in amount over the ordinary proportion.

Juniper. The experiments with this substance were conduct-
ed on a healthy man thirty-five years of age. The average con-
dition of his urine for the three days immediately preceding the
investigations was as follows : quantity 1237.5 cubic centime-
tres, specific gravity 1022.50 ; total solids 61.23 grammes, of
which 23.12 were inorganic, and 38.11 organic matter. It was
of ordinary colour and odour, and of strong acid reaction.

Sixteen ounces of the officinal infusion of the berries of the
Juniperus communis were taken during the twenty-four hours,
and the manner of living kept as nearly as possible to corres-
pond with that of the preliminary experiments.

1st day. For this day the quantity of urine amounted to 1732
cubic centimetres, the specific gravity of which was 1016.38 ;
the total solids were 62.75 grammes ; of this amount 25.43
grammes were inorganic, and 37.32 organic constituents.

The urine was of a pale straw-colour and gave off the char-
acteristic odour produced by juniper. The reaction was feebly
acidv

2nd day. The quantity of urine passed on this day was 1885.2
cubic centimetres. The specific gravity was 1014.15, and the
total solids 58.49 grammes, 22.17 of which were inorganic, and
36.22 organic matter. The physical characteristics were similar
to those of the day before. The reaction was barely acid.

1859.] Action of Certain Vegetable Diuretics. 259

3rd day. On this day the quantity of urine was 1672.5 cubic
centimetres, with a specific gravity of 1018.41. The total solids
amounted to 63.27 grammes, of which 27.50 were inorganic,
and 35.73 organic matter. The physical characteristics and re-
action were the same as on the previous day.

From these experiments it is seen that whilst the quantity of
urine was materially increased by the juniper, the amount of
solid matter, as a whole, was but slightly affected, the loss in or-
ganic matter being about compensated for by the increase of the
inorganic.

Squill. The experiments with this substance were instituted
upon myself, and were conducted upon the same general prin-
ciples as the foregoing series. The average daily quantity of
urine, for the three days preceding the investigations, was 1358
cubic centimetres. The specific gravity was 1023.51, and the
total solids 69.35 grammes ; of this amount 27.22 were inorgan-
ic, and 42.13 organic matter.

I took two grains of the dry bulb of the Scilla maritima, three
times in the twenty -four hours. The other conditions remain-
ing the same as in the preliminary examination of the urine.

1st day. The quantity of urine passed on this day was 1572
cubic centimetres, of 1020.34 specific gravity. The total solid
matter was 6067 grammes, 31.07 of this amount being inorgan-
ic, and 29.60 organic constituents. The urine was of feeble
acid reaction.

2nd day. Quantity of urine 1493.5 cubic centimetres, speci-
fic gravity 1020.90, total solids 58.22 grammes, inorganic matter
30.15, organic 28.07 grammes. The reaction, etc., were the
same as on the preceding day.

3rd day. On this day the quantity of urine amounted to 1535
cubic centimetres, and was of 1019.37 specific gravity. The to-
tal amount of solid matter was 61.58 grammes, of which 30.58
were inorganic, and 31.00 organic constituents. The reaction,
colour, etc., were unchanged.

From the above experiments it is perceived that the action of
the squill was similar to that of the digitalis and juniper, i.e.,
causing an increase in the water of the urine and inorganic sol-
ids, but a reduction of the amount of organic matter. The loss
of organic matter was considerably greater than with either of
the other substances.

Colchicum. The investigations into the action of this sub-
stance were performed upon a healthy man twenty-eight years
of age. The urine for the three days immediately preceding the
commencement of the experiments, was of the following daily
average character; quantity 1230 cubic centimetres, specific
gravity 1025.08 ; total solids 63.12 grammes, inorganic matter
29.83, and organic 33.29. The reaction was very strongly acid.

N. 8. VOL. XV. NO. IV. 19

Action of Certain Vegetable Diuretics.

[April,

One and a half drachms of the officinal tincture of the seeds
of the Colchicum autumnale were given three times in twenty-
four hours, and continued for three days. During this period
the food, exercise,, etc., were as nearly as possible the same as
during the preliminary series.

1st day. The quantity of urine passed on this day was 1595.7
cubic centimetres, with a specific gravity of 1024.37. The total
solids amounted to 77.29 grammes, the inorganic matter of
which was 36.50 grammes, and the organic 20.79 grammes.
The reaction was strongly acid.

2nd day. Quantity of urine 1484.1 cubic centimetres, specific
gravity 1024.31 ; total solids 75.22 grammes. The amount of
inorganic matter was 35.01 grammes, and of organic 40.21. The
reaction was very strongly acid.

3rd day. On this day the quantity of urine amounted to 1620'
cubic centimetres, and was of 1022.6 specific gravity. The total
amount of solid matter was 7&.33 grammes, of which 34.20 were
inorganic, and 45.13 organic constituents. Reaction strongly
acid.

It is thus perceived that the action of the colchicum, as com-
pared with that of the other substances experimented with, was
very remarkable, it being the only one with which there was
an increase in the amount of solid matter eliminated, both or-
ganic and inorganic.

From the foregoing experiments the following table embrac-
ing the averages of each series of investigations is constructed :

Normal standard.
Digitalis

Normal standard. . ,
Juniper. ,

Normal standard.,
Squill.... . ..

Normal standard. . . .
Colchicum. ....

QUANTITY

SPECIFIC

TOTAL

INORGANIC

ORGANIG

OF URINE.

GRAVITY.

SOLIDS.

SOLIDS.

SOLIDS.

1474.5

1024.30

75.31

30.17

45.14

1822.8

roi5.87

67.00

31.54

35.43

1237 .5

1022.50

61.23

23.12

38.11

1763.2

1016.28

61.50

25.03

36.42.

1358.0

1023.51

69.35

27.22

42.13

1533.5

1020.20

60.15

30.-60

29.55

1280.0

1025.08

63.12

29.83

33.29

1556.6

1023.58

77.28

35.23

42.04

From the foregoing investigations, I think it is deducible that
neither digitalis, juniper, nor squill, increases the total amount
of solid matter eliminated by the kidneys, and that the organic
matter is considerably reduced through their influence. Al-
though they do not increase the amount of inorganic matter
removed through the urine, yet as it is the organic matter which
is generally considered as contaminating the blood in disease, it
is evident they exert no effect whatever in depurating this fluid,,
but on the contrary are positively injurious.

1859.] Epilepsy. 261

The results obtained, in so far as the experiments with digi-
talis, squill, or juniper, are [concerned, are similar to those ob-
tained by Krahmer, but are materially different as regards the
colchicum. For, although Krahmer found that under the influ-
ence of this medicine there was an increase in the amount of
organic matter excreted, this was so small as to lead to the sup-
position that it may have been accidental, and besides there was
a reduction in the quantity of inorganic substance removed. It
is desirable, therefore, that we should have further observations
with this article. [Proc. Biol. Dep. Acad. Nat. Scs. of Philad.

Epilepsy for Thirty-two years in a man aged Forty -four ) with
discoloration of the Skin from Nitrate of Silver; Operation of
Castration. Under the care of Mr. Holthouse.

Among the causes of epilepsy mentioned by various writers,
extreme sexual excesses are considered as not the least important.
They would appear to have much influence on the frequency of
the fits, as is shown in the narrative of the following case, the
notes of which were taken by Mr. H. Ponsonby Adair, house-
surgeon to the hospital. There are cases on record in which
castration has been resorted to as a means of relief. In one re-
ported by Mr. J. P. Frank, the aura epileptica began in the
testicle, and it is asserted that a permanent cure followed castra-
tion.

This operation is much practised at the present day among
the Eastern nations, for the sole purpose of depriving their slaves
of manhood ; and Mr. Curling informs us, in his work on the
" Diseases of the Testis," that in Italy it was once frequently
performed, on account of its effects on the vocal organs.

Eli B , aged forty-four, widower, native of the United States,
bookseller, was admitted into Luke ward, in the Westminster
Hospital, on the 4th of January, under the care of Mr. Holt-
house, in order to have the operation of castration performed for
the cure of epilepsy.

The patient is one of fourteen children, of whom eleven are
living and healthy ; his father is alive, aged eighty-four, and his
mother died at eighty. There is no insanity in his family, nor
is any member of it afflicted with epilepsy. He was a healthy
child till he was ten years of age, when he commenced to prac-
tice masturbation, and soon after had an epileptic fit, in which
he bit his tongue. This was followed by severe pain in the
head, and incapacity for exertion next day. The fits occurred
every three or four weeks. They came on suddenly, without
any premonitory symptoms. During the first two years he took
"skull-cap tea," without effect ; his diet was also regulated. He

262 Epilepsy. [April,

still continued to practice self-abuse, and did not finally relin-
quish it till he was twenty-two, about the time when he began
to take nitrate of silver. For two years he tried homoeopathy,
the fits increasing in severity. He was at school up to the age
of fifteen, when he tried a sea- voyage, but without benefit. Hav-
ing returned, he sailed for South America, where he remained
for two years, the fits being as frequent as before. While at
New York he contracted gonorrhoea, having been accustomed
to frequent sexual intercourse from the age of sixteen, in addi-
tion to the habit of self-abuse. He remained in New York for
a few months, trying various remedies, among them sulphate of
zinc, but without relief. He went again to the South for a few
months, and upon his return he placed himself under the care
of Dr. Kissam, (his brother-in-law,) who prescribed nitrate of
silver, in doses of one-eighth of a grain, three times daily, and in
two months it was increased to half a grain. Very soon after
he began to take this remedy, the severity and frequency of the
fits began to decrease, and he was so convinced of its efficacy,
that he continued its use for about eight months, against the ad-
vice of Dr. Kissam, who feared it might affect his skin, which,
indeed, it did to some extent, giving it a blue tint. At the end
of this time, the fits left him for a period of two years, having-
gradually decreased in frequency under the use of the nitrate of
silver. From the time of his contracting gonorrhoea till his
marriage, he abstained altogether from sexual intercourse and
the habit of self-abuse, so that during the whole time he was
taking the nitrate of silver he had no extraneous sexual excite-
ment ; yet during this period he says that he was constantly
troubled with nocturnal erections, and frequent seminal emis-
sions. Being now twenty -four years of age, he married, shortly
after which he again became addicted to sexual excesses. He
left his wife and his business for several months, and travelled ;
the fits, however, recurred every three or four weeks, and were
very severe. On his return his wife died, and he remained a
widower six years, abstaining altogether from sexual excesses,
although frequently troubled with erections. During the six
years he broke his arm, several fingers, and his leg twice, while
in the fits. At the age of thirty he married a second time, the
fits having increased in number and severity. He was often
compelled to send his wife into the country for a day or two, in
order to avoid sexual excitement. The fits now recurred daily.
His wife died a year after marriage. After this he again abstain-
ed from sexual excesses. Dr. Horace Green, of New York, now
cauterized his larynx daily with nitrate of silver, and at the end
of three or four months he would be free from fits for nineteen
days ; when they did recur, they were so slight that he scarcely
lost consciousness, and did not fall down. This plan^of treat-

1859.] Epilepsy. 2$3

ment was pursued for two or three years, at the end of which
time he became attached to another young woman, which re-
vived all his old amatory feelings, and the fits began to increase
in frequency, recurring at intervals of fourteen days, when they
would continue daily for a week, and then cease for fourteen
days more. Galvanism was now tried, with some slight benefi-
cial effect. Next arsenic, in the form of Fowler's solution, which
he continued until the fits recurred daily, and he became so
prostrate that he was confined to his bed. For a long time he
took iron to neutralize the effects of the arsenic, but for months
he was compelled to walk on crutches. He came to England
two years ago, to have tracheotomy performed by Dr. Marshall
Hall, who had advised it when he saw the man in America.
Dr. Hall died soon after the man's arrival, and he went to Paris,
and was under the care of M. Xelaton. Afterwards he placed
himself under the care of M. Trousseau, who gave him Belladon-
na, which affected his vision, but not his fits. Dr. de Lasiauve
next treated him with camphor for four months, without effect
He returned to England, and was under Mr. Simon, at St. Tho-
mas's Hospital, in order to have castration performed, in which
he had great faith, for he attributed his fits chiefly to sexual ex-
citement, which still troubled him much ; but his wish was not
acceded to. He took bromide of potassium without any benefit,
and then the nitrate of silver for two or three months, in half-grain
doses three times a day. The skin became darker than before,
and the fits recurred daily. He next went to Germany, and
was there sounded for a stone in the bladder on account of fre-
quent micturition, which he has had since infancy. No calcu-
lus was present. He was an inmate of the hospitals of Vienna,
Prague, and Dresden. He left the latter in October, 1858, and
was admitted into the Westminster Hospital, under Dr. Radcliffe,
on the 30th of the month, and remained in two months, during
which time he took quinine and iron, and camphor, but without
avail. Since his second wife's death he has entirely abstained
from sexual intercourse, though he has been constantly troubled
with nocturnal erections, and occasional seminal emissions, and
these continued up to the time when he came under the care of
Mr. Holthouse, to whom he applied to perform castration, which,
after much deliberation, he consented to do ; and it was perform-
ed upon both testicles on the 4th of January, 1859, under the
influence of chloroform. Two or three hours afterwards, there
was considerable hemorrhage, which was checked by the appli-
cation of cold. He had one fit during the hemorrhage. His
face has a bluish-slate tinge, which pervades the body, but the
color is darkest on the face. His fits are of the rotary kind, pre-
ceded by a sudden scream, and lasting not more than a minute,
and when over he is quite himself again. In the fit which he

264 Faces. [April,

had in bed after the operation, he did not scream, but merely
struggled violently.

January 5th. He had another fit this morning.

6th. The fit recurred early this morning.

7th. At four this morning another fit occurred. He says
that after his second marrage the fits frequently followed imme-
diately on the act of connection.

8th. Has had no fit at all to-day.

9th. Had a very slight attack this morning, scarcely more
than a giddiness for a minute. Altogether, since the operation,
the fits have been exceedingly mild. [Lancet, and North Ameri-
can Med. Chir. Review.

Faeces.

Keces consists partly of undigested, partly of indigestible sub-
stances ; their odor depends on volatile fatty acids : butyric acid,
and capric acid also called faecin. Sulphuric acid is employed
as a test for faeces in cases of strangulated hernia, &c, after hav-
ing first mixed them with water ; the fatty acids are thus vola-
tilized, and are then recognized by their smell. Sulphuretted
and phosphuretted hydrogen are formed in the intestinal canal,
and are partially absorbed by the fasces. The color of normal
faeces is yellowish brown, from caprophaein, which is a product
of biliphaein. Biliphaein does not occur as such in them. Capro-
phaein immediately strikes a red color with nitric acid. If the
flow of bile into the intestinal tube be obstructed, the faeces as-
sume a pale color. Soluble salts are found only in very small
quantity in the faeces ; under the microscope, we observe portions
of vegetable matter (spiral vessels), and from these the ashes of
incinerated faeces derive their potash. The earthy phosphates
are found in great quantity ; in rachitis they are so abundant,
that the ashes occupy almost as much space as the faeces did be-
fore incineration. Of iron there is scarcely a trace ; the ashes
are white.

The consistence of abnormal faeces may be natural, increased
or diminished.

1. In faeces of natural consistence we do not find much that is
abnormal. In affections of the bones, and especially in rachitis,
the earthy phosphates are present, as has been observed, in ex-
cessive quantity. After the use of ferruginous remedies (which
however, usually produce a thinner, porridge-like consistence),
and after hemorrhoidal bleeding, we observe a darker, blackish-
green color, derived from sulphuret of iron. The ashes then
have a rusty brown color, whilst the ashes of vegetable coloring
matters are white. Analysis does not show whether the iron is

1859.] boa 265

derived from the chalybeate preparations which have been taken,
or from blood. In thin faeces albumen may be sought for.

2. Increased consistence is observed after the ingestion of car-
bonate of lime (in spring-water, or as chalk, &c) in abstinence
from drink, in chlorotic patients, &c.

3. Diminished consistence. Before examination, the portions
which are not quite fluid should be dissolved or suspended in
water. We may distinguish.

(a) "Watery Discharges. These contain soluble salts, which
do not ordinarily occur in the fleces, and usually some biliphae-
in ; their reaction is sometimes neutral, sometimes acid ; in child-
ren this is owing to the presence of lactic acid.

(b) Serous Discharges. The fluid floating above the solid
portions contains albumen, although the solid parts do not con-
tain blood (in which case these portions would be of a greenish
or brownish-black color). They have an alkaline reaction de-
rived from carbonate of soda, sometimes also from ammonia, as
in typhus, and are generally poor in caprophaein. They occur
in chronic diarrhoea, dysentery, typhus, and cholera.

(c) Bloody Discharges. They are either of a bright red color,
from the lowest part of the intestinal canal, and exhibit blood-
corpuscles under the microscope ; or are darker colored in pro-
portion as the effusion has taken place higher up in the tube ; if
they are derived from the stomach, they are black as pitch. Iron
may be demonstrated in the ashes and albumen in the fluid
portions.

(d) Bilious Discharges are sometimes pap-like, sometimes
watery, sometimes serous; they usually contain biliphaein in-
stead of caprophaeim It is detected by means of Heller's test
Great importance is often ascribed to them, as they are supposed
to be connected with an affection of the liver. When diarrhoea
sets in rapidly, the first motions almost always contain biliphaein ;
this is, therefore, formed after the exhibition of purgatives, in
the commencement of cholera, &c. Where biliphaein is long
persistent (cholorrhoea) we may infer the existence of an affec-
tion of the liver. In dysentery the excretion of bile seems some-
what increased.

The green stools which occur during the use of mineral waters
often proceed from sulphuret of iron. After calomel, they pro-
ceed from sulphuret of mercury ; but we should remember in
both cases that biliphaein passes off in the beginning, as during
the administration of other purgatives.

(e) and (/) Mucous and Purulent Discharges are not easily
distinguished. The microscope exhibits no diagnostic charac-
ters. In purulent stools the faecal serum contains albumen.
Mucus is found in the mass, as transparent lumps capable of
being drawn out into threads ; it is also often voided in this form

266 Treatment of Yellow Fever. [April,

without any faecal mass. Pus is more equably intermixed ;
where ammonia is not present, and has not already affected the
pus, the ordinary test for that secretion may be applied to these
faecal masses.

All diarrhceal discharges may become ammoniacal ; it is a
bad sign : we find a strongly alkaline reaction, and with it inva-
riably crystals of ammoniaco-magnesian phosphate. This condi-
tion frequently attends purulent diarrhoea in typhus and puer-
peral fever. In dysentery the faeces may become ammoniacal
without giving rise to an unfavorable prognosis, as the develop-
ment of ammonia proceeds from the decomposition of intermin-
gled urea derived from the blood and serum.

Biliary Calculi are in general distinguished from conglomer-
ated faeces by floating in water. They may consist of,

1. Cholesterine, which occurs in masses of all possible sizes,
sometimes exceeding that of a pigeon's egg ; such calculi are
ordinarily white or slightly colored with biliphaein. Ignited on
platina foil, they first melt, and then burn with a yellow flame,
forming much soot, and developing a smell of burning fat. They
dissolve in boiling alcohol, from which the cholesterine precipi-
tates on cooling in the form of white scales. It is by this pro-
cess cholesterine is usually obtained.

2. Cholesterine and Biliphaein. This is the most usual form
of biliary calculi ; they are of a brownish-yellow or dark orange
color, and participate in the characters of Nos. 1 and 3.

3. Biliphcein. These calculi are blackish-brown, do not fuse
on platina foil, but burn with a faintly yellow flame. Extract-
ed with solution of potash they give a dark orange-yellow solu-
tion, to which Heller's test is to be applied.

4. Inspissated Bile. These are very common in the old ; are
usually small, black or green, very hard, and do not fuse when
heated on platina foil. They are to be extracted with solution
of potash, to which Heller's test for biliphaein and Pettinkofer's
test for bilin are to be subsequently applied.

5. Carbon. (Demonstrated by Berzelius) ; these are rare, do
not fuse, and are insoluble in all re-agents. [Heller, by Dahl, and
Medical News.

Bradycrote Treatment of Yellow Fever by Gelseminum Sempervi-
rens. By Drs. White and Ford, Charleston, S. C.

In view of the results obtained from a reduction of the pulse, in
the treatment of the fever as observed under the veratrum, and
in order to contrast with this drug another remedy possessing
similar powers, at the suggestion of Dr. White, we also used in
the present epidemic the tincture of gelseminum sempervirens,

1859.]

Treatment of Yellow Fever.

267

which was prepared, after the following formula: ^. Had, gel-
sem. semp., iv., alcohol (95 per cent.) aq. com., aa 5viij. M.
And digest 14 days, then filter. The initial doses of this tincture
were, for adults, from 20 to 30 drops and for children, from 5
to 20 drops, every hour for the first four hours, and as with the
veratrum the secondary doses were half as large.

Certain cases which had been seen late, or were characterized
by notable irritability of the stomach, as also some which showed
no special malignity were treated by this agent with marked
advantage; upon whose employment Dr. White decided in con-
sequence of the statements of Dr. Cleveland, of Cincinnati, and
of Dr. Mayes, of South Carolina, in this journal, concerning its
influence upon the pulse and freedom from irritant properties,
&c. From notes taken upon cases thus treated, we have dedu-
ced the following numbers :

Total number treated with gelseminum sempervirens, 24 ; all
of which recovered. Of these, 15 were males and 9 females.
Adults, 12, and children, 12 ; whites, 22 ; and blacks, 2 ; natives
of Charleston, 10; South Corolina, 5; Ireland, 7; Germany, 2.

Mean frequency of Pulse,

ADULT MALES.

Beats per Min.

ADULT FEMALES,

Beats per Min.

CHILDREN.

Beats per Min.

When first given - - -
Twelve hours after - -

112.4
55.4

101.3
54.6

122.2

70.9

Of the wrhole number treated, 2 vomited black vomit, 5 passed
black vomit downwards. In 3 cases hemorrhage occurred from
tongue, gums or nasal passages.

One woman was in the sixth month of her pregnancy, and
did not abort.

Avera. duration of treatment.

For

ADULT MALES.

Davs.

ADULT FEMALES

Days,

9.3

CHILDREN.

Days.

No marked prostration wras caused by this remedy. The pulse
being, however, much lessquickly reduced than by the veratrum.
In few cases was the heart's action fully lowered in less than 12
hours, and it was well controlled throughout the rest of the
disease in the majority of cases. The concurrent treatment was
the same as with the veratrum. Mercurialization was complete
in 10 cases ; incomplete in 14 cases. In a few instances, a marked
redness of the tongue was observed, a condition that was not
distinctly noticed during the administration of the veratrum.
The gelseminum appeared to produce a general calming influ-
ence even during the early period of its administration, but was
not found to possess any marked narcotic properties. It seemed
also, to promote the action of the kidneys, and during its use
only, in several cases, an erythema of the skin was noticed.
This drug appeared to influence the volume of the pulse before

268 Matters Discharged by Vomiting [April,

it affected its frequency, and in most cases for the rest of the
disease to control both conditions in an equal manner emesis
was not observed to ensue upon the administration of this medi-
cine ; the gastric irritability peculiar to the disease being moreo-
ver to all appearance favorably influenced.

The total number of cases of yellow fever treated with a slow
pulse by the veratrum viride and gelseminum sempervirens, was
conjointly 141, of which 15 died and 124 recovered.

Total number of cases treated by ordinary methods were 6,
of which 3 recovered and 3 died. These vomited black vomit
and died. One was a pregnant woman in her seventh month,
who died without abortion.

In conclusion, we beg leave to remark, that the confidence
with which we were inspired by the use of these drugs in the
commencement of the epidemic has continued unabated : that
we still continue to use them, and intend to do so again, should
our city be unfortunately re- visited by this obdurate and calami-
tous disease.

With apologies for the length and statistical nature of this
communication, we remain respectfully yours. [N~. York Jour,
of Materia Medica.

Matters Discharged by Vomiting.

According to the chemical nature of their contents we may
distinguish the following varieties :

1. Normal Contents of the Stomach. These, in addition to the
ingesta, consists of a mucous, transparent fluid, having a strong-
ly acid re-action, which is a mixture of mucus and gastric juice.
In the latter we find all the salts of the blood and a peculiar
acid, the acid of the stomach. This possesses the energy former-
ly attributed to pepsin ; pepsin is only a product of decomposi-
tion, developed by the action of dilute hydrochloric acid on
mucus. The acid of the stomach is soluble in alcohol and in
water ; if we evaporate the alcohol, a viscid mass of syrupy con-
sistence remains behind. Free hydrochloric acid is not found
in the stomach, except when the chloride of sodium of the gastric
juice is decomposed by acids. Lactic acid and fatty acid are
derived solely from the food.

2. Watery vomitus is the normal contents of the stomach
plus water, has an acid re-action, contains no albumen, and
must be carefully distinguished from the following:

3. Serous vomitus. In this the gastric juice has nearly disap-
peared ; it has an alkaline reaction, and may be almost consid-
ered as a very watery serum of the blood ; it contains small quan-
tities of albumen, alkaline carbonate, and albuminate of soda.
It occurs in cases of very frequently repeated vomiting, where

1859.] Hautle, or Animal Bread of Hie Mexicans. . 269

the effort gives rise to hyperemia and exosmosis: consequently
in pregnant women, almost constantly in perforating ulcer, which
has not yet produced hemorrhage, in carcinoma, &c., and in
cholera.

4. Uremic vomitus occurs in connection with other uremic
phenomena. It has an alkaline reaction in consequence of the
presence of carbonate of ammonia, which is detected as in albu-
minous urine ; it contains in addition albumen, urea, and some-
times uric acid and uroxanthin.

5. Bilious vomitus. Chiefly in hyperemia of the liver, espe-
cially when metallic poisons become deposited in that organ,
which takes place very rapidly, as in poisoning by copper and
arsenic. Biliphsein is usually present in the green or blue, rarely
in the yellow, modification ; in poisoning with copper, the color
is derived from it. Bile is also frequently found mixed with the
varieties of vomitus. Biliphaein is demonstrated by means of
Heller's test ; bilin is decomposed so rapidly in the stomach,
that it can be rarely detected.

6. Bloody vomitus. We may find a fresh red color, or it
may have already become of a blackish brown ; in the first case,
we shall be able to discover blood corpuscles ; in the second,
these will not be apparent ; in both cases, we shall have albu-
men. To distinguish the colored substance from berries which
may have been eaten, we may burn it on a piece of platina foil ;
fruits give a white ash, blood a rusty brown. The ash may be
dissolved in hydrochloric acid, neutralized with ammonia, and
tested for iron.

7. Foecal vomitus is characterized by a yellow color and faecal
smell, the latter being increased on the addition of concentrated
sulphuric acid.

8. Purulent vomitus is distinguished by means of the potash
test, and by testing for albumen. Heller, byDahl, and Med. News.

On the Hautle, or Animal Bread of the Mexicans. By M. Guerix-
Mexeville.

In the Bulletin de la Societe Imperiale Zoologique aV Acclimation,
M. Guerin-Meneville has published a very interesting paper on
a sort of bread which the Mexicans call Hautle, and which is
made of the eggs of three species of hemipterous insects belong-
ing to the group of water-bugs.

According to M. Craveri, by whom some of the Mexican
bread, and of the insects yielding it, were brought to Europe,
these insects and their eggs are very common in the fresh waters
of the lagunes of Mexico. The natives cultivate in the lagune of
Chalco, a sort of carex called toule, on which the insects readily

270 Hautle, or Animal Bread of the Mexicans. [April,

deposit their eggs. Numerous bundles of these plants are made,
which are taken to a lagune, the Tescuco, where they float in
great numbers on the water. The insects soon come and de-
posit their eggs on the plants, and in about a month the bundles
are removed from the water, dried, and then beaten over a large
cloth to separate the myriads of eggs with which the insects had
covered them. These eggs are then cleaned and sifted, put in
sacks like flour, and sold to the people for making a sort of cake
or buiscuit, called hautle, which forms a tolerably good food, but
has a fleshy taste, and is slightly acid. The bundles of carex
are replaced in the lake and afford a fresh supply of eggs, which
process may be repeated for an indefinite number of times.

Moreover, says M. Craveri, the Mexicans collect quantities of
these insects from the surface of the water by means of hooped
nets, and these are dried and sold as food for birds. In Mexico,
these dried insects are sold in the streets and markets, the deal-
ers crying " Moschitos, Moschitos" just as in Europe they cry
" Food for your singing birds".

It appears that these insects have been used from an early
period, for Thomas Gage, a religionist, who sailed to Mexico in
1625, says, in speaking of articles sold in the markets, that they
had cakes made of a sort of scum collected from the lakes of
Mexico, and that this was also sold in other towns.

Brantz Mayer, in his work on Mexico {Mexico as it Was, and
as it Is, 1844), says, " On the lake of Tescuco, I saw men occu-
pied in collecting the eggs of flies from the surface of plants and
cloths arranged in long rows as places of resort for the insects.
These eggs, called Agayacath, formed a favorite food of the
Indians long before the conquest, and when made into cakes
resemble the roe of fish, having a similar taste and appearance.
After the use of frogs in France, and birds' nests in China, I
think these eggs may be considered a delicacy, and I found that
they were not rejected from the tables of the fashionable inhabi-
tants of the capital.

The more recent observation of Messrs. Saussure, Salle, Valet
D'Aoust, &c, have confirmed the facts already stated, at least in
the most essential particulars.

The insects which principally produce this animal farina of
Mexico, are two species of the genus Corixa of Geoffroy, hemip-
terous insects of the family of water bugs. One of these species
has been described by M. Guerin-Meneville as new, and has been
named by him Carixa fermorata. The other, identified in 1831
by Thomas Says, as one of those sold in the market at Mexico,
bears the name of Corixa mercenaria.

The eggs of these two species are attached in innumerable
quantities to the triangular leaves of the carex forming the bun-
dles which are deposited in the water. They are of an oval form

1859.] Spontaneous Hydrophobia. 271

with a protuberance at one end and a pedicle at the other extremi-
ty, by means of which they are fixed to a small round disc,
which the mother cements to the leaf.

Among these eggs, which are grouped closely together, and
sometimes fixed one over another, there are found others, which
are larger, of a long and cylindrical form, and which are fixed
to the same leaves. These belong to another larger insect, a
species of Notonecta, which M. Guerin-Meneville has named
Notonecta unifasciata. [Jl. de Pharm., and London Phar. Jour.

A Case of Spontaneous Hydrophobia. By Dr. Henrich.

F. K., thirty years of age, suffered on the twenty-ninth of May,
1857, of cephalalgia, which radiated from the forehead to the
occiput, and of all the symptoms of a cold in the head. On the
morning of the thirteenth he complained of chills, and distressing
horripilations. Dr. Henrich examined the patient attentively,
without finding in the throat or elsewhere a single sign of disease.
In the evening he was called in great haste to the patient, whom
he found sitting in the bed, the face bathed in perspiration, pale,
and expressive of terror ; the eyes injected, brilliant, haggard ; the
voice hoarse, anxious, and broken. The patient complained of
pain and constriction in the throat and chest, of intense thirst
with impossibility to drink, and of dryness of the mouth. The
respiratory movements were accelerated, superficial, and irregu-
lar; they became normal in the interval of the spasms, which
followed each other rapidly ; but when the throat became con-
stricted, the patient seemed to suffocate, and carried the hand to
the neck as if to remove an obstacle to respiration. The saliva
flowed in great quantity from his mouth. Pulse ninety, and
feeble. Pharynx a little reddened, and covered like the mouth
with viscid mucus.

After earnest entreaties, Dr. Henrich finally succeeded in try-
ing to overcome his violent horror of liquids ; after having for a
long time struggled against a convulsive contraction of the mus-
cles of the forearm, he could finally bring a glass of water to his
mouth, but hardly had the first few drops of the liquid touched
his lips, when he was seized with a violent attack of suffocation.
He threw his glass away with a gesture of despair, and taking
refuge in the remotest part of the bedr cried out to take the
water away ; that he could not swallow ; that he was suffocating.

In this condition he remained during the night. The impres-
sion of light or of a current of air exercised, however, no percep-
tible influence upon the spasms, and the vesicles of Morochetti
were not found on the margin of the tongue. In spite of ven-
esection, a blister on the chest, etc^ all the symptoms were aggra-

272 Amussafs Operation for Artificial Anus. [April,

vated the next day ; chloroform exasperated them ; and they
became less violent only for a few moments, after the patient
had lost about a pound of blood through the wound made by
the venesection, which had opened again ; but soon they return-
ed with greater intensity ; tetanic convulsions and opisthotonos
supervened, and the patient expired half an hour later. He had
preserved the full power of his intellectual functions until teta*
nus came on.

On autopsy, a very slight swelling of the base of the tongue
was discovered ; the pharynx was in a healthy condition ; some
pulmonary hypostasis, and two hemorrhagic suffusions in the
mucous membrane of the stomach were found. All the other
organs, the spinal marrow included,, presented no alteration.
The blood was black, liquid, and diffluent.

Dr. Henrich assured himself, by the most careful inquiries,
that the patient had never been bitten by a dog, either mad or
healthy, and that he did not believe himself at all attacked by
hydrophobia. For three weeks previous, however, he was in
low spirits, and without being otherwise sick, had a presentiment
of his approaching death, as he said. He indulged, however,
in excessive coitus, (he was married and kept two mistresses),
and was troubled with grief and sorrow. To these two causes
combined, the appearance of the terrible malady may be attribu-
table. (Henkds Zeitschrift filr Staatsarzneikunde, 1858, p. 361).

This case, which belongs to the third class of spontaneous hy-
drophobia of M. Chomel, {Diet, de Med., tome xv. 1837), is,
among all the published cases, one of the most characteristic.
Cases of similar kind have been reported by MM. Ely, Burgreave,
(Gaz. des Hopitaux, 1854), Lessmann, (Preuss. Vereinszeitung,
1854), Bulley, (Assoc. Med. Journ, 1854, Nov. 11), and Puteg-
nat, (Journ. de Med. de Bruxelles, June, 1853). (Gazette Hebdo-
mad, 1858, 40). [North American Med. Chir. Review.

Successful Case of Amussafs Operation for Artificial Anus.

A case now under Mr. Hutchinson's care as an out-patient of
the Metropolitan Free Hospital, affords an interesting illustra-
tion of the occasional value of Amussat's operation. The bowels
had been obstinately constipated for three weeks and eleven
days ; in spite of the use of free enemata, neither feces nor fla-
tus had been got away. The obstruction was caused by the
pressure of a large malignant tumour which completely filled
the upper part of the pelvis. The abdomen was greatly dis-
tended, and the pain and vomiting were almost incessant. The
patient being evidently about to sink, Mr. Hutchinson deter-
mined to open the colon in the left loin. This was done with-

1859.] Effects of Cold on ttte Human Body. 273

out wound of the peritoneum, and a large utensil full of fluid
feces escaped at the time. An artificial anus was established,
through which ever since the bowels have been freely relieved.
More than a month has now elapsed since the operation. The
malignant tumour continues to grow rapidly, and will before
long cause the patients death. It is worth mention, that the
inconvenience caused by the anus in the loin has been very
trivial, a poultice over the part being found quite sufficient to
prevent the incontinent escape of gas or fecal matters. If proof
of the need which existed for another mode of relief, is the fact
that neither flatus nor feces have passed by the rectum since the
operation. The same case is of much interest as an instance of
a return of cancer in the pelvis after ovariotomy. Probably
not fewer than between three and four hundred ovariotomy
operations have now been performed, and as far as we are aware
no other instance of the return of cancer afterwards has yet been
recorded. The patient made a good recovery after the extirpa-
tion of the ovarian cyst, and regained her health and strength.
Within three months, however, there were evidences of a solid
pelvic tumour, which afterwards grew rapidly. [Med. T. & Gaz.

Some Experimental Researches on the Effects of Cold on the Human
Body. By MM. Tholozax and Brown-Sequard.

A series of researches permits the authors to draw up the fol-
lowing propositions: 1. If our extremities are exposed to the
action of cold water, they can in a very short time lose a con-
siderable portion of their temperature, (according to our experi-
ments, from ten to eighteen degrees). 2. After an extremity
has lost much of its temperature, (from ten to eighteen degrees), it
does not regain it before the end of forty -five minntes or an hour
in an atmosphere varying from twelve to eighteen degrees. 3.
Contrary to the opinion of Edwards, the lowering of the tempera-
ture of a small part of the human body has no sensible influence
upon the general temperature. 4. The lowering of the tempera-
ture of one hand can produce considerable falling of the temper-
ature of the other, without the general temperature of the body
being sensibly diminished.

Dr. Brown-Sequard has ascertained that the latter phenome-
non becomes more marked if the immersed hand is the seat of
more intense pain, and if the temperature of the air in which the
other hand is kept is less elevated ; it is also proportional to the
contraction of the vessels of the hand not immersed, and it is
this contraction exclusively which produces the falling of the
temperature. This phenomenon is an example of reflex action
upon the blood- vessels, their muscles contracting under the in-

/

274: The Metallic Seton. [April,

fluence of an irritation applied to the sensitive nerves of another
extremity ; it is further remarkable, that this reflex action takes
place only between homologous parts, and that the immersion
of the hand, for instance, into cold water, exercises no appreci-
able influence upon the temperature of the feet. [Journal de la
Physiologie, and North American Med. Ghir. Review.

The Metallic Seton.

As wire is replacing silk and other organic materials for sutures,
so it is likely to be used in cases where a seaton is used for the
purpose of setting up inflammation in serous sacs. Dr. Simpson
has used the wire seton with success in hydrocele, and his
practice has been followed in London by Mr. Spencer Wells.
The first case in which he tried it was one of hydrocele of the
round ligament in an out-patient at the Samaritan Hospital.
The cyst was of the size of a small orange. It had existed sever-
al years, and had been mistaken for hernia. Mr. Wells tapped
it the first day the woman applied, and evacuated more than an
ounce of clear serum. It filled again in a few days, and he then
passed an iron wire through it by means of a common needle,
and fastened it loosely in a loop. The fluid drained off, adhe-
sive inflammation was set up, and the wire removed on the
third day. The tumour remained quite solid for a few days
afterwards, but has gradually disappeared, and the cure appears
to be complete. Two other cases, one of a cyst in the neck con-
nected with the thyroid gland, and the other a mammary cyst,
have been treated in the same way, and are going on satisfacto-
rily. This mode of treatment is simpler and safer than the in-
jection of iodine, and will probably prove equally or more ef-
fectual. [Med, Times and Gazette.

On Rheumatism of the Diaphragm. By Dr. Chenevier.

After reporting several cases of this disease, the author gives
the following description of it : The disease commences with a
sudden pain at the points of attachment of the diaphragm, which
produces a feeling of constriction at the base of the thorax, but
is not augmented on pressure. Deep inspirations are impossible,
and respiration is carried on only by the superior ribs. Per-
cussion is normal, and auscultation does not reveal any change
in the respiratory murmur, which is only somewhat weaker at
the base of the thorax ; there is no cough ; sometimes, however,
a painful hiccough. The abdominal organs offer no symptom
of disease. The attack lasts from one to eight hours, and disap-
pears then without leaving any trace. The prognosis is favora-
ble. Kheumatism of the diaphragm is easily distinguished from

1859.] Editorial 275

inflammatory diseases of the lungs by the absence oft!
toms of the latter. It could only be mistaken for
affection of neighboring organs, as, for instance, inte sos
ralgia; but it is sufficiently distinguished from it by th
being felt particularly in the three characteristic poini
in the neuralgia just mentioned it is confined to one side
angina pectoris it is distinguished by the peculiarity
pain proceeds in this malady from the sternum and rad
one side to the arm. Jn nervous asthma, which also c
ces with sudden difficulty of breathing, the peculiar feeli
constriction as well as the confinement of the respiratory m
ments to the superior ribs, is not noticed; the two latter symp-
toms are pathognomonic of rheumatism of the diaphragm.

The treatment of the disease consists in the application
cups, mustard poultices, anodyne embrocations, and chloroform ;
if it is obstinate, the endermic application of morphia will be
useful. [Gazette des Hopitaux, and North Amer. Med. Chir. Rev.

EDITORIAL AND MISCELLANEOUS.

For the Members of the Medical Society of the State of Georgia.

At the last annual meeting of the Medical Society of the State
of Georgia, held at Madison, it was determined by a vote of the
Society, "that all the Medical Journals in the State be requested to pub-
lish the Constitution, <fcc, in their columns." This request we cheerfully
acceded to at the time, and we now, in accordance with our agreement,
present the several articles of the Constitution, at a time when they may
be most useful to the members of the Society. The Roll ot members
would be very properly here recorded, but as this may require careful
revision, on account of deaths, removals, and resignations of members,
we defer its publication for the present.

The Medical Societv of the State of Georgia had its on'mn in the man-
ner we find recorded in a pamphlet containing the Proceedings of the
State Medical Convention : uIn pursuance of a call from the Medical Col-
lege of the State of Georgia, [Augusta,] and the Georgia Medical Society of
Savanna)), addressed to the Practitioners of Medicine throughout the
State, they assembled in Convention, in the city of Macon, on Tuesday,
the 20th of March, 1849."

This Convention was temporarily organized by calling Dr. Thomas
Hoxey, of Columbus, to the Chair, and appointing Dr. S. W. Burney, of
Monroe Co., Secretary. When, on motion of Dr. K. I >. Arnold, of Savan-
nah, the members presented their names, it was found that thirty-one
n. s. VOL. xv. no. iv. 20

276 Editorial [April,

Counties were represented viz : Baker, Baldwin, Bibb, Burke, Chatham,
Clark, Cobb, Crawford, Dooley, Fayette, Floyd, Gwinnett, Henry, Hous-
ton, Jasper, Jones, Lee, Madison, Merri wether, Monroe, Morgan, Musco-
gee, Oglethorpe, Pike, Richmond, Stewart, Sumter, Troup, Twiggs, Upson
and Washington.

" On motion of Dr. J. M. Green, the Chairman appointed a Committee
consisting of one from each county represented, to nominate officers for
the permanent organization of the Convention.

The Committee retired, and upon returning, reported through its
Chairman the following, viz :

Lewis D. Ford, M. IX, of Augusta, President; R. D. Arnold, M. D., of
Savannah, 1st Vice-President ; T. R. Lamar, M. D., of Macon, 2nd Vice-
President ; James M. Green, M. D. and C. T. Quintard, M. D., of Macon,
Secretaries.

Dr. Arnold moved the appointment of a Committee to draft a Consti-
tution and By-Laws for the permanent organization of a State Medical
Society, which being carried, the President of the Convention according-
ly designated the following:

Dr. R. D. Arnold, of Chatham ; Dr. J. M.Green, of Bibb; Dr. Thomas
Hoxey, of Muscogee; Dr. Charles West, of Houston ; Dr. H. J. Ogleby,
of Morgan ; Dr. R. Q. Dickenson, of Baker, and Dr. Gorden, of Gwinnett.

At the second session of the Convention, the Committee appointed to
draft a Constitution and By-Laws announced, through their Chairman,
that they were prepared to report. The Report of the Committee was
received, the Articles discussed and acted on separately, and finally
unanimously adopted.

Dr. Charles Thompson, of Macon, tben presented the following:

Resolved, That the Convention do now resolve itself into " The Medi-
cal Society of the State of Georgia" and that the officers of the Con-
vention continue to act as officers of the Society until an election can
be had.

This being adopted, the members prepared ballots upon counting of
which, it appeared that the following gentlemen were elected :

Lewis D. Ford, M. D., of Augusta, President ; R. D. Arnold, M. D., of
Savannah, 1st Vice-President; Thomas R. Lamar, M. D., of Macon, 2nd
Vice-President ; James M. Green, M. D., of Macon, Corresponding Secre-
tary ; Charles T. Quintard, M. D., of Macon, Recording Secretary ; S. W.
Burney, M. D., of Monroe county, Treasurer.

Having- thus presented a brief abstract of the e-arTy history of the
Medical Society of the State of Georgia, as we have been able to con-
dense it from the minutes of the preliminary Convention of 1849, we
herewith furnish our readers, and the members of the Society, with tlie

1859.] Editorial. 277

Constitution and By-Laws which have governed its deliberations in its
various meetings, from the year 1849, to the present time.

Constitution of the Medical Society of the State of Georgia, adopted
March 20th, 1849.

Article I. Title of the Society.
The name and style of the Society shall be " The Medical Society of
the State of Georgia"

Article II. Objects of the Society.
The objects of this Society shall be the advancement of Medical know-
ledge the elevation of professional character the protection of the
interests of its members the extension of the bounds of Medical Science,
and the promotion of all measures adapted to relieve suffering humanity
and to protect the lives and improve the health of the community.

Article III. Members of the Society. -
Sec 1. The Society shall consist of every person now present as a
member of the State Medical Convention, who is a graduate of a respect-
able Medical College, or who may be authorized to practise by the legis-
lative act of 1839, re-constituting the Medical Board of the State, and
who shall conform to the regulations of the Society.

Sec. 2. Any Member of the Profession, thus qualified, can hereafter,
on written application to the Society, through the Corresponding Secre-
tary, be admitted to it by a vote of two-thirds of the members present.

Article IV. Of the Officers.

Sec 1. The Officers of the Society shall be a President, two Vice-
Presidents, a Corresponding and a Recording Secretary, and a Treasurer.

Sec 2. Each officer shall be elected annually, by ballot, on a general
ticket, and shall serve for one year, or until another be elected to suc-
ceed him.

Article V. Duties of Officers.

Sec 1. The President shall preside at the meetings, preserve order,
and perform such other duties as custom and parliamentary usage may
require. He shall not be eligible two terms in succession.

Sec 2. The Vice-Presidents, when called upon, shall assist the Pres-
ident in the performance of his duties, and during the absence of, or at
the request of the President, one of them shall officiate in his place.

Sec 3. The Corresponding Secretary shall conduct the correspond-
ence and perform such other duties as usually appertain to that office.

Sec 4. The Recording Secretary shall keep correct minutes of the
proceedings, and when approved, shall fairly transcribe the same in a
book to be kept for that purpose. He shall have charge of all papers
belonging to the Society, other than those appertaining to the Treasurer
and Corresponding Secretary, and give due notice of the annual meetings.

Sec 5. The Treasurer shall receive all monies belonging to the Soci-
ety, and disburse them as directed, preserving vouchers for the same.
He shall annually present a statement of the finances of the Society,
which shall be referred to a committee to be audited.

278 Editorial [April,

Article VI. Of Auxiliary Societies.

Sec. 1. The members of the Profession in any county, or in any two
or more adjacent counties, where there is not a sufficient number in one
county, in this State, who desire so to do, may form themselves into an
Auxiliary Society : Provided, that public notice of the proposed meet-
ing be given, and that all the regular members of the profession in said
county or counties be invited to join therein ; and said Society may
adopt rules for their government, provided the same do not contravene
those of the State Society may elect officers, and do all such acts as
may be necessary to carry out the objects of their association.

Sec. 2. No one shall be admitted a member of an Auxiliary Society,
unless he is either a graduate in Medicine, of some respectable Medical
School, or has a license to practise from the Medical Board of Georgia,
or is recognised as a practitioner by the act reviving that body, passed
in 183&; and who, moreover, is in good moral and professional stand-
ing in the place where he resides, and is a regular practitioner.

Sec 3. Any physician who shall procure a patent for a remedy, or
instrument of surgery, or who uses in his practice any secret remedy or
nostrum, or who shall hereafter give a certificate in favor of such instru-
ment or remedy, shall be disqualified from becoming a member of an
Auxiliary Society, and consequently of the State Society.

Sec 4. As soon as an Auxiliary Society is organized, the Seeretary
thereof shall transmit to the Corresponding Secretary of the State Soci-
ety, a copy of their rules and regulations, with the names of the officers
and members.

Sec 5. Every Auxiliary Society shall enforce the observance, by its
members, of the Code of Ethics adopted by the State Society ; and they
shall be authorised to censure or expel any member convicted of violat-
ing its provisions.

Sec 6. The Auxiliary Societies shall report annually to the State
Society a list of their members and officers, any new rules they may
adopt, and such other matters as they may deem interesting.

Sec 7. The Auxiliary Societies shall hold, at least, two meetings in
every year.

Article VIL Meetings of the Society.

Sec 1. The Society shall hold an Annual Meeting on the second
Wednesday in the month of April of each year.

Sec 2. The place of meeting shall be determined, for each succeed-
ing year, by a vote of the Society.

Article VIII. Of the Funds.

Means for defraying the expenses of the annual meetings, and current
expenses of the Society, may be raised by an annual assessment on its
members) of not more than two dollars each..

Article IX. Code of Ethics.

This Society adopts, as a part of its regulations, the Code of Ethics of
the American Medicai Association.

Article X. Alterations,

No alteration or amendment of this Constitution shall be made, un-
less it receives the vote of two-thirds of the members present.

1859.] Editorial. 279

By-Laws. Order of Business.
1st. The President, or, in his absence, one of the Vice-Presidents,
shall call to order ; in case of the absence of all these officers, a Chair-
man pro tern, shall be appointed for that purpose.
2nd. Galling the roll of members.
3rd. Reading of the minutes.

4th. Election of Officers, and Delegates to the American Medical As-
sociation.

5 th. Any business which requires early consideration may be intro-
duced.

6th. Reports from Auxiliary Societies.

7th. The correspondence shall be read by the Corresponding Secre-
tary.

8th. Written communications may be discussed.
9th. Oral communications may be made and discussed.
10th. Resolutions introducing new business.
11th. Selection of a place for the nex^ meeting.
12th. Miscellaneous business.

There can be little doubt, that much of the misunderstanding and
difficulties between Physicians arise from the fact that the established
ethics of our profession, on many points, are not generally known. They
cannot be too often repeated. They are founded in principles of pro-
priety and right. They are the true test and standard by which to
direct our own conduct, and to judge the conduct of our fellows; and
the man who does not come up fully, squarely aud openly, to the re-
quirements of that code, in his dealings, both with patients and physi-
cians, it is neither harsh nor uncharitable to pronounce his conduct as
unprofessional. How important, then, is it that these principles be kept
ever before the Profession.

In future successive numbers of this Journal, we will take pleasure in
presenting to our readers, and to the members of the Society, the Code of
Ethics of the American Medical Association, which has been adopted by
the Medical Society of the State of Georgia, as their rule of conduct in
matters pertaining both to professional intercourse among themselves,
and to their relation to the community at large.

Respectfully, Henry F. Campbell.

Robert Campbell.

Transactions of the American Medical Association, vol. xi., 1858. Prof.
F. Gurney Smith, Chairman Committee on Publication. Philadel-
phia: Collins, printer. 1858.

The present volume of this important work the embodiment of the
labors of the Association during the past year fully equals in size and
in value, any previous volume of the Transactions. Between its covers,
the Association presents to the Medical profession of the world, ten hun.

280 Editorial [April,

dred and twenty-seven pages, embracing a series of reports which dis-
cuss, with more or less ability, a number and a variety of some of the
most important and interesting subjects, which can engage the attention
of scientific men in all countries.

Besides the minutes of the eleventh meeting, the reports of various
business committees, the plan of organization, code of ethics, and list of
officers and permanent members, the volume contains a number of pa-
pers, which give to it a scientific interest, unsurpassed by that of any
previous volume, and some of which are well calculated to advance the
position of American Medicine wherever they may be read.

1st. The annual address of the President, Prof. Paul F. Eve, which
has already been presented to our readers, is a paper of great interest,
and highly creditable to its distinguished author. In this address, the
entire work of the Association has been reviewed, and its usefulness, in
the advancement of American Medicine, ably vindicated. This is just
such a paper as should appear at the end of the first decade of the Asso-
ciation, to record the results which its labors had accomplished, pp. 10.
2nd. Report on the Medical Topography and Epidemic Diseases of
Kentucky, by W. L. Sutton, M.D., of Georgetown, Ky. embracing 88
pages.

3rd. Report on the Topography and Epidemic Diseases of New
Jersey, and the Treatment thereof, by Leyden A. Smith, M.D., contain-
ed in 10 pages.

4th. Report of the Committee on the Epidemic Diseases of Ohio, by
George Mendenhall, M.D.

Each of these reports is marked by much ability, and will be found
useful as statistical records for future reference.

5th. Report of the Committee on Medical Literature, by A. B. Palm-
er, M.D.

In this paper, Dr. Palmer gives a comprehensive, though compend-
ious review of most of the American publications and American reprints
of foreign works. His criticisms appears to be just and judicious, and
the entire report is characterized by great elegance of diction and fervor
of sentiment ; it is a useful, though by no means, a complete bibliograph
of American medical literature for the few past years, and does credit to
the reporter. It occupies a space of about 60 pages in the volume.

6th. Report of the Special Committee on Medical Education, by James
R. Wood, M.D., of New York 11 pages.

" Among the leading objects," says the reporter " of the American
Medical Association, since its organization, has been the elevation of the
standard of Medical education. Every member of this body, fully im-
pressed with the greatness and dignity of his calling, has deplored the

1859.] Editorial 281

inferior qualifications of vast numbers of those who annually enter the
ranks of the profession, and has naturally sought to remedy the evil."

Thus, deeplv impressed with the importance of his subject, Dr. Wood
considers fairly and impartially, we think, the various elements which
enter into the process of Medical education in this country, and discusses
modestly, and with great moderation, the objectionable features in our
system, under the five following heads : 1st, Primary Medical Schools;
2ndly, The number of Professorships in Medical Colleges; 3rdly, The
length and number of terms during the year ; 4th3y, The requisite qual-
ifications for graduation ; and, othly, Such other subjects as are to give
uniformity to our Medical systems.

In conclusion. Dr. Wood very properly refers the responsibility of all
proposed changes in our system of Medical education, to the entire corps
of Medical Colleges from every part of our country, by calling a con-
vention of delegates from the various Medical Schools, in which every
interest may be fully and fairly represented.

" In order to give our Medical Colleges/' thus concludes the report,
" an opportunity to consider the recommendations here advanced, and
that this body may have the advantage of their wisdom and their ma-
ture views, before any definite action is taken upon them, your commit-
tee submits 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 Medi-
cal education.

" Resolved, That the present Report of the Special Committee on Me-
dical Education be referred to such Convention for its consideration.

" Resolved, That said Convention of Delegates, from the several Col-
leges of the United States, be requested to submit to the meeting of this
Association, in May, 1859, the result of their deliberations."

By reference to the minutes of the last meeting of the Association, we
find that the blanks, left in Dr. Wood's first resolution, were filled by the
appointment of a definite day and place of meeting.

Dr. Frank H. Hamilton, of New York, from the Committee on Dele-
gates from Medical Colleges, reported the following :

"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 Louisville, on
Monday, the day irnmediattly preceding the convention of the American
Medical Association for the year 1859, at ten o"clcck in the morning, at
such place as the Committee of Arrangements shall designate."1

The above is a very important meeting. There should be a full re-
presentation of the Schools, in order that the determinations of the Con-

282 Editorial. [April,

vention may be the result of the mature deliberation of those most inter-
ested in the subject of Medical education. Inconvenient and unsatisfac-
tory recommendations might, otherwise, be presented, with which many
Colleges would find it impossible to comply. We hope each School
will have its delegate present, to assist in deliberations so nearly affect-
ing the interests of the entire sisterhood.

Tth. Report on Spontaneous Umbilical Haemorrhage of the Newly-
born, by J. Foster Jenkins, M.D., of Yonkers, N. Y., pp. 47.

This is a most valuable report on a disease of acknowledged obscurity,
both as to its causes and best method of treatment. Dr. Jenkins' paper
is by far the best and most thorough examination of the subject we have
ever met. It would make a very useful monograph for practitioners.

8th. Report on the Influence of Marriages of Consanguinity upon Off-
spring, by S. M. Bemiss, M.D., of Louisville, Ky.

Dr. Bemiss enters at once into the very midst of his subject, by bring-
ing it, in all its important bearings before the reader, in his very first
paragraph. " Is the offspring of marriages of consanguinity equal phy-
sically and mentally to the offspring of parents not connected by ties of
blood both classes being supposed to be similarly circumstanced in
respect to all other causes affecting the integrity of their issue ?"

This report occupies over one hundred pages of the present volume,
not over fifteen of which are devoted to the discussion of the subject ;
all the rest, statistics, collected from the various States of the Union.
The author seems more inclined to let the "facts," as presented in his
valuable tables, " speak for him," than to enter into a protracted disqui-
sition. Such statistics will hereafter be found very valuable in the fur-
ther examination of this very important, though delicate subject. Dr.
Bemiss deserves the thanks of the profession for this very able report,
and the faithfulness shown by him, in collecting, arranging, and proper-
ly presenting the facts, is worthy of our highest commendation. His
tabulations are made from over eight hundred and seventy observations
of marriages of consanguinity, in various degrees of relationship.

9th. Report on the Functions of the Cerebellum, by E. Andrews, M.D.,
of Chicago, 111.

In this report, the cerebellum is examined transcendentally with a
view to arrive at its function through its anatomy. We may infer, that
the author at some future time will consider the results of experiment,
and of the effects of disease as illustrating the functions of this often dis-
cussed, and as yet, still mysterious portion of the encephalon. The text
is illustrated by wood-cuts, presenting in a gradually descending scale,
the encephalons of the vertebrate division from that of man to that of the
turtle. 16 pages.

1859.] Editorial 283

In addition to the Reports which we have thus hastily referred to,
there are the following which shall receive attention in our next
number : 1. Report on the Treatment best adapted to each Variety of
Cataract, by Mark Stephenson, M.D., of New York pp. 22. 2. Report
on the Medical Jurisprudence of Insanity, by C. B. Coventry, M.D., of
Utica, X. Y. pp. 50. 3. Report on the Law of Registration of Births,
Marriages and Deaths, by Edward Jarvis, M.D., of Dorchester, Mass.
pp. 20. 4. Report on the Nervous System in Febrile Diseases and the
Classification of Fevers by the Nervous System, by Heniy F. Campbell,
A.M., M.D., of Augusta, Ga. pp. 170 5. Report on Moral Insanity in
its Relations to Medical Jurisprudence, by D. Meredith Reese, M.D.,
LL.D., of New York 26 pages. 6. Report on Stomatis Matema, by
D. L. McGugin, A.M., M.D., of Keokuk, Iowa pp. 30. 1. Report on
the True Position and Value of Operative Surgery as a Therapeutic
Agent, by J. B. Flint, M.D., of Louisville, Ky pp. 18. 8. A Method for
Preserving Membranous Pathological Specimens, by R. D. Arnold, M.D.
of Savannah, Ga. 9. Letter from E. D. Fenner, M.D., to President of
Association. 10 and 11, the two Prize Essays:

First, The Clinical Study of the Heart Sounds in Health and Disease,
by Austin Flint, M.D., of Buffalo, N. Y. pp. 52. Second, Vision, and
some of its Anomalies, as revealed by the Ophthalmoscope, by Montrose
A. Pallen, M.D., of St. Louis, Mo. pp. 65.

We regret that time and space are not sufficient for us to notice the
above in our present number.

The present volume of the Transactions fully equals in style and typo-
graphical execution that of any of its predecessors; great praise is due
to the indefatigable Committee of Publication, for the correctness and
promptness with which they have produced and distributed so large a
work in so short a time. Their work was much retarded, waiting for
proof-sheets sent to distant reporters. "When such has been the cause
of delay, it is certainly surprising that it had not been more protracted.

Books and Pamphlets. On account of the large space already
occupied by our Original and Editorial Departments in the present
number, we have been obliged to defer the notices of several books,
pamphlets and new journals, until our next issue.

Scraps of Practice.
Headache and its Remedies. How much, within a few years, has medi-
cal opinion changed in regard to the causes of headache, and pari passu, in
relation to the remedies suitable for its relief. Time was, when the term
" headache" conveyed more or less indefinitely the idea of some affection

284 Editorial [April,

of the brain, or its membranes, of an inflammatory or congestive char-
acter, and neither opiates, nor quinine, nor stimulants were, for a moment,
considered admissible. Even at the present day, there are many in some
regions of our country, who regard both quinine and opium as contra-
indicated in these cases. Such is not our experience. Headache is
promptly relieved, in most individuals, by small doses of the sulphate of
morphine say, one quarter of a grain. There are others an unfortu-
nate class whose idiosyncrasies forbid the use of any opiate whatever;
these, of course, must forego this remedy. Quinine, in a single dose of
5 to 10 grains, will often be found to ward off an attack of headache, if
taken at its beginning, and sometimes, to dispel it entirely, even when
fully established. We have never known quinine to increase headache,
or when given in very large doses, ever to produce it though this is
the current impression, long observation has convinced us that it is a
mistaken one. We know several martyrs to this disagreeable affection,
who habitually take a few grains of quinine every morning with their
breakfast coffee, and continue the practice for months at a time, with
the best results. The effect of quinine, we admit, is to modify the sen-
sations about the head; but seldom or never does this modification
assume the form of pain. In the vast majority of cases the quinine will
relieve it. When the headache is intermittent, the effect of course is
even more marked. Quinine is, in our opinion, always a safe remedy in
headache ; if we even apprehended inflammation of the brain or its mem-
branes, we would give quinine the more freely as a most reliable means
for its prevention.

Sick Headache is a term which, unfortunately, too many under-
stand, from an experimental knowledge. In this form, there seems to be
an intimate relation between the nerves of the stomach (pneumogastric)
and those of the head (trifacial, etc.). The cause may begin, it appears
to us, either at the head as from exposure to cold, or it, as most frequent-
ly, may begin in the stomach, as from improper diet or the spontaneous
vitiation of the secretions, generally giving rise to a superabundance of
acid there : at whichever point the cause may operate, the effect is the
same ; both the head and the stomach become affected, the one with
pain in the frontal occipital and temporal nerves, the other, with nausea
of the most distressing kind truly, " the whole head is sick, the whole
heart faint." Where the cause is operating from the nerves of the head
as from exposure to cold, we have found moderate, though decided doses
of some opiate with perhaps a foot-bath, to be the best remedy. When,
however, the cause begins to operate in the stomach, impressing the
sentient nerves of the head with the painful reflex sensation through the
pneumogastric, we find it best, first, to correct that condition of the se-

1859.] Editorial 285

cretions, whatever it may be. Now, to do this, something more appear*
to be necessary than simply to correct acidity. Some stimulant is re-
quired ; we have recommended small doses of brandy with bicarbonate
of soda ; champaigne will sometimes relieve both the headache and the
nausea : coffee very often does. The following, however, is one of the
most reliable remedies for headache, arising from this condition of the
stomach, which we have ever used ; we commend it to all who are trou-
bled, whether as medical attendants or sufferers, with this most distress-
ing of all the forms of headache :

ft. Of Bicarbonate of Soda 3ij.

" Chloric .Ether, $$s.

" Camphor Water giiiss.

Mix. Dose, one tablespoonful, every two or three hours, with a little
water.

The above are some of the principal remedies for headache, though
the means for its relief in particular cases must, of course, vary with the
special cause and condition of the system from which it arises. h. y. c.

Diuretics. New medicines are not, by any means, always the most
reliable. This remark applies very particularly to Diuretics. Every day
we find new diuretics suggested, and their efficacy lauded in the journals :
we are naturally induced to try them, and often to the neglect even,
sometimes to the entire forgetfulness of the older, better established and
more reliable ones, which we only have recourse to, when the fashiona-
ble article has disappointed our expectations. In several recent cases of
anasarca, this was our own mortifying experience. After trying some of
the latest and most lauded diuretics, both simple and compound, we met
the remark, in Todd's Lectures on the Urinary Organs, that Bitartrate
of Potash (Cream of Tartar) is, after all, the most reliable diuretic. All
our old experience with the remedy, in former times, arose up before us,
and we tried it with more satisfactory success than any of the others.
The mode of administration is one teaspoonful three times a-day, either
as a powder in molasses, or in the form of a sweetened acidulated drink.
About once a week, in obstinate cases, we add 20 grs. of pulverized Jalap
to the morning dose, to produce gentle purgation from the bowels.

Moral. Try that which is new, if it promises well, but by no means,
neglect that which \ms proved itself good, though it may be ever so old.

h. f. c.

Tartrate of Iron and Potash in Phagedenic Ulcer. M. Ricord, of
Paris, recommends this salt very highly in certain forms of syphilis.
We have used it frequently with truly surprising results. We now re-

286 Editorial and Miscellaneous. [April;

call to mind a case in which a very large ulcer threatened to destroy
the glans penis : the young man was brought very low by exhausting
hemorrhages, and the ulcer was rapidly progressing ; in consultation with
his attending physician, we advised from 5 to 10 grains tartrate of iron
and potash, three times a day, with a strong solution of the same kept
constantly applied to the affected part, on lint. The bleeding was soon
arrested, and the deep ulcer filled up with wonderful rapidity. We
have used the remedy many times since, and we are always pleased with
its effects in similar cases. h. f. c.

On the Inhalation of Cinchonia and its Salts. Read before the Biologi-
cal Department of the Academy of Natural Sciences, December, 1858,
By S. W. Mitchell, M. D., of Philadelphia.

Howtever it may be regarded in other regions, to the Southern Practi-
tioner, the following proposition for the administration of the preparations
of the great anti-periodic, by inhalation, will appear as a very happy
one, and its successful accomplishment, as a most important desideratum.
How often are we called to patients in the initial stage of a " congestive
chill," when the introduction of Quinine into his system, by any means
whatever, appears to be his only chance of life, and yet, to our horror,
neither the stomach nor the rectum, will tolerate it ; and if they did, the
action from these surfaces is too slow to be available. As the author
truly remarks, " the passage to the blood, through the lungs, seems to
be always an open track ;" can we dare to hope, that the proposition
here contained may some day, be so far perfected in its applicatiou as
that the effect of Quinine may be as instantly produced upon the system,
by inhalation, as we find Chloroform, and the various ^Ethers affecting
the system. When that day arrives, we can truly say that no case of
malarial fever, however complicated with nausea and diarrhoea, will
resist the curative efforts of our art. We wish Dr. Mitchell every suc-
cess in these very important investigations. [Edts. S. M. & S. Jour.

There can be very little doubt that at some future time we shall possess
the means of giving to patients many potent remedies in the form of
inhalation, rather than in the usual way. This is at least among the
hopes of the therapeutist of the present day. Absorption of medicinal
substances by the intestinal mucous surface is but too often uncertain,
while the passage to the blood, through the lungs, seems to be always
an open track, when the agent inhaled is in a state of vapor. How
desirable it would be to possess the means of inhaling quinine in the
congestive fevers of our malarious districts, we can very well conceive.
Guided by these ideas, I have sought industriously for some means of
attaining this result, and although I have failed, as I shall here show, in
evolving any very marked practical benefit from these researches, I have

1859.] Miscellaneous. 287

met with certain foots of such interest that I desire to put them on re-
cord as indicating a novel direction tor medical thought and action.

At one time, the analogy in chemical composition, between certain of
the newly formed ethers and quinia itself, seemed to point out the*
fit subjects for therapeutic use and trial. The difficulty of procuring
them, obliged me, however, to relinquish effort in this direction, and I
turned from them to examine anew the alkaloids derived from cinchona
bark. While thus engaged, one of my friends, now Dr. Bill, of the army,
pointed out to me in Fresenius's Chemistry, his account of cinchonia,
which he describes as volatile at high temperatures.

Struck with this, I searched carefully for any account of its inhalation,
but as yet have been unable to find in the books on Cinchona any de-
scription of inhalation, as a mode of using the alkaloid in question. The
last complete work on quinia, by M. Briquet, enumerates many methods
of employing the alkaloids and bark, but neither among the means in
use, or out of use, is this one alluded to. Occasionally, in disease of the
lungs or throat, inhalation of pulverized cinchona bark has been resorted
to, and M. Briquet relates, "Traite Therapeutique du Quinquina et de
ses prepatationes," p. 118, that those who work in the storehouses of
cinchona bark are sometimes thus cured of malarious fevers. This could
only occur through accidental ingestion, and inhalation of the floating
particles of bark.

Cinchonia and its salts are the only alkaloids which appear to be vol-
atile by heat. After many experiments, I have finally resorted to the
following very simple method of inhaling them : About forty grains of
pure cinchonia, being mixed up with sand, and placed in a capsule, and
heated by a spirit-lamp. The sand is useful in diffusing the heat, and
preventing too rapid a destruction of the alkaloid. A heat of about 300
degrees melts the particles of cinchonia into a brown fluid, and from this,
if the evaporation be carefully managed, the volatilized alkaloid escapes
in the form of a gray vapor.

When a microscope glass is held over the capsule, and the heat is too
elevated, the cinchonia decomposes, and a dark red gummy-matter, with
the odor of burned benzoin, adheres to the glass. A rather lower tem-
perature drives oft* the cinchonia in a gray vapor, which may be made
to re-deposit the pure alkaloid upon the interior of a funnel held over it,
or upon a microscope slide. The alkaloid thus obtained is in branching
needles.

On a number of occasions, I inhaled the vapors of cinchonia, often
breathing them for ten or twenty minutes, without much inconvenience,
when care was taken to regulate the supply of heat. The brown or red-
dish volatile substance which is given off when the heat used is too
great, so irritates the throat as to cause nausea, and oblige the patient
to cease inhaling.

When carefully inhaled, a part of the alkaloid is deposited on the
throat and in the mouth, where its sub-bitter taste is-soon perceived. To
guard against error, which might arise from swallowing these portions
of the alkaloid, I refrained from swallowing whilst inhaling, and fre-
quently rinsed the throat with water.

Upon four occasions, I noted the symptoms caused by the cinchonia

288 Miscellaneous. [April,

thus employed, taking care to allow the excitement of the system pro-
duced by the inhalation to pass away before I counted the pulse. In
three instances the pulse fell, losing from six to ten beats per minute.
In the fourth, the pulse remained a few beats above the normal number.
The person on whom these experiments were made is liable to still
greater depression of cardiac energy, when under the influence of quinia.
At first, it was difficult to separate the ordinary signs of cinch onisra
from the feelings of cerebral confusion, caused by breathing too rapidly.
These sensations, however, were evanescent. At the end of a quarter of
an hour, or even less, the head was clear, and within half an hour after-
wards the patient felt a quickly increasing headache, with giddiness, and
sometimes a feeling as though the brain was swelling into monstrous
bulk. These sensations passed away within four or five hours, unless
the inhalation was renewed.

Still uncertain as to whether or not the alkaloid entered the blood, I
caused a healthy adult, set. twenty-nine years, to inhale the fumes from
forty grains of the heated cinchonia four times in one clay. Symptoms
of cinchonism were felt only after the first inhalation, which was made
at ten A.M.; at twelve M., the second inhalation took place, and at the
same time four ounces of clear urine, sp.gr. 1023, were passed. The
other inhalations occurred in the afternoon and evening, but none other
of the urine passed was saved, until 7 A.M. next day.

The first specimen was examined by Bouchardat's test, the iodated
iodide of potassium. This reagent gave a faint but decisive brown pre-
cipitate of iodide of cinchonia, when employed in the usual way ; when,
however, I placed in a test tube a portion of the test solution, and slowly
poured upon it the lighter wine, a profuse deposit of the iodide announc-
ed the presence of cinchonia in the urine. In the usual mode of making
this test although the precipitate is perceptible enough it almost im-
mediately redissolves in the urine, which appears to possess a remarka-
ble power of dissolving the iodides of cinchonia and quinia, since when
these precipitates are thrown down from an aqueous solution of a salt of
either alkaloid, they are found to be very insoluble. The second speci-
men of urine contained only traces of cinchonia, and twenty-four hours
after the last inhalation no evidence of the presence of the alkaloid in
the urine could in any way be obtained.

It will be readily seen from what I have said, that I do not anticipate
any remarkably valuable practical results from the new mode of admin-
istering cinchonia in vapor. The want of the therapeutic power in this
alkaloid, when compared with quinia dose for dose the difficulty of
regulating the heat so as to volatilize, and yet not decompose it, as well
as the unpleasantness of the process of inhalation, combine to deprive
these experiments of any great practical utility. In a single case of ter-
tian intermittent fever, I employed the inhalation of cinchonia vapor.
The patient had no new attack for one month, although no other ulte-
rior measures were employed. The case was a very irregular and un-
certain one, and I therefore attach but little faith to this single thera-
peutic test. I should add that my patient complained a good deal of
the effect of the alkaloid upon his glottis and larynx. For a time it
altered the tones of his voice very considerably.

1859.] Miscellaneous. 289

In two cases of chronic bronchitis, of long standing, I also used the
fumes of cinch onia ; one of these dated his first improvement from the
use of these inhalations, in which he persisted every other day, for more
than two weeks; no other treatment was used until he had been much
aided by the means above described. He learned after a time to employ
the cinchonia without my aid. The other patient submitted to one in-
halation, but declined any further proceedings of a similar character,
declariug that the remedy was worse than the disease, only shorter.
When we are successful in volatilizing the alkaloid without decomposi-
tion, the process of inhalation is not very disagreeable ; but when the
heat is too high, and the cinchonia becomes altered, it is extremely diffi-
cult to continue to breathe it.

The salts of cinchonia are also volatile by heat, but they offer no
advantages which do not equally belong to pure cinchonia. The sul-
phate is quite inadmissible for inhalation use, since sulphuretted gases
are given off in small amounts when the heat is too elevated, and decom-
position takes place.

The Treatment of Asthma. We are sure that every physician will be
deeply interested in whatever tends to advance our knowledge of that
troublesome affection, asthma, and especially in respect to the remedial
measures most likely to secure relief to those who are afflicted with it.

" In connection with this subject," says the Boston Medical and Surgi-
cal Journal, " we take occasion to call attention to the instructive lectures
of Trousseau, now being translated for the journal by Dr. Abbot, of this
city.

We lately had the opportunity afforded us of reading a short treatise,
translated from the Italian, upon the use of compressed air in the treat-
ment of asthma. This agent has, we believe, been tried in New York
city possibly elsewhere in the United States but we are not aware
with what measure of success. To carry out the treatment, requires an
apartment of cast iron, with the apparatus suitable to compress several
volumes of atmospheric air into the room prepared for it. The theory
seems excellent we should be glad to know how extensively, and with
what results this plan of air-treatment has been tried in this country.
Any facts will be of advantage. We may add that the friend who lent
us the little volume referred to, has a strong personal interest in know-
ins: how much reliance can be placed upon this, or upon any treatment.
Will those who happen to have heard of, or to have seen any experi-
ments of this nature, with compressed airT favor us with an account of
them ?"

Ozonometer. Dr. Lankester exhibited to the Chemical Section of the
British Association for the Advancement of Science, at its late meeting
in Leeds, an instrument for measuring the constant intensity of ozone.
This instrument consisted of two small rollers included in a box, which
were moved by means of ordinary clock-work. Over the roller a strip
of paper, prepared with iodide of potassium and starch is allowed to re-
volve, the paper becoming exposed to the air for an inch of its surface

290 Miscellaneous.

in the lid of the box. Twenty-four inches of paper pass over the rollers
in the course of twenty-four hours, and thus registers, by its colour, the
intensity of the action of ozone in the atmosphere. By this instrument,
the intensity of the ozone for every hour in the twenty-four could be
registered, and minima and maxima, with an average, ascertained. Dr.
Lankester pointed out the importance of ascertaining the presence of
ozone, on account of its undoubted relation to health. He drew atten-
tion to a series of tables which had been drawn up from the registrations
of the anemometer made at London, Blackheath, and Felixstow, on the
coast of Suffolk. From these it was seen that the relation of these three
places was 0, 22, and 55. The instrument acted also as a clock, and
the time could be accurately marked upon the ozonized paper.

Mr. Marshall made some remarks on his own observations during the
last twelve months, and stated that he had not been able lo discover,
though as.isted in the investigation by medical gentlemen, that there
was any obvious connection between ozone and the state of health.

[British Medical Journal.

Sir Benjamin Brodie. An unfounded report in one of the foreign
periodicals soon gained currency that this distinguished member of our
profession had been made a member of the House of Peers. This report
has, however, served the purpose of awakening the medical men of Lon-
don to the conviction that they are entitled to a representative in the
Upper House, and they will, no doubt, take action upon the subject, and
refer it to Lord Derby, who will give the question an impartial hearing.
Without this advancement, Sir Benjamin Brodie now has a higher posi-
tion than has ever before been held by a British surgeon, having been
recently elected President of the Royal Society, and President of the
Medical Council. We hope that he may attain this higher honor, to
Avhich his high scientific and literary attainments most certainly entitle
him. [North-A?ncrican Med. Chir. Review.

Prizes at the Academie de Medicine, for 1 858. The Academy prize of
one thousand francs, on the application of the microscope ; the Capuron
prize, on the death of the infant during parturition ; the Civrieux prize,
on the difference between neuralgia and neuritis; and the Barbier prize,
for the cure of diseases generally thought incurable, have not been ad-
judged, on accouut of deficiency of memoirs, or insufficiency of merit.

M. Bauchet obtained the Portal prize, on the pathology, treatment, and
diagnosis of ovarian cysts. The Itard prize, for the best work of two
years standing, on practical medicine or applied therapeutics, has-been
adjudged to M. Duchenne. The Argenteuil prize of twelve thousand
francs, on the greatest improvement in the treatment of stricture of the
urethra or other diseases of the urinary organs, was not awarded to any
one author, but was divided in sums varying from four thousand to one
thousand francs among six competitors. [lb.

New Appointments at the Faculty of Medicine of Paris. The Chair
of Anatomy, rendered vacant by the retirement of M. Denonvilliers, has
been filled by the appointment of M. Jarjavay. M. Gosselin succeeds M.
Cloquet as Professor of Surgical Pathology. [lb.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. X?.] AUGUSTA, GEORGIA, MAY, 1859. [No. 5.

ORIGINAL AND ECLECTIC.

ARTICLE XII.

An Essay on the Adaptation of Climate to the Consumptive, for a
permanent residence; embracing an Examination of the climate
of certain localities of frequent resort; and also, an Investigation
of the degree of adapted ness of the Pacific Climates of the United
States. Presented to the Medical Society of the State of Geor-
gia, at its annual meeting, held at Atlanta, April 13th, 1859.
By William Henry Doughty, M. D., of Augusta, Ga.
(Ordered to be printed.)

" As ' the possible is immense,' so the human mind, if the legitimate object of
all science, (which is to observe facts and to trace their relations and sequences)
is kept steadily in view, will be continually verging towards Trutfc in the inves-
tigation of physical causes." Forrt.

GENERAL CONSIDERATIONS.

Those diseases, which, in a pathological point of view, seem
to be the developing manifestations of an inherent constitution-
al diathesis (hereditary or acquired) have, as they eminently
merit, received considerable attention at the hands of our noble
profession. If it is necessary to adduce the proof of this, we
have but to refer the sceptic to the history of pulmonary con-
sumption. From the earliest and oldest records, we observe
the great mind of the profession, as it is to-day, drawn out in
the endeavor to comprehend its mysterious phenomena, to cor-
rectly appreciate its etiological relationship to things external
and internal ; and to diminish its uniform tendency to death.

N. S. VOL. XV. NO. V. 21

292 Doughty. An Essay, on the Adaptation of [May,

It is perhaps impossible to form an adequate conception of the
real merits of the subject, for the mind almost instinctively
recoils, at the magnitude of the effort, which is necessary to en-
able it to grasp at once all of its historical representation the
frequency of its occurrence,* its uniform fatality, the rapidity of
its progress, the obscurity of its causes, its universality, and its
defiance of medical skill. So universal is it, that scarcely any
region of the globe is totally exempt, whilst in those, where it is
oftenest met with, all ages and sexes fall ready victims to it.
The young and the gay ; the beautiful and the lovely ; the strong
and the brave, yea, the exalted of the earth, are the common
subjects of its savages, and are daily transferred from this ter-
estrial sphere to enter upon the realizations of the untried future.
What may be said of tuberculosis, which is properly defined, a
tendency to the deposition of tubercular matter, is perhaps true
of all the other diatheses, for when examined, they too have
afforded ample and enlarged data to the theorist upon which to
speculate, and have called forth the deepest powers of research,
the closest reasoning, and the strictest analyses of facts. It may
be further stated, that if the tubercular diathesis, as we are refer-
ring to this more particularly, has afforded these enlarged facili-
ties to the speculative pathologist and been subjected to the
most rigid scrutiny by the philosophic, in neither case, have the
results proved flattering, since it is, to day, a stumbling block to
the former, and has shown itself the profoundest subtlety to
the latter.

To unravel this mysterious agency, presupposes our ability to
determine its cause or causes, and this indeed would seem almost
superhuman, since it requires us to give not only the histology of
the predispositions of individuals the developing relation of
centric and excentric circumstances to those predispositions
but also imposes upon us the impracticable duty of accounting
for the morbific qualities or nature of organic cells: for foetuses
themselves are found to be invaded by this disease, and it is
probable, if the means existed for demonstration, that the eviden-
ces of this disposition are more or less manifest in the primitive
cells. The foundation is weak, consequently, the supcrstruc-

* It is calculated, that one-fourth the deaths which occur in Great Britain and
Ireland, are produced by consumption. We presume that the proportion is about
one-seventh in the United States.

1859.] Climate to tJie Consumptive, &c. 293

ture must be tottering and insecure, while the compensation is
mere fortuitousness.

Having premised this much, we bring our remarks a little
nearer the object of this essay, which is to investigate the adap'
tation of climate, for a permanent residence, to the vsants of the
tuberculous invalid. We are aware, that it is an old and hack-
neyed theme, indeed almost obsolete, but yet hope by the ar-
rangement which we have adopted, to elicit much to excite
interest, and to throw some light upon a field, confessedly dark
and difficult.

The treatment of consumption has been properly divided into
hygienic and therapeutic, more stress latterly, being laid upon the
former. Just here, it may be said, that if the prevention of the
ordinary accidental diseases of climates, requires so careful ad-
justment of all the healthful functions, which are sought to be
carried out by hygienic measures, how much more careful should
we be, to avoid, not only the ordinary exciting causes of disease,
which the elements around afford, and the neglect of certain
duties impose, but to regulate and dispose to healthful action,
those hidden but vital functions, which in the hands of this per-
verting agent, prove so powerful for destructive physical results.
Prominent among the hygienic and prophylactic measures
which have been adopted, stands the subject of climate. The
greater frequency of the disease in certain geographical locali-
ties over others, seems to have attracted the attention of the pro-
fession at an early date, and accordingly we find, that different
places at different times, have receivecT their sanction and com-
mendation. Indeed, the suitability of climate to the consump-
tive, a subject very naturally pre-eminent in the mind of the
sufferer himself, has received a very large share of professional
attention.

Numerous and various attempts have been made to ascertain
some place or other, where the declining consumptive might
breathe a restorative and invigorating atmosphere, but the num-
ber of failures, has only equalled those attempts, for it must be
apparent to every intelligent mind, that no chemical condition
of the atmosphere in particular places, is capable of producing
the desired results, because, " the constituents of the atmosphere
whether it be analyzed at the equator or at the poles, are the
same." A determining cause of these oft-repeated failures is

DOUGHTY. An Essay on the Adaptation of [May,

found in the fact, that professional men, with some exceptions,
in their endeavor to search out a suitable climate, have appar-
ently ignored every physical condition of the atmosphere, other
than that of its temperature. That this is so, will not be doubt-
ed, if we will closely scan the remarks of authors and writers
generally upon the subject. They express their ideas of the
requisition of proper climatic relations by the words, " equable
climate", and if we study the true intent and meaning of this
phrase, by their subsequent remarks, it will be almost invaria-
bly found, that an equable climate is one possessing uniformi-
ty of temperature.

Before progressing farther, we desire to make one remark, con-
cerning the respiratory apparatus and its relation to climatic
conditions. It is proper, that we should separate as distinctly
as possible, the strictly physical part of the respiratory act from
that of its vital functions. This is necessary, in order to enable
us to distinguish the action of certain agents upon the apparatus,
both physically and vitally, and the mutual reaction of their re-
sults upon each other. The respiratory mucous surface offers
no obstacle to the action of certain physical forces ; on the con-
trary, it presents many requisites for the successful and perfect
action of the process of evaporation, and that which regulates the
law of " the diffusion of gases."

The absorption of atmospheric air by the pulmonary tissue is
represented by physiologists, as being an act strictly physical in
its nature, since, t; all that is requisite for it, is the exposure of
the blood to the influence of the atmospheric air, or in aquatic
animals, of air dissolved in water, through the medium of a
membrane, that shall permit the diffusion of gases* an inter-
change, there taking place, between the gaseous matters on both
sides".* To illustrate : suppose a moving mass of fluid, car-
bonized blood, be maintained through a homogeneous membran-
ous tube, in contact with, or surrounded by atmospheric air,
would not absorption of oxygen, sufficient to decarbonize the
mass in some degree, take place? And would not the con-
tained carbon manifest a reciprocal tendency to escape into the
surrounding atmosphere ? The proper view to be taken of this
absorption of atmospheric air by the lungs, we believe to be, that,
whilst its absorption is under the control of physical forces, and
*See Carpenter's Physiology, page 559.

1859.] Climate to the Consumptive, d'c. 295

therefore physical in its own nature, yet, it is subsidiary to the
accomplishment of results essentially vital in their nature, e. g.,
the proper aeration of the blood, the maintenance of animal heat,
etc. In the language of a writer in a literary journal,* "it is
the physical fact upon which the vital force depends, but it is
not the vital function itself."

The fallacy of the idea of simple uniformity of temperature,
being all that is necessary for the climate of the consumptive,
has been abundantly proved by those who have availed them-
selves of this delusion for many have died in those regions to
which they have emigrated, whilst perhaps the majority, at long-
er or shorter intervals, have returned without material benefit,
if not injury. We do not desire to be understood, as asserting,
that no allusion to other conditions of the air, has been made
literally, for authors do mention as peculiarly pernicious, the
union of cold and moisture. Yet, when these Yerj men urge their
patients to retreat to warmer climates, little or nothing is said
about the presence or absence of moisture. It readily appears,
that not xmly the temperature of the atmosphere of a locality
must be considered, but its varying conditions of dryness and
humidity ; rarity and density ; its climatic seasons in all of their
features ; its prevailing winds whether warm or cold, moist or
dry the class of diseases, that coincides with their prevalence,
and finally, the degree of circulation of the atmosphere. These
various conditions require a close attention, and should in no
case, be disregarded, for no benefit can accrue to the invalid from
the temperature of a clime, if its humidity be such as to impede
the natural exhalation of aqueous vapor from the lungs and
skin; or if its dryness be such, as to preserve a preter-natural
dryness of the mucous tract and tegumentary surface, from in-
creased evaporation ; or if its density be such, as to excite two
great exertion in the act of respiration ; or if its rarity be such,
as to operate unfavorably by quickening it, and producing a
state of breathing somewhat akin to that of the asthmatic. For
these and other reasons, it is necessary for us in the selection of
a climate, to search out one where the degree of heat will act,
neither as an over-stimulant nor as a debilitant, but preserve the
vital activities at a moderate, normal standard ; where the natu-

* See Eclectic Magazine of Foreign Literature, Nov. 1858, page 347, copied
originally from Blackwood's Magazine.

296 Doughty. An Essay on the Adaptation of [May,

ral exhalation from the skin and lungs, may neither be -too
much increased nor diminished; and where the respiratory
organs themselves may not be enfeebled by too great exertion.
In short, a happy medium must be struck between these varied
barometrical, hygrometrical, and thermometrical conditions, or
at least^where a majority of these several conditions are favorable,
a due regard being also paid to the incidental conditions men-
tioned above. We regret to acknowledge the exceeding great
difficulty of finding such a climate, but although this desidera-
tum should never be realized, yet an enlightened theory must
suggest a proper relationship between these sensible conditions
of the atmosphere and the invalid, before a simple change of
climate can prove remedial in its effects.

Again : perhaps a cursory notice of the effects of these various
conditions upon the human system in health, is required of us,
before entering upon the farther prosecution of the subject. To
enter into a discussion about the effects of temperature alone
upon the system, would be altogether foreign to the present sub-
ject, since it is necessarily modified in its effects, by some other
associated condition, as humidity, dryness, rarity, density and
the degree of circulation of the atmosphere ; or two or more may
be combined with it. According to the associated condition or
conditions, will be the difference of effects manifested upon that
system. Heat of atmosphere with moisture will produce effects
radically different from heat and dryness. So also cold and
moisture will secure effects widely different from cold and dry-
ness. Moreover the degree of those effects, in either case, will
be more or less regulated by its barometric pressure and its state
of circulation.

Heat and moisture exercise an enervating, enfeebling, relaxing
influence upon the human system ; when excessive, and with
a stagnant condition of atmosphere, they produce a feeling of
oppression or suffocation, and create a predisposition in that
system to such diseases, as are manifested by symptoms of de-
bility. They also impede the natural transpiration from the
skin and lungs, by enfeebling the capillary system, and causing
the accumulation and deposition of the aqueous secretions upon
those surfaces. This latter phenomenon is especially seen, when
the air is quiet. The rate of exhalation of carbonic acid from
the system, is also increased with the degree of moisture of the

1S59.] Climate to die Consumptive, &c. 297

atmosphere. Lehmaun,* in certain experiments, with this ex-
press object in view, " found, that while 1000 grammes weight
of pigeons, yielded in dry air 6055 grammes carbonic acid per
hour, at the temperature of 75, and -i*69 grammes at 100 ;
the same animals, in moist air, yielded 6*769 grammes at 75,
and 7"76 grammes at 100, and while 1000 grammes weight of
rabbits exhaled, in dry air, 0450 grammes per hour at a tem-
perature of 100, they exhaled as much as 0'677 grammes in a
moist atmosphere at the same temperature."

Heat and dryness exercise an irritating influence, allied to
feverishness, upon the animal frame favor the exhaustion of
its nervous energies occasion the too rapid escape of its juices
by transpiration, thereby producing an unnatural dryness of the
various evaporating surfaces, and the diminution of the watery
element of the various secretions: the quietness of the atmos-
phere regulates to some extent the degree of these effects. Per-
sons subjected to such a condition of atmosphere feel the skin
excited and burning, in fact, as if it was congested in itsefforts
to supply with moisture the greedy atmosphere about it. This
peripheral determination of the blood, withdrawing the usual
quantity from the central organs, deranges their action from a
deficient nutrient stimulus, and produces a want of co-ordination
of the ordinary nervous actions. Accordingly, such suffer with
headache, derangement of the biliary and other secretions ; are
irritable, breathe irregularly, and are more or less tremulous.
The desert air is a striking and familiar example of this state.
Intolerant thirst points at once to the cause and to the means
of temporary relief. This condition is the one experienced along
the shores of the Mediterranean sea, during the prevalence of
the famous sirocco, the effect of which has been well described
by Dr. James Johnson.f " During," says he, " the continuance
of this wind, all nature appears to languish ; vegetation withers
and dies; the beasts of the field droop; while those who are
strongly susceptible to electrical changes in the air, such as pre-
cede and attend a thunder storm, will easily understand the
effects of the sirocco on the human frame, as an increased degree
of the sensation which they then experience. The animal
spirits seem too much exhausted to admit of the least bodily

* See Carpenter's Physiology, pa^e S>5 laat edition.
f See Johnson on Tropical Climates

298 Doughty. An Essay on the Adaptation of [May,

exertion, and the spring and elasticity of the air appears to be
lost."

The effects of low temperature was definitely ascertained by
Vierordt, in experiments upon himself.* He ascertained, that
with the decrease of the temperature, the pulse and number of
respirations became increased in frequency, per minute, and
that the volume of an expiration in cubic inches, the carbonic
acid in the expired air, and the barometric pressure were also
increased. "The action of cold," says Dr. Lee,f "under these
circumstances, not only represses the exhalent functions and
tends to occasion a congestive state of the thoracic and abdomi-
nal viscera and, as a consequence, acute and chronic inflamma-
tion of these organs, or of their serous or mucous membranes
but also, by depressing the vital energies, favors the supervention
of cachectic states of the system." Cold, therefore, exercises a
contrary effect to heat, by constringing the capillaries of the differ-
ent surfaces and causing a central determination of the vital
fluid, and when its impression is carried, either by its degree,
suddenness, or prolonged contact, to an injurious extent, we find
these central organs taking on diseased action. A union of cold
and moisture is universally found more productive of disease,
than that of cold and dryness, as is abundantly testified by
catarrhal, bronchitic, and pneumonic affections. The dryness
of the atmosphere, by its physical action in promoting aqueous
transpiration, when associated with cold, exerts an influence,
which tends to the preservation of the integrity of the evapor-
ating surfaces, the purity of the blood, and the healthful action
of the various organic processes. The highest order of health,
we believe to be consonant with these two relative conditions of
the atmosphere, as shown by the ruddy complexion, and glow-
ing cheek; the vigorous intellect; muscularity of frame; and
the sthenic nature of the diseases to which such persons are sub-
ject. Barometric pressure was found by Vierordt to increase
the pulsations, the respirations, and the cubic inches of expired
air per minute.

The climatic seasons are found to influence materially many
of the functions of the system. In the winter, greater elimina-
tion from the internal secreting organs, diminished cutaneous

* His experiments extended from 37 4 to 752 Fahr.
f See Prize Essay on Consumption, page 33.

1859.] Climate to the Consumptive, &c. 299

transpiration, and an increase in the exhalation of carbonic acid,
occur, and also a reduction in the animal temperature, unless
compensated for by proper clothing. Summer presents almost
the opposite of these various phenomena, and is so familiar, as
not to require even mention of its influence. Concerning spring
and autumn, we may remark, that their characteristic feature,
changeableness of atmospheric condition, renders them peculiar-
ly noticeable, rather for a contrariety of effects, than any strict
uniformity, being uniform in but one, namely their greater pro-
duction of disease.

The prevailing winds of a locality deserve notice, because they
are more or less productive of the various meteorological condi-
tions above noticed, and will exert an effect upon the human
system, in strict accordance with that particular condition of the
atmosphere, which they induce. The influence of certain winds
in the production and prevalence of certain diseases was noted
in the early history of etiology, and the study of their effects is
sometimes painfully realized in the exciting of endemic agencies,
and in the propagation and extension of those which are epidemic
in their tendency. The winds frequently prove the instrument
for the conveyance of pestilential materials from one locality to
another, and occasionally this is so distinctly seen, that the path
of the pestilence is the course of the wind. It is even said, that,
in the occupants of the same house, those occupying opposite
parts, as its northern and southern exposures, will acquire a
predisposition to and manifest disease of a totally different charac-
ter, each from the other. Of the two, however, a southern and
western exposure is, we believe, considered the most salubrious.
If then, the injurious influence of the winds is reduced to so small
a compass, as to assist in begetting a difference of predisposition
to, and disease in the occupants of the same dwelling, how careful-
ly should we select localities for the consumptive.

The foregoing is a meagre portrayal of the effects of such
meteorological states of the atmosphere upon the healthy econo-
my, what then must be the degree of these effects, upon the en-
feebled system of the consumptive ? With the blood, altered in
quality; his nervous energies impaired; the position of the
respiratory membrane altered; its extent diminished, and its
circulation retarded ; in short, the very foundations of health
and life sapped, it is not wonderful that we are rather anxious
to admit its incurability.

300 Doughty. An Essay on the Adaptation of [May,

West Indies. Kesuming our former connexion, the pulmona-
ry invalid is instructed to repair to an equable clime. Now,
having seen that the most approved definition of this phrase is
uniformity of temperature, we conceive that the public has been
misled by the profession ; for persons have oftentimes by profes-
sional advice, migrated to localities, where, not only the hu-
midity, dryness, density or other condition of the atmosphere,
were injurious, but the climatic seasons themselves have con-
tributed to prevent restoration. Is it not true, that a large num-
ber of physicians in order to recommend this or that locality,
merely furnish themselves with, or enquire into the mean an-
nual temperature, apparently regardless of the inclemency of the
winter months, the relaxing and enervating effects of the pro-
longed summer heat, or the changeableness of the other seasons ?
Our observation teaches us, that it is true, in a large number of
cases, that professional men, disregarding or rather overlooking
the various extremes alluded to, have recklessly advised change
of air, which to say the least, has been of no avail whatever.
For instance, it is common for the consumptive to resort to a
residence in the West Indies, allured thither by the uniformity
of temperature, which is said to characterize those islands; for
some of them, present a mean annual temperature of 79. We
have no statistics, by which to become acquainted with their
barometrical and hygrometrical conditions, nor indeed with their
monthly and daily ranges of the thermometer, but from their
geographical position, their relation to certain currents of the
ocean, and the fact of their falling within the region of the north-
east trade wind, we question very much their applicability, if
not disbelieve it. Situated between the southern portion of
the North Atlantic ocean, the Caribbean sea, and the Gulf of
Mexico, and being within the trade-wind region, itself a field of
moisture, they afford ample facilities for the generation and
presence of moisture. A high dew-point, prolonged high heat,
with perhaps a dense atmosphere, characterize their climatic
features ; therefore the very nature of their atmospherical con-
ditions go far to substantiate the observation and experience of
Dr. John Hunter,* " that those, who come from England are not
benefited by the warmth of the island; on the contrary, the
disease is precipitated and proves fatal sooner, than it would
* Bell and Stokes' Practice, page 250.

1859.] Climate to the Consumptive, &c. SOI

have done in a more temperate air. Of this we have repeated
examples among the soldiers, several of whom arrived on the
island with beginning consumptions, and were quickly carried
off by that disease." We think, that the hastening of the dis-
ease to a fatal termination, does not depend solely, as intimated,
upon the warmth of the island, but to a great extent upon the
associated and illy-adapted conditions of humidity and prolonged
high heat. We may safely remark, that theory now shows, that
which required experience and observation to prove, namely,
that benefit may not be confidently expected for the consump-
tive, from a change of residence to these islands. Their damp-
ness of climate, perhaps increased by the character of the soil, as
indicated by their products, is such as to prevent a due elimina-
tion of the various secretions from the evaporating surfaces ; and
from its association with a high temperature, produces labored
breathing, relaxation of the general system, languor and debili-
ty, thus favoring the progress of the deposit of tubercles, and the
maturation of those already deposited. The influence upon the
animal system, of the association of great warmth and humidity
is effectively described by Lieut. Maury, U. S. N.,* when speak-
ing of the warm, saturated air, which blows sometimes from the
region of the Gulf streams he says, "when the east winds
blow along the Atlantic coast for a little while, they bring us air,
saturated with moisture from the Gulf stream, and we complain
of the sultry, oppressive, heavy atmosphere ; the invalid grows worse,
and the well-man feels ill, because, when he takes this atmos-
phere into his lungs, it is already so charged with moisture, that
it cannot take up and carry off, that which encumbers his lungs
and which nature has caused his blood to bring and leave there,
that respiration may take up and carry off."

Florida. Again, let us consider the climate of the State of
Florida.

The inclination to travel south, in hope of benefit, doubtless
suggested by the less proportion of deaths from consumption
here, than in more north erlj- regions, and by its reputation for
equability of winter temperature especially, has shown itself
remarkably in the case of this State. A distinguished writer
(Dr. Forry) upon Climate, says : " Compared with the other re-
* Physical Geography of the Sea, page 95.

302 Doughty. Am Essay on the Adaptation of [May,

gions of the United States, the peninsula of Florida has a climate
wholly peculiar. The lime, the orange and the fig, find there a
genial temperature ; the course of vegetation is unceasing ; cu-
linary vegetables are cultivated and wild flowers spring up and
flourish in the month of January ; and so little is the tempera-
ture of the lakes and rivers diminished during the winter months,
that one may almost, at any time, bathe in their waters. The
climate is so exceedingly mild and uniform, that, besides the
vegetable productions of the Southern States, generally, many
of a tropical character are produced." Further on, he says, " in
this system of climate, the rigors of winter are unknown and
smiling verdure never ceases to reign." The mean annual tem-
perature of its most equable and uniform locality, Key Wes
7609 the difference of the mean summer and winter tempera-
tures is ll34r. With these evidences of its apparent appropri-
ateness, it has been said of it, that "here the pulmonary invalid
may exchange for the inclement season of the north, or the de-
teriorated atmosphere of a room to which he may be confined,
the mild and equable temperature, the soft and balmy breezes
of an evergreen land." Without denying the assumption of
benefit, in toto, we propose to examine its legitimate claims to
our confidence and support, by a study of its meteorological
conditions. But before proceeding farther, we would remark,
that the claims which it presents to professional confidence are
as great, if not greater, than those of the West Indies, south of
Europe. I

Geographically, Florida is a peninsula, bounded on the south,
and east, by the Gulf of Mexico and Atlantic ocean, respective-
ly; its northern and western boundaries connect it with the
states of Georgia and Alabama. Topographically, it is described
as follows: "belonging entirely to the Atlantic plain, no part
of the surface rises more than two hundred feet above the level
of the ocean ; south of lat. 28, it consists chiefly of a vast mo:
called the Everglades; north of this, to the Georgia line, the
surface is mostly a dead level, with scarcely an undulation.
The ridcfe, dividing the waters east and west, is not more than
one hundred and fifty feet high, and disappears at Lake Tohop-
kalika. This northern portion is an extensive pine forest, inter-
spersed with ponds, swamps, low savannahs, and hammocks,
which last are rich bottoms, overgrown with trees and a redund-

"-?.] Climate to (he Gmsumptive, Ac. I .":

ant undergro wih. The barrens are covered with forests of pine,
with little undergrowth. The soil consists mostly of sand, bnt
the hammocks, which are numerous,- have a fertile soil, com*
posed of clay and sand. The savannahs, which are covered
with a tall grass, are inundated during the wet season. The
river swamps are mostly overgrown with cypress and cypress-
knees."7 Its products, besides fruit, are cotton, rice, sugar-cane,
indigo, maize, tobacco, etc

Hygrometrically, its condition is alone to be inferred from
collateral circumstances, since no statistics of this character have
ever fallen under our inspection. It is said* "that the air is
much more humid, than in our more northern regions ;"" that
44 the dews, even in winter, are generally tcxj heavy;'"' thai

extreme difficulty. ** During the summer, books become cover-
ed with mould and keys rust in one's pockets f " fungi flourish
luxuriantly.7' The following summary of the quantity of rain,
that falls at particular places in this State, will not be without
interest at this place. There fell at Key West* in 1851, 59"57
inches; in 1852, 5431 inches; and in 1851 ^7"91 inches. The
average annual quantity is 47*65 inches. At Fort Brooke,
Tampa Bay, in 1840,there fell 89-86 inches, in 1813, 56-28 inch-
in 1816, 51-20 inches; in 1852, 69-26 inches; and in 1854,

: r inches. The average annual quantity is 5547 inches. The
lowest measurement recorded in eleven years is 44*7 7 inches in
1853. At Fort Barraccas, Pensacola, Florida, in 1843, there
fell 62-16 inches; in 1841, 59-58 inches; and in 1854, 50*82 in-
ches. The average annual quantity is 5698 inches. At Fort
Marion, St. Augustine, in 1844 there fell, 29-91 inches. The
sverageannual quantity is 31*90 inches.

A_-;.,:l ;, ?'. _i: .'/.;>:::: i:;,.- ':;--::: zz:ii ',: i"s :":~;.::: Srcs:::?.
the difference at Key West, between the mean summer and win-
ter temperatures, being only lnWL But the extremes of the
riimatie seasons are not always indicated by refcarencfl be tibs
y.r:\ ;-;..:;.:: :-;;--.-: ::..: .::-:5. :'.::_-; r.:_;;^ ;m..:./. - :.:.'.:."._-. ~ :-.c:
qrothef taaasa^nTiay shows modesste a-rusgu, mdyet^ thfl
Iberinctnelor may fluctuate between great fcitifn* is As jmm
or in the respective seasons. A writer, (Dr. Kitchen of Indiana)

30i Doughty. An Essay on the Adaptation of [May,

in the Nashville Journal of Medicine and Surgery* says, " in re-
gard to uniformity of temperature, I find that during a period of
ninety-two consecutive days, there were thirty-seven mornings,
that the thermometer exhibited a change of over ten degrees in
twenty-four hours, on twenty-six of these mornings, the changes
amounted to from ten to twenty degrees, and on eleven of them,
to from twenty to thirty degrees. On one occasion, the mercu-
ry fell forty-six degrees within a period of twelve hours, and on
another thirty-eight degrees in the same length of time". The
same writerf previously says, that, " the weather for the largest
portion of December, 1855, was mild and pleasant, indeed, such
was the case almost throughout the entire United States. On
only one morning during the month, was the mercury found
below the freezing point; on Christmas day, however, there was
a sudden severe change of temperature amounting to twenty de-
grees in one hour.'1''

Again, \ "in the year 1765, John Bartran, states, that on the
3d of January, being on the St. John's river, north of Lake
George, the thermometer was at 26, wind north-west, the
ground was frozen an inch thick, on the banks ; this was the
fatal night that destroyed the lemon, citron and banana trees in
St. Augustine." Williams says, in 1774, there was a snow
storm, which extended over most of the territory. In Februa-
ry, 1822, the cold was so intense in West Florida, that all the
fruit trees were killed to the ground; but this season was com-
paratively mild in East Florida. On the contrary, East Florida,
suffered exceedingly from a violent frost, on the 6th April,
1828 ; on this bitter night, crops of cotton, corn, and fruits were
all destroyed. The thermometer at Six-mile creek, on the St.
John's, stood at 27, and the ice made an inch thick. The crops
of corn and cotton were cut off, as far south as Tomoka. During
the month of February 1835, East Florida was visited by a frost,
much more severe than any before experienced. A severe
north-west wind blew ten days in succession, but more violently
for about three days; during this period the mercury sank
seven degrees below zero. The St. John's river was frozen several
rods from the shore, and all kinds of fruit trees were killed to
the ground ; many of them never started again, even from the

See Vol. x. June, 1856. f See same Volume. The Italics are his.

\ See DeBow's Review, voL i., page 341.

1859.] Climate to the Consumptive, d'c. 305

roots. Frost is felt at some seasons, in every part of Florida ;
though not usually below latitude 27. Vignoles says, "the
nipping of the white frost is occasionally felt so far south as
the extreme capes of Florida, though not an annual visitant".*
In the year 1800, Jan. 10th, "snow and hail fell the whole day"
at St. Mary's river, Florida; and on the 11th the snow was five
inches deep. The lowest observed temperatures were 10th, 37 ;
11th, 28; 12th, 3. (Forbes".f

We have never seen a statement x)f the barometric pressure
of the atmosphere of this State, but presume that of the north-
ern portion is somewhat heavier than that of the southern,
inasmuch as it is represented as being dryer. Its sandy soil may
partially account for the same observation. But no part of the
peninsula being higher than two hundred feet above the sea, a
mere nominal difference must exist between the degree of pres-
sure over the two.

Dr. Charles A. Lee, in a letter to Dr. Forry, remarks " I
have no doubt, whatever, that the state of the dew-point, exerts
a far greater influence upon animal bodies, especially in the pro-
duction of disease, than temperature itself. This arises chiefly
from the circumstance, that a high state of the dew-point, inter-
rupts to a greater or less extent, the healthy function of the skin
and lungs, two of the most important organs in the body. I
maintain, that perfect decarbonization of the blood cannot take
place in the lungs with a high dew-point, and consequently that
the vital fluid cannot receive a sufficient quantity of oxygen, to
fit it for those various offices, which it is designed to perform
in the animal economy. Evaporation from the surface of the
body is either checked, or the 53 ounces of fluid given off from
the skin every 2-1 hours, in a moderate dew-point, is disposed

* It has been suggested, that perhaps these dates are not reliable, especially,
that -which dates the temperature on the St. John's river, to have been below
zero. The following quotation from Lorin Blodget's late work, fully corrobo-
rates it In speaking of the extremes of temperature, experienced every where
in the year 1835, he says, "nearly all the surface of the United States as then
observed, or all that east of the great plain*, was below zero on February 8th,
Kathez at the south-west, and Savannah on the Atlantic coast, being the limits,
though a large inland area of the north of Florida was also below zero, its limits
being about the 29th parallel." (Blodget's Climatology of the U. States, p. 150.)

During the month of February (8) of this year, the thermometer stood at 4,
5 A. M., at Augusta Arsenal. Geo.

+ See Blodget's Climatology of the United States, page 147.

306 Doughty. An Essay on the Adaptation of [May,

of through some different channel, constituting a material de-
rangement of the animal economy." The State of Florida must
possess a high dew-point, for the prevalence of paroxysmal fevers,
often epidemic, which always go, hand in hand, with "a high
temperature and a high dew-point," point unerringly to the fact.
But let us examine more closely the why and the wherefore of
this great relative humidity.

Being situated betweeen the warm waters of the Gulf, and
those, still warmer, of the Gulf-stream, it is impossible that it can
be insensible to the vast quantity of water evaporated from their
surfaces ; and when the south-east and south-west winds blow,
coming in the first instance from the Gulf-stream and the broad
Atlantic beyond; in the second, from the Gulf of Mexico and
perhaps the Caribbean sea; still farther south, what a densely hu-
mid atmosphere, one would suppose, it must have. These sea-
winds prevail a great part of the year. With no mountain ranges
to interrupt or obstruct the free entrance of the winds; and being
also reduced almost to a level with the sea, the immense vol-
umes of aqueous vapor, with which they are loaded, cover the
earth and saturate its atmosphere. * " The whole country being
a dead level, the super-abundant moisture remains until evapor-
ated by the sun's rays; and the winds traversing the grounds
thus saturated, it is supposed, possess considerable agency in the
causation of fevers." In addition to this, consider the vast and
copiously evaporating surface which it contains within itself.
Its extensive morass covering the southern portion, known as
the Everglades, its ponds, swamps, low savannahs, hammocks,
and rich bottoms, covered with trees and shrubberry; notice
also the fact, that rain falls at particular seasons! that during
six months, an average of from 32 to 34 inches of water falls
throughout the State, and its loss by evaporation, with some
exception, during the remaining portion. All of these circum-
stances conspire to deprive it of much, that might otherwise

* This is especially true of the wet season.

f According to Mr. Blodget, this state falls, neither in an area of constant pre-
cipitation, nor in one of strictly periodical rain. He assigns it an intermediate
position, under the title of sub-tropical. Although he again says: that, "It ap-
pears to be a climate ordinarily of a division into two principal seasons, in regard
to the rains, the wet summer and the dry winter, yet either may be interrupted
by extremes of an opposite character, much greater than those occurring in any
other known district."

1859.] Climate to the Consumptive, &c. 307

recommend it. Temperature alone, the variableness of which
we have exhibited above, will not suffice to answer our present
demands, but the degree of humidity is a paramount considera-
tion in the investigation, influencing, as it does, not only the
physical part of respiration, but its vital results. It may be in-
cidentally stated that, perhaps, when the north or continental
winds prevail, as they frequently do in the winter season, that
the moisture over the various low places on its surface, and
along the rivers and coast, is made to assume a more sensible
condition that of mists, fogs, etc. Dr. Kitchen, from whom
we have already quoted, had spent the winter in Florida, being
a consumptive, though without material benefit. He says, that
"there is an impression entertained by some, that Florida air
possesses curative properties," and that "nothing but disappoint-
ment can result to the invalid who entertains such an idea, for
the most that can be said of a winter spent there, is, that it places
persons in delicate health under more favorable circumstances
for recovery, than can be had in more northern latitudes," For
those in the early stage of phthisis, the most rigid hygienic meas-
ures must be adopted and carried out to secure benefit ; but for
those farther advanced in the disease, he considers that they
"will do better to remain at home." So potent is the evidence
of its unadaptedness to the consumptive for a permanent resi-
dence, that we think, with some foundation in truth and obser-
vation, we might essay to disturb its quiet, as a winter resort.*
The vicissitudes which may characterize its winter season, as we
have given them from the records of the past, would prove
nearly all that is requisite, but we do not present them for that
purpose, for however marked those occasional vicissitudes may
be, yet, when compared with those constant changes farther
north, they must be preferred.

As some intimation in regard to the temperature of the waters
in and about this State in the winter, has been made, we present
the following quotation from the Army Meteorological Register,
and with which we will conclude our remarks upon its climate.
"The Gulf coasts are not modified by its high temperature in

* This part of the subject will be thoroughly canvassed in our comparison of
the Pacific climates, with this State. In view of this, we have omitted much that
might have been given in this connexion,

N. S. VOL. XV. NO. V. 22

SOS DOUGHTY. An Essay on the Adaptation of [May,

winter, so much as would seem inevitable under ordinary cir-
cumstances, and the only apparent reason is the great relative
refrigeration of the continent generally, and the consequent
prevalence of land winds instead of winds towards the continent.
These winds are violent also, in proportion to the contrast of
temperature, and as no general atmospheric circulation aids to
drive the sea-air inland, as is the case in the west winds of the
European coast, and to some extent in the summer winds of the
Gulf, the natural reversion from the land prevails, and little
modification of the climate of winter is due to the presence of
warm waters in the Gulf."

Hypothetic-ally, it m iy be asserted, that a uniformly moist
atmosphere, with a prolonged high temperature, when under
the regulating influence of large bodies of water, is less apt to
produce catarrhal, bronchitic, and pneumonic affections, than
where it is ever varying in regard to dryness and humidityT
cold and heat, etc. Indeed, even the almost constant co-exist-
ence of a prolonged low temperature with humidity is less pro-
ductive of the same diseases. To substantiate these positions, we
may point to the universally greater frequency and proportion
of catarrhal diseases in the interior of our country, especially
where the interior is remote from large bodies of water. Diseas-
es of the respiratory organs of this character, contrary to the
common opinion, are less frequent along the Atlantic coast of
the northern portion of the United States, and in the neighbor-
hood of the great chain of inland seas or lakes along its north-
ern boundary, where a uniformly low temperature coincides with
great dampness ; and also, in its southern portion, where a high
temperature and a high dew-point co-exist, than in the inland
portion of it, where summer follows winter so closely, that spring
almost escapes observation, and the change, from summer to
winter, is equally abrupt, possessing at the same time an atmos-
phere constantly and rapidly changing from moist to dry and the
reverse. It is also worthy of observation, that in these regions,
the thermometer has the greatest annual range having at some
of themr a range from 1 10 to 130 Fahr. According to Dr. Forry
there were fewer cases of pulmonary disease among the soldiers of
the army, stationed along the sea-coast, north and south, and in
the forts, along the great lakes, than among those stationed in the
interior, and distant from the latter. Being acquainted with the

1859.] Climate to the Consumptive, &c. 309

atmospherical vicissitudes of these regions, the fact is readily
accounted for. Nature has endowed man with the happy
faculty of adapting himself to the various physical and sensible
conditions around him, where auy thing like uniformity in re-
spect to these states is observed ; but where no uniformity exists,
and where everything is change and variableness, it were indeed
impossible for him, with all his genius, to properly adapt him-
self thereto. He may clothe himself against the frigid aspects
of an arctic winter, or temper his frame to the fiery heat of the
torrid zone, but when subjected, to both in quick succession,
and at uncertain intervals, with their variations as to dryness
and humidity, the system, wounded on every side, falls an easy
prey to such influences. One day, the excretory functions of
the skin diminished, and the renal and respiratory apparatuses
active in compensation, by an increased elimination from their
surfaces : the next, every pore of the skin open, and its func-
tions increased, while the respiratory mucous surface is greeted
with an atmosphere so dry, as to keep it in a state of unnatural
dryness; or so humid, as to favor the accumulation and non-
elimination of a sufficiency of aqueous substance by both surfa-
ces from the blood thus affecting injuriously both the physical
and vital relations of the phenomena of respiration, and the
organic processes of the system generally. It would seem in-
deed impossible not to contract colds. Dr. Kitchen states, that
he "met with numerous cases of bronchitis and pneumonia,"
during the winter that he spent in Florida; but as the period of
observation by Dr. Forry was much longer (10 years) and at a
time (during the Seminole war) when a large bod}7" of troops
had been collected in this State, we prefer to adopt his state-
ment that of their comparatively rare occur renee.

It should be borne in mind, that in speaking of the climate of
the West Indies, and Florida, we are not arguing their favora-
bleness for the production of tubercular disease in the native
inhabitants; for the predisposition which it begets in them is to
a totally different class of diseases, but we do mean to say, that
an analysis of their meteorological and topographical conditions
forbids the anticipation of permanent benefit to the consumptive,
transported from other climes, and annuls the propriety of their
recommendation, as places of resort for a permanent residence
yea, apparently, this exotic can only find the elements of swift-
er decay.

310 Doughty. An Essay on the Adaptation of [May,

South of Europe. Other countries farther northward, have
from time to time, been recommended with the hope of ameliora-
tion to the consumptive. With English and European writers
generally, the south of Europe has enjoyed an extended reputa-
tion ; indeed it is not uncommon for those of this Continent, who
are able, to resort to this region. However, the reputation which
it has enjoyed, does not so fully obtain at present. Now it ap-
pears to be recommended, simply in the absence of a better, and
not from any real adaptedness. The city of Bordeaux, upon
the south-western border of France, has a mean annual tempera-
ture of 57.1 ; the mean temperature of the summer is 71.1 ; that
of the winter 43 ; and the mean temperature of the coldest
winter month is 41.00. Madrid, in Spain, has a mean annual
temperature of 57.Q4 ; the mean temperature of summer is 74.1 ;
that of the winter 42.Q1 ; and the difference of the mean temper-
atures of summer and winter is 32.

The frequent condensation of moisture into mists and fogs,
along the south-western part of the Continent, is doubtless at-
tributable, to the contact of the warm vapor which saturates the
air brought thither from the wide-spread Gulf-stream the great
and beneficent moderator of the climate of western Europe,
with the cooler air over the land, especially when the continen-
tal winds prevail. It is said by a distinguished writer,* that,
without the moderating influence of this stream, the "soft climates
of both France and England would be as that of Labrador, se-
vere in the extreme and ice-bound." But, whilst it serves to
mollify and soften the climate of these countries, by depriving
them of a frigidity, natural to them in its absence, rendering them
habitable, and making them the special seat of commerce and
civilization, yet, when that influence is analysed in connexion
with our present object, the abundance of moisture transported
thence by the south-west winds to the south-western and west-
ern portions of the entire Continent, renders it totally unadapted
to those laboring under pulmonary disease. Now, we are taught,
that the south-western winds are the prevailing and rain-giving
winds of Europe, and if we bear in mind the region (south-east
trade-wind region, according to Lieut. Maury) whence they
emanate and those over which they pass, together with the pe-
culiar exposure of those countries on its south-west to the same,
* Lieut Maury Physical Geography of the Sea.

1859.] Climate to the Consumptive, &c. 311

before they can have possibly been deprived of their moisture
by precipitation, we possess satisfactory reason to believe, that
too great humidity must exist not to render a permanent resi-
dence injurious to the consumptive patient. To forge this chain
of evidence, still stronger, we invite attention to a consideration
of the iso-chimenal and iso-thermal lines of these localities.*
If we examine a chart with these lines mapped out, it will be ob-
served, that the iso-chimenal line, which, in crossing the Continent
of Europe, passes through the south of France, enters about
midway of Ireland, latitude 52i; then descends abruptly about
6 latitude, entering France about Bordeaux, and passing a
little above Marseilles and Montpelier; thence it passes to
Bologna, " the coldest of the Italian cities," and here commences
a gradual descent, cutting across the Black Sea, just above Con-
stantinople, about latitude 43jS\ All of the places on this line,
have the same mean winter temperature, yet who thinks of send-
ing the consumptive to Constantinople for a winter residence?

The iso-thermal line, which passes through the south of France,
starting just above Bordeaux, takes a north-eastwardly direction
over Strasburg, towards Cracow, and leaves the European Conti-
nent to the north of the Caspian Sea. The sufferings of the
allied army in the late war with Eussia, during the winter cam-
paign in Crimea, farther south than any place along this line
in its course through the Russinn territory, teach practically a
condition of climate, too rigorous for the consumptive to en-
dure. This region, thus presenting a mean winter temperature
about that of Dublin, Bologna, and Constantinople; and a mean
summer temperature about that of Strasburg, Cracow, and the
south of Russia, would seem, from these circumstances alone,
very unpromising, but when associated with that meteorological
element before discussed, is stamped with an unmistakable
want of real adaptedness to the ends in view.

In the consideration of their thermometrical conditions, it
should be remembered, that " the mean temperature of the hot-
test and coldest months, (nor of the various seasons, we may
add,f) by no means, indicate the limits between which the ther-
mometer may fluctuate between one and the same spot. It thus

* Our remarks are intended to bear more particularly upon the south of France
and its neighborhood, as these are the points most generally recommended.
f The Parenthetic sentence is our own.

312 Doughty. An Essay on the Adaptation of [May,

happens, that, even in districts enjoying a warm climate and a
mild winter, an extraordinary degree of cold is felt thus, for in-
stance, in the year, 1507, the harbor of Marseilles was frozen over
its whole extent, for which a cold of at least 0.Q4 was requisite.
In 1709, the Gulf of Venice, and the harbors of Marseilles,
Geneva and Cette were frozen over; and in 1789, the ther-
mometer fell at Marseilles to 16."* The occasional severity
of these localities is worthy of notice, as it shows, that uniformity
of temperature does not always characterize them. Whatever
of benefit, therefore, can be had by a residence here, is to be
attributed to a rigid observance of all the numerous hygienic
measures, by those who sojourn there, and is to a very limited
degree, ascribable to any natural climatic condition.

Again, we present the following remarks of Dr. Johnson,f
as illustrative of the real character of that portion of Europe,
which borders the Mediterranean Sea. "Placed," says he,
"between the burning sand of Africa on the one side, and the
Alps and Pyrennees on the other, the Mediterranean skies are
alternately parched by the south-east chilled by the north-west,
or stilled by the Sirrocco winds. Thus, from Barcelona to Geneva,
the iron-bound coast presents a succession of dreary mountains
and craggy rocks, the tops of the former being frequently
covered with snow, from the beginning of March till the end of
May. From these, the frigid Euroclydons descend in whirlwinds
upon the contiguous ocean ; while at other times, the Sirocco
breathes fire from the deserts of Sahara and Lybia." After giving
the effects of this latter wind upon the animal and vegetable
world along its coast, he continues thus : " After this description,
the Mediterranean climate could hardly be set down, as one that
was favorable to the lungs of a northern invalid, seeking refuge
from the atmospherical vicissitudes of England. Yet numerous
writers describe this portion of the globe as enjoying a happy
medium between intertropical heat and hyperborean cold. But,
we must not calculate on heat, cold or evenness of temperature,
by the parallel of latitude ; on the contrary, as a modern author
has justly observed, c storms most tremendous occasionally burst
from the mountains, with the most piercing coldness, on many
of the boasted retreats along the northern shores of the Mediter-
ranean.' " Finally, we find the following allusion to the climate

* See Muller's Physics and Meteorology. f Tropical Climates, page 238.

1859. J Climate to Hie Consumptive, etc. 313

of these localities, taken from one of the standard authorities of
the present day. "The climate of the Mediterranean and of
southern Europe generally, does not merit the reputation, which
it has hitherto, or until recently enjoyed for the cure of con-
sumption. On the contrary, it excites with singular and alarm-
ing rapidity the tubercular diathesis into actual disease, by pro-
moting the development and softening of tubercle."*

We might subject other localities, highly recommended, to a
]ike examination, but it would involve too great sameness to
awaken interest, and lengthen this article unnecessarily. Suffice
it to say, that the result of a farther prosecution of the investi-
gation would not be less unsatisfactory, for it is a melancholy
and painful fact, that no place has yet been proposed, that fully
complies with all of the necessary circumstances.

Having thus passed in review, the various conditions requisite
for the adaptation of natural climate to the consumptive^ and
given a brief recital of the influence of certain meteorological
conditions upon the system in health, and their probable effects
upon the diseased ; and having tested the applicability and
adaptedness of the West Indies, Florida, and Southern Europe,
by those meteorological conditions deemed necessary to be com-
plied with ; and having further shown their unadaptedness or
want of suitability to the requirements of the consumptive, we
propose to examine the climate of certain other regions, hither-
to obscure and without repute ; at the same time, indulging the
hope, that the search may not prove entirely fruitless. Even if
we do not succeed in demonstrating a strict compliance with
every necessary, still we think, that we shall be able to present
such a record, as will claim a far higher recommendation, than
those we have passed in review.

Before, however, we enter upon this field of investigation, we
desire to make a correction of certain statements, which seem
likely to pass unnoticed. In the attempt, by certain writers, to
show that the combination of heat and moisture is equally pro-
ductive of phthisis pulmonalis, with that of an association of
cold and moisture, comparisons have been made between places
in the south of Europe ; numerous islands in its vicinity ; and
the warmer regions of the southern portion of North America, as
the West India Islands, and the Southern States of this Con -
* See Bell and Stokes' Practice, page 24S.

314 DOUGHTY. An Essay on the Adaptation of [May,

federacy. When fairly contrasted with each other, the less pro-
portion of deaths from consumption in warm climates, is a fact,
which remains yet ud controverted. We may instance, its less
frequency in the southern portion of the United States; and
contrasts made between the West Indies, farther south, and
England, show a relatively less proportion in the former. Dr.
Edwin Lee,"* in the Prize Essay, upon Phthisis Pulmonalis, states,
upon the authority of Dr. Forry, that the proportion of phthisical
patients in the southern region of the United States, is even
greater than that of the northern. He remarks : "Dr. Forry,
in his statistical researches in the medical department of the
American army, remarks, that in the whole southern region of
the United States, the proportion of soldiers annually attacked
by consumption amounted to 10 T3o per 1000 ; the total amount
of deaths from consumption and haemoptysis amounts to 108 ;
whereas, in the northern region, the proportion of consumptive
soldiers is but 7 (each year) per 1000, that of the deaths, being
47 ; and, moreover, in that part of the northern region, where
the climate is the most severe, the proportion of phthisical pa-
tients is not more than 5 per 1000." By an examination of the
author referred to, it will be found, that the number of deaths
from consumption and haemoptysis is 101, instead of 108, as re-
ported for the southern region. It is true, that the statistical
table given by Dr. Forry, at the conclusion of his " General De-
ductions (Pulmonary Diseases)," does show a much greater
frequency of this disease in the southern region, than in the
northern ; but this is readily accounted for, by the fact, that in
this table, for convenience of arrrangement, the middle and
southern divisions were consolidated under the head of the
" Southern Kegion." He divided the United States into three
great divisions, the Northern, Middle, and Southern the Mid-
dle, embracing the most of the north-western states, a few of
the middle states, and those of the southern, most northwardly;
the Southern, embracing the posts on the lower Mississippi and
Florida. This author himself, as if to prevent any unjust con-
clusions, in regard to the Southern Division, says, that, " it is in
the middle districts of the United States, however, that pneumo-
nitis, pleuritis, and phthisis pulmonalis, are most prevalent, the

* See Prize Essay on the Effects of Climate on Tuberculous Disease, by Edwin
Lee, M.R.C.S. June 6, 1855.

1859.] Climate to Ote Consumptive, etc. 315

peninsula of Florida having a lower average, than any other
region." Moreover, by the table* referred to, it will be seen,
that the proportion of cases (phthisis) in the Northern Region
was 23 per 1000 deaths, 46 per 1000. The ratio of cases in
the Southern Region, separate from the Middle, was 18 per
1000 deaths, 19 per 1000. The addition to the latter of the
ratio of cases and deaths in the Middle Division, will explain
the great preponderance, in the Southern Region, as stated by
Dr. Lee. Ratio of cases in the Middle Division, per 1000, of
phthisis pulmonalis, 24 deaths, 80 per 1000. Consolidating
the Southern and Middle Divisions, we have 42 cases per 1000
deaths, 99 per 1000. The comparison of the Northern and
Southern, under these circumstances, stands, ratio of cases per
1000, as 23 to 18 deaths, per 1000, as 46 to 19, which shows
both greater frequency and higher mortality in the former. In
that part of the Northern Division, where the climate is most
severe, but most dry, the ratio of cases, per 1000, was 5 deaths,
22 per 1000. Comparing this with the Southern Division, we
observe, that whilst the proportion of cases in the former is less,
the number of deaths is greater. Dr. Forry states, that " the
high mortality of the Southern region is caused by the Middle
Division of the United States, the average on our southern
coast, being comparatively low. Taking the statistics of the
coasts in East Florida and those on the lower Mississippi,
the ratio of phthisis pulmonalis is found to be only 1 T\, and
that of the remaining lesions of this class to be no more than
Tro, per 1000 of mean strength." Further on, he says, that the
ratio of cases and deaths is greater in the Middle region, than at
either extreme. In thus remarking upon the statements of Dr.
Lee, we do not desire to cast any reflection, but simply to rectify
an error, into which perhaps unwittingly, he had fallen, and also
to rescue the Southern portion of this Union, from the erroneous
and unjust conclusion, which might have been drawn from this
allusion to its salubrity.

[to be continued.]
* See Forry Climate of the TJ. States, p. 242.

V. B. VOL. XV. so. v. 23

r
316 Landrum. Case of Uterine Polypus.

ARTICLE XIII.

Case of Uterine Polypus. By Z. P. Landrum, M.D., of Lexing-
ton, Georgia.

The suffering, distress, loss of health, and sometimes of life, that
follow in the train of these morbid growths, are incentives to
physicians to attain to that knowledge of their existence, and of
the means of their relief, which will, in most cases, lead to their
early detection and removal. Instances have occurred in which
the physician in charge has administered drugs, for years, to cure
uterine polypi ; and permitted the slow march of their repeated
bleedings to sap the powers of a vigorous constitution, and scat-
ter the mildews of sorrow and death over the hopes and affec-
tions of those of his case. How criminally guilty must the
physician be, who, from ignorance and avarice, permits a wo-
man to drink his drugs for years and finally die, whilst her
confidence in his skill was the only barrier to that relief and
health, which might have been proffered by the superior attain-
ments of others. Such men do not deserve to be called physi-
cians, but rather death pedlars, upon whom should rest the
execrations of all good people.

Certain peculiarities connected with an unfortunate case of
uterine polypus that recently came under my observation, is my
apology for penning this article. We do not expect to record
anything new to those who are familiar with the annals of med-
icine, but rather to refresh the minds of the readers of this
journal, with a very interesting case of disease and suffering,
and with comments on some of its peculiarities.

Mrs. B., aged forty years, experienced the first symptoms of
a polypus, in the year 1855 her youngest child being five
years old. Her last labor was without unusual difficulty, and
her health afterwards was good, until the first attack of alarm-
ing hemorrhage, in 1855. The attending physician expressed
the opinion, that her womb was threatened with mortification,
from which it was saved only by his timely efforts. (He was one
of the " knowing doctors.) Since then, her "bleedings and faint-
ings" have been doctored by several phj^sicians, none of whom
examined her condition in such way as to know the cause of
her ailments. She applied to me for treatment last June which

1859.] Lax DRUM. Case of Uterine Polypus. 317

I could not consistently grant, because she was unwilling to
submit to vaginal examination. I suspected that a polypus was
doing the mischief, and acquainted her with my suspicions, with
the assurance that if they were well founded, medicines would
be of no permanent benefit. I saw her no more, until the 27th
of January last, when I was requested to visit her by her family
physician. Her condition at this time was one of extreme peril.
Her sallow complexion, shrunken features, dry, red and pointed
tongue ; small, irritable and frequent pulse told but too plainly
that her constitutional vigor had been blighted, and the resist-
ing forces of life were rapidly succumbing. She consented to a
vaginal examination, but stated that her case was not a polypus
as I had suspicion ed, but an inverted womb, as revealed in a
similar examination made by a highly respectable practitioner
the day before. Familiar with the difficulties that beset a cor-
rect diagnosis in some cases of uterine polypi, I insisted on
making the examination for myself. The history recited of her
sufferings, during this last attack, which at this time was of two
weeks' duration, was painful in the extreme. The contractile
throes of agony were worse, she said, than all the labor pains
she had ever suffered.

After emptying her bladder (for she was unable to void her
urine), I examined the tumour, which lay in the vagina, its
lower part resting between the external labia. This lower part
was oval in shape, and slightly lobulated on its surface. About
midway the tumour there was an hour-glass constriction, caused,
as I afterwards ascertained, by its decomposition and sloughing
at this point. Its size, both below and above the constriction,
was greater than a hen's egg. Its neck was but very little
smaller than its body, and was connected by a cartilaginous
formation with the interior part of the uterine fundus, which
was partially inverted and drawn down, in a conical form, to
the mouth of the womb. The neck of the womb was oblitera-
ted, and its mouth in the circular shape it assumes at the latter
part of the first stage of labour. After passing my finger be-
tween the lips of the os uteri and the tumour, and examining
its connection with the inverted fundus, I traced the body of the
womb from the mouth, which was turned up behind the os pu-
bis, downwards and backwards into the hollow of the sacrum.
This reverted condition of the womb was made more evident

818 Landrum. Case of Uterine Polypus. [May,

afterwards by a rectal examination. The womb, therefore, was
reverted, partially inverted, and had a polypus attached to its
inverted portion. The polypus sprouted from the anterior part
of the fundus, or from the superior and anterior part of the body.
This connection imparted to its weighty and to the uterine con-
tractions for its expulsion, such a direction, as to cause its retro-
version at the time of its inversion , this we suppose.

The constriction in the middle of the tumour, caused by
ulcerative softening and sloughing, impressed such peculiarity
in shape, as to be a subject of some difficulty at my first examina-
tion. Three days afterwards, however, the sloughing at this
point had progressed to such an extent, that the two portions
of the polypus were held together only by a narrow band of
cellular tissue. What caused the rapid death at this point?
"We are of opinion that the polypus was not expelled from the
uterine cavity in its entire length at one time, but was arrested
in the uterine lips at the point of sloughing, and injured here in
its circulation and life, which hastened its death beyond that of
other parts when the whole tumour was expelled. The carti-
laginous connection of the tumour and womb is also anomalous.
They (polypi) are supposed by Dr. Meigs to " consist merely in
hypertrophy of some superficial layer of the womb, or else in a
hypertrophy of some area of its tubular mucous membrane only,
and that the tumour is, in this sense, a part, and a real part of
the womb itself, a fibroid growth, partaking of the true nature
of the uterine tissue ; or if it consists of mucous lamina it will
be soft and cellular," &c. Though this may be a correct view
of the primary development and early formation of these tu-
mours, it cannot be supposed that they continue long in struc-
ture as simple hypertropbied uterine tissue, but become hetero-
logue by certain changes which take place in their inner growth,
modifying their organization variously, and producing in this
instance the cartilaginous union of the tumour and womb.

The large size of the neck, which existed in this case, is very
unusual with polypous tumours. Doctor Bedford says, "a
polypus is apediculated tumour, " &c. Doctor Meigs defines poly-
pus to be " a tumour growing by a narrow neck" &c. Churchill
says, they are " attached to the womb by a neck or pedicle" &c.
Murphy says, "you will have little difficulty in recognizing a
polypus when it descends into the vagina so low as to interfere

1859.] Landrum. Case of Uterine Polypus. 319

with labour. Besides the firm fleshy feel of the tumour, it is
extremely moveable, and when the head is pressed back in the
intervals of pains, its pyriform shape and long, narrow stem will
be obvious." Such is the description almost uniformly given
by medical writers of these " sarcomatous swellings."

Baillie, however, in his Morbid Anatomy, says he has seen a
polypus, less than his fist, adhering by a neck as large as his
wrist. Doctor Samuel Cooper refers to this subject as follows:
"Nor will any certainty (in diagnosis) be gained by adverting
to the ordinary form of polypus, its enlarged base, and narrow
pedicle since the records of the profession furnish abundant
evidence, that the neck of such a tumour is often as large, and
sometimes larger than the inferior extremity." A neck as large,
or nearly as large, as the body of a polypus, might render diffi-
cult an otherwise easy diagnosis, unless we are prepared for
such anomalous developments.

The vaginal discharges were profuse, irritating, and of a most
offensive character. Dr. Samuel Cooper says, " uterine polypi
have sometimes been got rid of by the spontaneous efforts of
nature ; this has happened when they have been expelled from
the uterus, and had their pedicles so strangulated by the cervix
of this organ as to make them slough away. This mode of cure,
however, is to be considered uncommon, not to be expected,
and perhaps not desired." This polypus was disintegrating and
dying, as described, and if there had remained any vigour of
constitution to resist its morbid irritations, it might possibly
"have been got rid of by the sponteneous efforts of nature."
But the strength of our patient was well nigh exhausted ; and
the peculiar excitement engrafted on a constitution, enfeebled
and depraved, by the local contact and absorption of the foul
and offensive effusions of a sloughing polypus, was too evident-
ly tending to death, to have justified the faintest hope of a suc-
cessful result in this way. Her condition was a lasting picture
of that particular combination of prostration with excitement
denominated irritative fever. It seems that the life of the pa-
tient, or the accidental death of the tumour, is the only limit to
growths of this character. They are parasites, whose vitality,
though supplied by the life forces of the human body, is unre-
strained byM.be organic laws which guard the size and growth
of natural tissues. The case seen by Dupuy tren weighed twenty-

Landrum. Case of Uterine Polypus. [May,

five pounds ; and the one described by De Claubry weighed
thirty -nine pounds, and was nearly three feet in its vertical
diameter. Churchill instances one, excised at the Meath Hos-
pital, which was more than fourteen inches long, and four or
five in diameter at the widest part. These enormous develop-
ments are necessarily very rare, as their precarious supply of
nerve force and blood furnishes occasions for their death, or the
death of the patient, long before so great a size is attained.

The difficulties of diagnosis presented by some cases of uterine
polypi, are very considerable. Mr. Newnham thinks " it is al-
ways difficult, and sometimes impossible, to distinguish partial
and chronic inversion of the womb from polypus."

The points of diagnosis in our case are, first, its history :

Mrs. B stated that her last labour was easy, and unattended

by any unusual occurrence, either in the birth of the child, or
the passage of the placenta; that five years from this date, she
had the first attack of exhausting hemorrhage, the repetition of
which, at intervals, had reduced her to her then pitiable condi-
tion ; that contractions of the womb were experienced during
several of the last attacks, and that the excruciating severity of
the last "pains" abated only with the appearance of a tumour
in the vagina, between the labia ; that leucorrhcea was a con-
stant disease with her in the intervals between " bleedings."

Secondly, the indication from the tumour : It had but little,
if any sensibility ; was in a state of partial gangrene ; could be
traced to its connection with the partially inverted fundus ; and
had but recently made its appearance.

Lastly, the indications from the uterus : The conical apex of
the partially inverted fundus could be felt immediately within
the uterine lips ; the os was circular, dilated, and permitted the
finger to be passed between it and the neck of the tumour, in its
entire circumference ; a silver probe could be passed for some
distance within the uterine cavity at its lower side ; the posterior
part of the body rested in the hollow of the sacrum, and the
mouth of the womb behind the pubis.

So soon as such arrangements as were necessary could be
be made, I ligated the tumour ; using for this purpose, a wire,
passed through a double silver canula. I was careful in the
performance of this operation, not to cany the wire within less
than three-quarters of an inch of the uterine lips, and to note

1859.] Laxdrum. Case of Uterine Polypus. 321

that there was no pain when the ligature was tightened. Doc-
tors Willis, Willingham, James S. Sims, and William T. Lan-
drum, were present, and confirmed my diagnosis, as well as the
propriety of the operation. There was no fresh disturbance in
the case during the balance of the day and night, except some
pain in the parotid gland, which had commenced swelling be-
fore the operation was performed.

This parotid inflammation I regard as a sequence of the
irritative fever, engrafted on a vitiated habit of constitution. It
is not an unfrequent attendant of the same condition of consti-
tution in low states of typhoid fever.

I visited the case the day after the operation, and whilst
-tightening the cord the entire tumour came away. It came
away, not at the point constricted by the wire cord, but three-
quarters of an inch above the cord, at its point of connection
with the womb. Denman speaks of this, as the uniform result
of the application of a ligature. Says he, ''there is not occa-
sion to fix it (the ligature) upon any precise part of the root or
stem, because the part beyond the ligature decays and comes
away with the rest, leaving the uterus clear." This is exactly
what took place in my case. Its point of separation presented
the cartilaginous formation to which we have referred, and had
the appearance of having been implanted into the womb, rather
than to have grown from its once healthy tissue. I now used
an injection of chlorate of potash, combined with warm water
and sweet milk, which I directed to be repeated twice a day.
Mrs. B. expressed feelings of great local relief, which continued
from this time until her death, near two weeks afterwards. She
was now given over to the care of my cousin, Doctor William
T. Landrum, with confident hopes of an ultimate recovery.
But, alas ! in this, we were but too sadly disappointed. The
irritative fever which might have abated, under sustaining treat-
ment, after the removal of the offensive mass and its irritating
emissions from the vagina, received fresh fuel from the progress-
ive inflammation of the parotid gland, developed a short time
before the performance of the operation. This continued to
increase with fearful rapidity for four or five days, attended at
intervals with severe rigors, the intensity of some of which
seemed, as if they would cut short the work. The gland sup-
purated, was lanced, and continued to discharge profusely for
eight days, when death closed the scene.

322 Greene. Treatment for Varicose Ulcers, &c. [May,

The vagina and womb were examined with a speculum, five
days after the removal of the tumour; and as far as could be
observed, were rapidly returning to a healthy condition. The
discharges lost their offensive character, had become slight in
quantity, and did not colour the daily injections. Beside, all
local complaint in that region had subsided from the day after
the operation, and the patient's attention was entirely engrossed
with her distress in the parotid gland. I think, from a review
of the whole case, I may safely say, that the operation was suc-
cessful, and that the patient's death was attributable to the inci-
dental inflammation of the parotid gland and its consequences.

ARTICLE XIV.

Vienna Paste, the best Treatment for Varicose Ulcers and Varicose
Veins. By William Alexander Greene, M. D., of Stark-
ville, Georgia.

Not having recently seen the mode of treating varicose ulcers and
varicose veins with Vienna paste published in any of our jour-
nals, I thought it would not be out of place to call the attention
of the profession to this mode of treatment as being not only
most efficacious, but least dangerous. The treatment of varicose
veins is a practical, every-day subject, but inferior to none in
interest for the practising physician or surgeon. In the language
of another, " allied as this affection is, externally, to questions
of practical surgery, on the one hand, and depending for its
causes on relations of the general venous system and general
external health, on the other, a wide field of speculation is af-
forded as to treatment." Various modes of treatment are pro-
posed; the most objectionable is the ligature of the veins. A
good deal of the danger of ligature of the veins is found to ori-
ginate in the fact that the vein is enlarged ; and the ligature,
when it should go deeper than the vein, will be found to have
wounded or transfixed the vein, and caused phlebitis. My short
experience assures me of the superior value of the treatment of
varicose veins by the caustic issue, or the extemporized mixture
of lime and potash. There is no mode of treatment yet discov-
ered, says Mr. Paget, which is entirely free from risk ; but he
ifl inclined to the impression that the treatment is most safely

1859.] Greene. Treatment for Varicose Ulcers, &c. 328

and most effectually conducted by means of the local applica-
tions of caustic issues on the surface, which thicken the course
of the venous trunk.

I have just treated, successfully, a case of varicose ulcer of
the leg, of nine years standing, which utterly incapacitated the
negro for labor: he was otherwise apparently active and healthy ;
aged twenty-eight. His history of the case is, that the veins
were varicosed for some time before the ulcer appeared since
which time he has been under every conceivable mode of treat-
ment, by physicians, and in the shape of ointments, lotions,
salves, etc., each, in its turn, recommended to him as the most
specific thing in the world, but still only making the thing
worse. The form of caustic used upon this case (as upon four
others I have treated with equal success,) consisted of potassa
fusa 9ij, quick lime 3i, separately, in powders in small phials,
and subsequently mixed with a glass or asbestos rod, at the
bed-side with spirits of wine when used. A dozen or two of
small pieces of common adhesive plaster are next obtained,
each of the size of a penny, a small circular hole cut in each,
of the size of a pea. One of these perforated pieces of plas-
ter is placed over each projection or varicose enlargement of
the vein, a very small quantity of the caustic paste is next ap-
plied with a bone spatula, to the skin over the vein in the circu-
lar hole left in the plaster; ten, twelve or fifteen minutes will
be sufficient time for the issue to produce its effect, at the expi-
ration of which period the whole limb is carefully sponged with
warm water, and all the plasters and caustic washed away.
Little else was necessary in this case, as in the general class of
these cases, issue merely requiring simple dressing, while the
ulcers on the leg went on healin g pari passu.

As a local application to the ulcer during the action on the
varicose vein of the issue, any simple ointment, or black wash is
all that is required.

This treatment I have found, in a limited experience, uni-
formly successful. I do not claim or publish it, of course, as orig-
inal, but merely wish to call the attention of practising physi-
cians to the utility of this mode of treatment. In my section of
country, where there are a great number of negroes, whose work
is laborious, there frequently occur such cases, and as the case
I nave mentioned, go uncured, useless to their owners, and

324 Lecture on Asthma. [^ay

whose existence are a burthen. They can and ought to be cured,
unless there is some peculiar constitutional obstruction.

Lectures on Asthma. Delivered at Hotel Dieu, by Prof. Trous-
seau. Translated from the Gazette des Hopitaux of Septem-
ber I6th, 1858, (for the Boston Med. and Surg Journal).

LECTURE III. EXAMINATION OF THE OPINIONS
OF THE PEOFESSION ON THIS DISEASE.

Having rapidly pointed out to you some of the causes under
the influence of which the attacks of asthma are produced, I pro-
ceed to examine with you the opinions which have had, and
still hold a place in science as to the nature of this complaint. I
shall speak of the opinions of Rostan, Louis and Beau, that I
may discuss them and give you my way of considering them, my
method of interpreting the facts in the case.

If* my honorable colleague, Prof. Rostan, admits to-day the
existence of purely nervous asthma, he has not always admitted
it. There was a time when he did not believe in this peculiar
neurosis of the respiratory organs, and he regarded it as being
symptomatic of affections of the heart. Influenced by the re-
collection of the laborious investigations which he had made on
this subject in the case of the asthma of old men, while he was
a physician of the Salpetriere, M. Rostan recognized no differ-
ence between asthma and dyspnoea. To him, these two words
were synonymous; to me, this is far from being the case.
Asthma is, in my eyes, a special, complete malady ; it is a mani-
festation, a particular form of a general condition, having very
different local expressions, manifestiug itself sometimes by attacks
of dyspnoea, of oppressed breathing, constituting asthma, but
able, also, to exhibit itself in attacks of articular gout, or gout
in a more diffused form, in attacks of gravel, or rheumatism.

It is not the difficulty of breathing which constitutes asthma ;
for it would be necessary in this case to call by this name the
dyspnoea which is symptomatic of diseases of the heart, or great
vessels, the violent distress which goes to the verge of suffoca-
tion in patients suffering from oedema of the glottis, or children
taken with croup. Now there is no one who would not shun
such a confusion. Between dyspnoea and asthma the difference
is immense. If asthma be a dyspnoea of special form and char-
acter, every attack of dyspnoea is not asthma.

Have you ever seen, in an individual affected with disease of
the heart, the attack of dyspnoea, which this occasions, to be
diminished by exercise ? Do you not every day witness the
contrary ? At will, so to speak, you may bring on an attack of
dyspnoea in any person affected with a disease" of the heart of

1859.] Lecture on Asthma. 325

moderate severity. Walking a little more rapidly than usual,
the act of going up stairs, are sufficient to bring on an oppres-
sion more or less considerable, sometimes bordering on suffoca-
tion. These attacks of symptomatic asthma ma}' always come
on independently of this cause ; they may occur in some per-
sons under the influence of moral emotion, in others without
appreciable cause.

But if spmptomatic dyspnoea may occur, as well as essentially
nervous asthma, without organic cause, it is important, in order
to distinguish one from the other, to consider what is their usual
course.

The attack of asthma behaves in a similar way to an attack of
fever : that is to say, it comes on with a certain amount of delay
sometimes, it is true, abruptly enough ; it arrives by degrees at
its climax, like all nervous affections, then decreases in the same
way, gradually, leaving the person who has suffered from it in
a state of perfect health, for a longer or shorter period, until the
return of a new attack.

Is this the course, is this character of a dyspnoea symptoma-
tic of diseases of the heart? Assuredly not; in that case the
attack is always abrupt, never does the oppression yield so com-
pletely ; always threatening, it never leaves, after the crisis, the
individual in the state of perfect health which falls to the lot of
the asthmatic.

The last, his attack over, is no longer exposed to its return
under the influence of the slightest emotion, or exercise a little
more violent than usual ; up to the commencement of an attack,
he will follow his usual manner of life without fear of being-
checked. An individual affected with disease of the heart is
always in danger of an attack, which the smallest cause may
bring on.

Without doubt, and it is necessary to be on our guard, true
attacks of asthma may complicate affections of the heart and
lungs. This is indisputable, neither of these classes of disease
exclude it.

Let us inquire what takes place here, and return to the more
general considerations of which I have often spoken to you.

A woman has a carcinomatous disease of the uterus ; she has
pains in the loins, pains in the lower abdomen, which increase
as it progresses, which are greater during menstruation, during
digestion, or in the act of defalcation, and which are exasperated
by digital examination : another will have no pain, while a third
will have uterine neuralgia, returning every day, rigorously at
the same hour, with a periodicity so regular that the patient can
foretell its return almost to a minute. In two patients whom I
have seen, one with Recamier, the other with my excellent
frend, Dr. Lassegen, these attacks lasted five or six hours ; in the
last patient they had continued for many years. The agony

326 Impermeable Stricture. [May,

was atrocious. During the paroxysm, the patient rolled and
writhed on her chamber floor. In the interval between the
attacks, she only felt a sensation of heat in the organ affected.

In these different cases, whether the pain be permanent or
intermittent, the lesion is the same. But in the latter case, there
is grafted on it a neuralgic affection ; to the cancer is added the
painful nervous affection, which it does not exclude.

In the same way, if an individual is affected with a disease of
the heart, this does not exclude, in his case, the possibility of
asthma. If some patients support the most serious affections of
the heart without experiencing symptoms of proportional severi-
ty, others suffer most terribly with lesions much less pronounced
than the first ; in others, still, a nervous disorder may be en-
grafted on the organic affection ; in a word, each individual has,
so to speak, his own way of carrying his disease; he may ex-
perience paroxysms of a peculiar character, according to his
temperament, and it is essential to be acquainted with his par-
oxysms to be able to separate the nervous element from the or-
ganic one which complicates it.

The patient whose autopsy we made on Sunday last, had
presented the most marked symptoms of angina of the chest.
What is this angina pectoris ? In a great'number, in the great-
est number of cases, it is a neuralgia symptomatic of an affection
of the heart and great bloodvessels; but in some cases it is per-
fectly independent of all organic affection of the central organs
of the circulation, independent even of all appreciable organic
change. It is a true epileptiform neuralgia, it is a form of mani-
festation of this fearful malady. It has its abruptness of attack,
its rapid course, its sudden cessation ; it is a kind of epileptic
vertigo, and some of those who have at other times had attacks
of angina pectoris, have later true attacks of epilepsy.

Nervous disorders, then, may be engrafted on organic diseas-
es, but they are independent of them, and these last are only the
occasion of their development. They are independent of them,
in the sense that the organic lesion is not ordinarily accompa-
nied by them ; and if; to return to asthma, we see it come on in
persons affected with diseases of the heart or lungs, it is the
evidence of their disease that they had, by nature, the asthmatic
diathesis. In them the lesion of the heart, the pulmonary dis-
ease, has been the occasion of the development of a malady
which has been lying dormant, and which, perhaps, was only
waiting for this occasion to manifest itself. S. L. A.

Impermeable Stricture.
M. Charles Philips terminates a series of papers upon this
subject with the following conclusions : 1. The transformation
of tissues produced by urethritis may completely obliterate the
canal. 2. Complete obliteration takes place more frequently

1859.] On Acupuncture,

after traumatic action than after simple inflammation. 3. It is
always complicated with urinary fistulas 4. Complete oblitera-
tion is perfectly distinct from stricture termed impermeable. 5.
This latter always allows a certain portion of urine to pass, either
at more or less close intervals, or continuously drop by drop.
6. Wherever urine can pass, a bougie may be always introduced,
on condition of our proceeding slowly, patiently, and with full
confidence in the power of the instrument. 7. Perforation is
the basis of the treatment of complete obliteration. 8. If the
obstacle is situated in the straight portion of the urethra, it
should be attacked by a trocar, the finger being able to follow
and guide this through the tissues. When the obstacle is situa-
ted in the curved portion, we should first introduce a grooved
canula into the perineal fistula, which may serve as a guide to
the trocar passed by the meatus. 9. If retention of the urine is
produced by stricture, catheterism should never be performed
by means of a metallic instrument. Filiform bougies should be
employed, which should be introduced slowly, and after a few
minutes withdrawn. Each time a little urine is discharged,
with relief to the patient; and when his suffering becomes
abated, we may fix the bougie, and the whole of the urine will
be discharged over it. 10. If the introduction of the bougie is
for the time impossible, and the retention becomes insupportable,
supra-pubic puncture of the bladder should be resorted to. 11.
If retention is complicated with infiltration of urine, and the
introduction of the bougie cannot at once' be accomplished, the
supra-pubic puncture should be made, as should be large incis-
ions into the perineum. After a few days the tissues will have
become sufficiently disgorged to admit of new attempts at catheter-
ism. Not being now pressed by the patient's sufferings from
retention, we may proceed slowly and cautiously, and we shall
traverse the stricture erroneously believed to be impermeable.
[Brit, and For. Med. Chir. Rev., from Bui. dc Tkcrap.

On Acupuncture. By Dr. T. Ogier Ward, Kensington.

I have read in the 'Journal' with much interest the lectures of
Dr. Brown-Sequard, especially the fifth, which seems to be the
most practical, inasmuch a s the experiments detailed, proved that
irritation, &c, of one part, may be transmitted by reflex action
to another more distant part, in the following manner. The
irritation is conveyed by an afferent nerve to the nervous cen-
tres, and thence is reflected to the more distant part through the
sympathetic which, by producing a contraction of the ves-
sels, reduces the hyperemia of the affected part. In this way
Dr. Brown-Sequard explains the benefit derived from the actual
cautery in facial neuralgia and affections of the eyes, when ap-

328 On Acupuncture. [May,

plied to the ear of the same side, or even between the shoulders.
A completely opposed explanation of the action of the actual
cautery has been recently given by Dr. Inman, in a paper read
to the Lancashire and Cheshire Branch ; and certainly Dr. Brown- 1
Sequard's experiments, though they establish the facts in some
cases, do not afford any explanation why this action of the
sympathetic nerves is confined to a part in a morbid condi-
tion, and does not extend, at least, so far as can be ascertained,
to the whole system. But whether Dr. Brown-Sequard or Dr.
Inman be right, non estmeitm tantas componere lites ; the object
of the present communication is to offer an explanation, deduced
from Dr. Brown-Sequard's experiments, of the benefit derived
from two operations much less severe than the actual cautery,
which, from its formidable appearance, is never likely to be used
extensively in this country, at least, in private practice.

The operations I allude to are, the injection of opiates beneath
the skin over the nerve affected in tic douloureux, and acupunc-
ture; in both of which, the great and immediate benefit by the
cessation of the pain, is to be attributed to the punctures, and
not to the opiate injected. I do not deny that the opiate may
be absorbed, and produce a certain amount of direct effect on
the nerve where this is situated superficially ; and the profound
sleep produced in some instances must be attributed to the
opiate; but in cases where the injection has been successful in
deeply-seated pains, I believe we may reasonably ascribe the
cure to the simple puncture, especially as we meet with the same
results from acupuncture. Hitherto the modus operandi of
acupuncture has been involved in mystery, but now Dr. Brown-
Sequard's discovery of the reflex action induced by counter-
irritation, appears to afford at least a plausible explanation of it.

Acupuncture is a remedy that seems to have its floods and
ebbs in public estimation ; for we see it much belauded in medi-
cal writings every ten years or so, even to its recommendation
in neuralgia of the heart; and then it again sinks into neglect
or oblivion ; and it is not unlikely that its disuse may be occa-
sioned partly by fear of the pain, and partly by the difficulty
the patient finds to believe so trifling an operation can produce
such powerful effects. Another reason for its neglect may be,
that, like every other remedy, it fails occasionally, and the prac-
titioner, disgusted at having persuaded his patient to submit to
a pain, which, though slight, has been attended with no benefit,
will not again undergo such a disappointment. However this
may be, its use is not as frequent as it deserves ; and now that
we know the rationale of its operation, I venture to bring
forward a few cases in illustration of its remedial powers, in order
that others may be induced to give it a more extensive trial,
and thus ascertain its true value in the treatment of neuralgic or
rheumatic pains.

1859.] On Acupuncture. 329

Case 1. A middle aged labourer came to me with a chronic
rheumatism of the parts about the right shoulder, particularly in
the deltoid, which was so painful that he could not raise his arm
horizontally. I inserted two needles into the muscle, one just
below the head of the humerus, and the other near the insertion
of the muscle and in about a quarter of an hour he could lay his
hand on his head, and in a few days was quite well, without a
second operation.

Case. 2. An elderly laborer, suffering from rheumatic pain
and stiffness of the rectus and other muscles in front of the right
thigh, so that he dragged the limb in walking, was enabled to
walk without much limping, after the insertion of three needles
down the front of the thigh for a period of twenty minutes; and
he required no further treatment.

Case 3. An old clergyman, very liable to sciatica, having
been advised to try acupuncture, was in the habit of using daily,
previous to dressing himself, two or three needles inserted along
the course of the nerve, to enable him to walk down stairs with
comfort.

Case 4. A lady of middle age, suffering so much from lum-
bago and sciatica, that she could not rise from her chair without
assistance, after trying hip baths and mustard poultices in vain,
was induced to apply the^needles to the most painful parts, when,
to her astonishment, the pain was much relieved, and after three
applications, was entirely removed.

Case 5. A lady advanced in pregnancy, similarly affected
to the last case, and who had failed in obtaining relief from
baths and mustard plasters, used a single needle with complete
success, but not without considerable disappointment from the
extreme pain produced by the operation. This is the only in-
stance of a complaint of the kind I have met with, as, after the
immediate pricking sensation during the passage of the needle
through the skin, the feeling is usually like that produced by
the strong pressure of the point of the ringer on the part.

In none of the above cases was there any constitutional affec-
tion, each patient stating that his health was perfect ; nor was
there any appearance of local inflammation. Indeed my use of
acupuncture has always been confined to such cases as the above,
and I should not expect that acute rheumatism or neuralgia
would be benefited by such means.

In conclusion, I would remark that, though the benefit of
acupuncture has been attributed by some writers to a quivering
of the affected muscles, which is indicated by a vibratory motion
of the needle whilst inverted, such an appearance has never pre-
sented itself in any of my experiments upon myself or others.
[British Med. Jour., and Braithwaite's Retrospect.

330 Various Formula* for Oelatinization of Cod-liver Oil. [May,

Various Formula* for the Gelatinization of Cod-Liver Oil.
M. STANISLAS MARTIN'S JELLY MODIFIED.

$. Cod-liver oil, lij.

Fresh spermaceti. 3ijss.

Simple syrup, 3vj.

Jamaica rum, 3yj.

Beat the ingredients together with the aid of heat, and when
the mixture has acquired some consistence, pour it into a wide-
mouthed bottle.

COD-LIVER OIL, SOLIDIFIED WITH GELATINE.

$. Pure gelatine, 3ss.

"Water, iv.

Simple syrup, 3iv.

Cod-liver oil, Sviij.

Aromatic essence. q. s.

Dissolve the gelatine in the boiling water, and add successive-
ly 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 porclain or
earthenware pot, which should be carefully closed.

COD-LIVER OIL GELATINIZED WITH CARRAGEEN OR IRISH MOSS.

#. Fucus crispus, - fss.

Water, 3xviij.

Simple syrup, Sviij.

Cod-liver oil, Bviij.

Aromatic, q. v.

Boil the carrageen in the water for twenty minutes ; pass the
decoction through flannel ; concentrate it until it is reduced to
four ounces by weight ; add the syrup, the oil, and the aromatic ;
whip the mixture briskly, having first placed it in a cold bath,
and pour it, while still a little warm, into the vessel intended to
receive it. The syrup may be replaced by an equal quantity of
Garus' elixir, mint or vanilla cream or rum, &c.

M. Sauvan proposes to combine cod-liver oil with Iceland
moss.

LICHEN AND COD-LIVER OIL.

$. Iceland moss jelly, oiv.

Gelatine, .... . 9iv.

Hydrocyanated cod-liver oil (to which two drops

of essence of bitter almonds have been added) 3 vj.
Prepare the Iceland moss jelly in the usual manner; melt the
gelatine and pass it into the vessel which is to hold it ; then

1859.] Use of the Ecraseur in Polypi of the Uterus. 331

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 spoonfuls daily. [Bull. Gen. de Therap, and
Dublin Hospital Gazette.

Practical Observations on the Use of the Ecraseur in Polypi of the
Uterus. By Dr. Kobert Jokn'S, Member of the Council of
the Surgical Society of Ireland, &c.

[A lady, ten years married, but never pregnant, consulted the
author last year, stating that during the last two years she had
been subject to severe menorrhagia, often passing large clots;
and also suffering from severe uterine pain, diarrhoea, sickness,
and other symptoms arising from loss of blood. She had a very
anaemic, even malignant aspect.]

On making a vaginal digital examination, I found a fibrous
polypus, about the size of a chestnut, projecting from the os
uteri, which, by very slight traction, was brought down into the
vagi Da ; it was attached to the inner and anterior surface of the
cervix, about an inch from the os, by a pedicle of about two
inches long, and half an inch thick; theos was patulous, flaccid,
and dilatable. Having determined to remove the tumour by
"ecrasement lineaire," I explained to my patient what I propos-
ed doing, to which she willingly consented, at the same time
saying that she would submit to any treatment to be again re-
stored to health. As she expected to be unwell on the day or so
following, I deferred any interference until after the period had
passed over, but I ordered a tonic mixture, containing the am-
monio-tartrate of iron, &c.

September 20th. The catamenia have ceased for three days.
Ordered to have the bowels well freed, and to repeat the tonic
iron mixture.

23rd. This morning I found my patient in a state of great
excitement, and very hysterical. Not deeming her a fit subject
for chloroform, I gave her some wine, which had the desired
effect. Having then placed her in the position for lithotomy
which I considered preferable to any other in such cases, when
operating on virgins, on females like Mrs. D., whose vagina is
not much dilated nor very dilatable without inflicting much un-
necessary pain, or on those whose os uteri is very high up I
then proceeded thus. Having gradually and gently introduced
the first two fingers of my right hand into the vagina, and having
found the polypus in the position before described, I passed a
finger on each side of its pedicle, a little above its insertion into
the tumour, and drew it down as near as possible to the peri-
neum ; having now replaced my fingers by the chain of the
ecraseur (which then surrounded the tumour,) I shortened it

V, B. VOL. XV. vo. v. 24

382 New Modes of Administering Iodine. [May,

until constriction was produced, and removed the polypus very
slowly and steadily. There was not a drop of blood shed either
during or subsequent to the ecrasement, nor did my patient ex-
perience the least pain. A very trifling vaginal, discolored dis-
discharge, caused by the debris of the pedicile, set in that evening,
and continued for three days. Cold water vaginal injections
having been daily employed, on the fifth day she was up and
about her house, and not a vestige of the pedicle could be dis-
covered by the " toucher," but as the os was still very patulous,
and felt rough, an examination with the speculum was institu-
ted, when an nicer was seen extending about two-thirds around
the os uteri, which yielded very quickly to a few applications
of solid nitrate of silver, when the os closed up to its normal
state. This lady called to visit me on the 3rd of December,
when in appearance she was greatly changed for the better, as
she had regained her natural healthy colour, and had lost the
malignant aspect. She stated that her periods had become per-
fectly regular and painless ; she had no vaginal discharge of any
description ; and, in fact, that she was in better health than she
had enjoyed for years.

The following facts, I think, are fairly deducible:

1. That vaginal hemorrhage, continuing for any length of
time, being accompanied by clots of blood, assuming particular
shapes, and having been preceded by an increase of flow at the
catamenial periods, is strong presumptive evidence of the exist-
ence of polypus of the uterus.

2. That the situation of the tumour, whether in the uterus or
descended into the vagina, does not seem to exercise any effect
in increasing or decreasing the hemorrhage.

3. That the amount of blood lost in this disease is not in pro-
portion to the magnitude of the tumour.

4. That ulceration of the os or cervix uteri is a very fruitful
source of hemorrhage in polypial disease.

5. That it is not by any means necessary to draw the tumour
externally to the vagina, in order to remove it by linear ecrase-
ment.

6. That there is no advantage derivable from ecrasing the
pedicle high up.

7. That the ecraseur is a valuable instrument if properly
employed ; that is very slowly and steadily ; but, if not, its use
is very doubtful, if not hazardous. [Dublin Quarterly Journal.

New Modes of Administering Iodine.

Efforts have lately been made in France to administer iodine
in a more efficacious manner than had hitherto beea done.
M. Leriche, of Lyons, has published valuable articles inZ' Union

1859.] Internal Treatment of Ulcers of the Leg. 333

Medicate, wherein he endeavors to show that iodine, combined
with vegetable substances, advantageously replaces cod-liver oil.
He proposes a syrup made of the juice of water-cress and iodine,
and also an iodine wine. The syrup has the advantage of not
fermenting, and contains exactly one grain of iodine per ounce.
The wine is composed thus: Bordeaux wine eight ounces; con-
centrated infusion of red roses about thirteen drachms; tincture
of iodine one drachm and a half. Each ounce contains one grain
of iodine. From one to six tablespoonfuls may be given daily,
according to the indications and the age of patients. In the
space of three years M. Leriche treated 38 scrofulous patients
with the wine ; 21 were perfectly cured after a treatment steadily
pursued for some time ; 8 did not improve at all ; and 9 improved
but slightly, either because the treatment was carried on imper-
fectly, or because it was left off too soon.

M. Boinet, on the other hand, well known by long-continued
investigations respecting the use of iodine, read on the 28th of
September last, before the Academy of Medicine of Paris, a
paper, in which he proposes to use iodine as an article of food.
The author administers iodine as found in nature, viz., combined
with those plants which contain the greatest quantity of the
alkaloid. The latter being thus given in minute doses, in a
continuous and almost imperceptible manner, yields most advan-
tageous results. M. Boinet uses fuci, marine plants, cruciferae,
salts containing iodine, and some mineral waters holding iodine
in solution. His excipients are ordinary bread, ginger-bread,
cakes, buiscuits, chocolate, wine, beer, syrup, &c, some being
especially calculated for children. Trials were begun by M.
Boinet as far back as 1849, upon subjects suffering very severe-
ly from the various well-known scrofulous symptoms, and most
of them were cured after continuing the iodized food for several
months. The author has not found that iodine administered for
a long time produced a loss of flesh and atrophy of certain or-
gans. Far from having these effects, the iodine, in his hands,
has invigorated patients, and favored the development of organs,
Messrs. Chatin and Trousseau are to report upon the paper.

[American Jour, of Med. Sciences.

On the Internal Treatment of Ulcers of the Leg by Iodide of Potas-
sium. By M. Trastour.

Without reviewing the theory of an " ulcerative diathesis,"
advanced by Phil. Boyer, M. Trastour is of the opinion that
ulcers of the leg are owing as often to a general disposition of
the economy, as to local causes, and this opinion seems to him
justified by the success which he has obtained from iodide of
potassium in the treatment of these ulcers. Kepeated observa-
tions permit him to draw up the following propositions: 1.

334 Intestines of a Pig fed ivith Typhoid Dejections. [MayT

Iodide of potassium, administered in a dose of two to six gram-
mes a day, cures the most obstinate ulcers of the leg in one or
two months, rarely more, no matter whether they are of syphili-
tic nature or not. The ulcers, and even the varicose congestion,
yield rapidly to this medication, which may be assisted by regu-
lated compression and a simple dressing. 2. The patients can
continue their occupation during the treatment; they do not re-
quire rest. 3. The cure by this simple method is easier, more
complete and reliable, than by any other known method.

There are however a certailn kind of ulcers which require a
special and more complex treatment; these arc the scorbutic,
herpetic, and scrofulous ulcers. Of ulcers which did not pre-
sent one of these peculiar characters, M. Trastour reports several
cases which speak highly in favor of his mode of treatment.
The modification which takes place in the ulcers by the use of
iodide of potassium may perhaps be explained by supposing that
this salt, which passes rapidly into all the secretions, passes also
into the ulcerous secretion. Brought in contact with the ulcers
from within to without, it modifies them, molecule after mole-
cule, that is to say, as completely as possible; at the same timeT
it acts upon the surrounding 'congestion, and upon the whole
constitution. [Journal de la Societe Academique de la Loire-
Inferieure, and North American Med. Chir. Review.

Intestines of a Pig, which, for six weeks before deathj had been fed
with " Typhoid Dejections."

Dr. Muechison exhibited these to the Pathological Society of
London, and observed that although it was generally admitted
that the true typhus fever is eminently contagious, many still
entertained doubts as to the contagious nature of the so-called
"typhoid fever;" yet it was difficult to explain in any other
way, the facts which had been adduced by Breton neau, Gend-
ron, Piedvache, and others. Some observers and more particu-
larly Dr Budd, of Bristol, and the late Dr. Snow, had thought
that typhoid fever was propagated by the dejections from the
bowels. Without questioning the validity of this supposition,
Dr. Murchison expressed his belief that many of the facts which
had been urged in its support might be explained on the hypo-
thesis of a spontaneous origin of the fewer from the putrid
emanations from the drains, which had been thought merely to
convey the poison. All those who had considered that the
fever might be communicated by the dejections had been strong
opponents of the possibility of its spontaneous origin. It was
obviously of great importance, both in a medical and a sanitary
point of view, to determine whether fever might be communica-
ted in the manner just alluded to. The experiment had been

1859.] Ergot in Certain Diseases of the Eye. 335

undertaken in order to throw some light upon this question ;
audits results were offered simply for what the results of one
experiment might be worth. A pig had been selected for the
experiment for the following reasons: 1. Because in its diet it
approached most nearly to man; and it was thought that less
difficulty would be encountered in making it submit to the ex-
periment than with other animals. 2. There were few or no
animals in which the structures that became specially diseased
in typhoid fever, viz. Peyer's patches, were so well developed.
3. Because there was evidence that the pig was liable to typhoid
fever. Cases of the disease, in this animal, in which the charac-
teristic lesions had been found after death, have been described
by Falke and other writers on veterinary medicine. The pig
selected was between three and four mouths old. Care was
taken that the dejections were obtained from typhoid patients in
whom they presented the light ochrey colour peculiar to the
disease in the most marked degree; they were mixed up with
barley-meal and other articles of food. The first was given on
Sept. 9th, 1858. For the first three weeks one was given every
day, or ever}' second or third da}'. During the next fortnight,
two or three were given every day; and, during the last week,
one every second day. They were eaten greedily. On two
different occasions, during the first fortnight, the animal had
slight diarrhoea, lasting for twelve hours, and its ears felt rather
hot; but these symptoms speedily subsided. With these excep-
tions, the animal exhibited no abnormal symptoms; its stools
were of normal consistence, and it increased greatly in weight
and size, as was shown by measurements taken at the com-
mencement and at the termination of the experiment. On Oct.
23d it was killed, and its body opened. There was abundance
of subcutaneous fat, and the muscular tissue appeared healthy
in every respect The intestines throughout were healthy.
There was not the slightest trace of any recent or old ulceration
anywhere, nor of any thickening or alteration of Peyer's patches,
or of the solitary glands. The mesenteric glands were not
enlarged. [London Lancet.

On the Use of Ergot in Certain Diseases of the Eye. By Dr. V.

WlLLEBRAND.

The known effect of ergot upon the unstriped muscular fibres
of the uterus, and upon the analogous tissues of the walls of the
blood-vessels, induced Dr. V. Willebrand to try this remedy in
several forms of diseases of the eye, in which he supposed that
the evil could be cured by exciting a greater contractility iu the
walls of the blood-vessels, or in other tissues containing un-
striped muscular fibres. The greatest benefit from the adminis-

336 Treatment of Syphilis in Pregnant Women. [May,

tration of ergot, the author derived in those disturbances of the
function of accommodation, described as hebetudo visits, (asthe-
nopia), in which the eye can accommodate itself only for a short
time sufficiently to occupations near to the face, (reading, writing,
sewing, etc). Dr. V. Willebrand met serious cases of this kind,
particularly among the pupils of young ladies' seminaries, who
are generally exposed to unfavorable conditions of ocular hy-
giene, such as writing with the body bent forward, and with in-
sufficient light. The author cured all these cases, at least for
some time, by the exhibition of ergot; at the same time he
ordered the eyes to be spared, and spectacles dampening the light
to be used. The author used the remedy successfully also in a
case of epophthalmus with hypertrophy of the heart and of the
thyroid gland, (a peculiar combination which has been lately
much discussed), and in blepharitis, and pustular syndermitis of
children. As the usual dose for adults, he prescribes five grains
of ergot, generally combined with magnes, carbon., sometimes,
if chlorosis is present, with iron, to be given three or four times
daily. [Archives fur Ophthalmologic, and North American Med.
Chir. Review.

On the Treatment of Syphilis in Pregnant Women. By. M. E.
Bertin.

Among the facts which have contributed the most to make the
employment of mercury during pregnancy objectionable, and to
diffuse the opinion that this medicine easily produces abortus
or death of the foetus, those which M. Colson has recorded in
his memoir, " De l'influence du traitement mercuriel sur les fonc-
tions de l'uterus," {Archives Generates, tome xviii. p. 24,) deserves
especial notice. M. Bertin has subjected these not very numer-
ous observations to a critical analysis, which shows peremptori-
ly that not one of them has the demonstrative character which
has been so readily attributed to them. He mentions then a re-
markable case of Moriceau, which shows that mercury not only
does not cause abortus, but that it may even prevent it, (Des
maladies des femmes grosses, etc., 2d edit., p. 179), and reports
the history of eleven pregnant women who were treated in the
Maison de Secours of Nancy. This is the complete series of all
the cases which have presented themselves during the first four
months of the year 1857.

All these patients, in whom pregnancy was more or less ad-
vanced, suffered from secondary symptoms, and were treated
with pills of protiodide of mercury, or with the liquor of Yan
Swieten. Out of these eleven women, eight were delivered at
term of living children, and their pregnancy had followed its
natural course during their sojourn in the hospital ; one of them

1859.] Inutility of Depletion in Syphilitic Iritis. 337

was subjected to two mercurial treatments while she was preg-
nant, and did net experience any bad consequences. In the
three other patients the pregnancy did not reach its term ; but it
is more than probable that the mercury had nothing to do with
this result. In fact, one of these women was delivered of a dead
child in a state of putrefaction, the movements of which had
ceased to be felt before the mother entered the hospital. The
second had miscarried already twice before she contracted the
venereal disease, and it is possible the third abortus took place
under the same influence as the two others. The last patient
was delivered of a living child of seven months, upon which,
consequently, the mercurial treatment could not have acted in a
fatal manner.

M. Bertin concludes, from these facts, that mercury does not
exert a fatal influence upon the human foetus, (contrary to the
opinion of Professor Trousseau), and admits, with Ricord, ? that
the period of pregnancy, far from opposing the employment of
energetic measures, demands still more attention and judicious
promptitude." [Compte Rendu des Travaux de la Societe de Med-
ecine de Xancy, and IbicL

Inutility of Depletion in Syphilitic Iritis.

Mr. J. Hamilton, Surgeon to the Richmond Hospital, states
(Dublin Hospital Gazette, May 15, 1857) his belief " that in the
treatment of syphilitic iritis, even the most acute cases, all that
is necessary to be done is to administer mercury properly, suit-
ed to the constitution of the patient, and the nature of the case,
and till full salivation-, and the application of the extract of bel-
ladonna round the eye, or of the solution of atropine in the eye.
I totally disagree with those authors Mr. Tyrrell, for instance
who recommend, in cases where the patient is broken down, to
administer tonics, &c., till he is able to bear the mercurial course,
the real fact being, that the best tonic is the mercury, combined
with opium, which by expelling a depressing poison from the
system, invigorates it, at the same time that it arrests the rav-
ages of a destructive specific disease ; whereas, while waiting for
the effects of tonics and diet, the eye may be lost. There could
not be, apparently, more feeble or depressed subjects than No,
8, Mary Byrne, or Xo. 4, John Callaghan, particularly the lat-
ter, who was literally nothing but skin and bone, with a pale
sallow face, contrasting with the large red tubercles with which
it was studded, and so weak he could scarcely stand; yet, under
the beneficial action of the mercury, while the eye was saved,
his flesh, strength, and complexion, all became rapidly restored,
so that in his last letter to me, he describes himself, in language
more remarkable for strength than orthography, 4 as strong as a
boss, and as fat as a wheal V

338 Inutility of Depletion in Syphilitic Iritis. [May,

" Many surgeons do not deplete, but the large majority still
do, by leeching and cupping; rarely, I believe, in this country,
by venesection, as recommended by Mr. Mackenzie. During
fourteen years, a very large number of cases of syphilitic iritis
have been under my care in the Eichmond Hospital, and I have
only cupped in one case; and with my present experience, I am
sure if that case presented itself now, I should not do so."

As this is one of those practical questions best decided by
facts, Mr. Hamilton quotes five cases from his case-book in sup-
port of his views. One of these cases we quote :

"John Callaghan, aet. 24, transmitted into No. 4 ward of the
Eichmond, from the Whitworth Hospital, February 26th, 1857.
He is one of the city police, and was once a stout powerful man,
but is now sickly -looking, sallow, and emaciated. A thickly
scattered eruption of tubercles over the face, on the eyebrows,
sides of the nose and chin. He became infected with syphilis
about ten months ago, and has since suffered from pains in his
bones, sore throat, and eruptions, with rapid decline of health
and strength. He has taken mercury irregularly. Ten days
ago the right eye became tender and inflamed, and quickly got
very bad. His only treatment has been one leech and a blister
to the temple, and bark mixture ; but he had taken no mercury
for a month.

"The right eye is affected with acute iritis; the sclerotic of a
deep dull red, most marked round the cornea; the conjunctiva
also is traversed by many large red vessels ; the iris of a dull
yellowish-gray, contrasting with the clear bluish-gray of the
other eye; the pupil hazy and irregular, adhesion existing at
the lower and outer rim, where the iris is of a dull reddish-
brown, as if a tubercle was about to form there; the pupil is
nearly as large as the other, perhaps slightly affected by the ex-
tract of belladonna which was applied last night; sight very
much injured though he can see me in a bright line at three
feet, he cannot discern a feature of my face ; intolerance of light,
and some lachrymation ; pain in the brow, extending to the
eyeball and temple, begins at ten o'clock at night, and lasts till
one o'clock, A.M. Submur. hydrarg. Bj, opii gr. ij, in pilulas x.

"Third day. Eye somewhat clearer ; the deposition of rusty-
colored lymph appears less; not so much pain last night. He
has taken eight pills, but no perceptible effect on the mouth,
nor any griping. The belladonna has had no influence on the

pupil.

" Fifth day. The mouth is sore, and there is some griping.
The eye is better, and he can distinguish my features, and the
studs on my shirt. To take a pill night and morning.

"Seventh day. Mouth fully sore; a very decided improve-
ment in his vision, and the appearance of the eye ; the iris clear-
ing, and the rusty lymph absorbing; pupil clear and black, and

1859.] Obstinate Hemorrhage, &c. 339

the redness much less. He bears light better; no nocturnal pain
of the brow the last two nights; the eruption of tubercles on his
face and body are fast disappearing.

"On the twelfth day the eye was not so well, more vascular
and uneasy evidently an attempt at a relapse. By increasing
the quantity of mercury for two days, he got better; all traces
of the iritis afterwards entirely disappeared.

"On the twenty-second day, having been quite well for sev-
eral days, he requested his dismissal, wishing to go to the coun-
try. I had a letter from him a few days since, saying that he
had regained strength and flesh, that the sight of the eye was as
good as ever, and no traces of the eruption existed. He had
continued to take the mercury so as to keep up the mercurial
action in the system, altogether for about ten weeks."

[American Jour, of the Med. Sciences.

Obstinate Hemorrhage following a division of the Froenum Lingual.
By A. Reeves Jackson, M.D., of Stroudsburg, Monroe Co.,
Pennsylvania.

Having occasionally seen reported in the medical journals, cases
of fatal hemorrhage from the division of the framuru linguae in
children, I am induced to relate the following case, in which a
very simple contrivance was entirely successful in checking the
bleeding, after an operation of this kind.

Some years ago I was called to see an infant, aged eight
months, son of Mr. S , near White Haven, Pa., in consulta-
tion with Dr. H., under the following circumstances. Thirty -six
hours previous to my arrival, Dr. H. had divided the fraenum
linguae, and the wound had been bleeding ever since, all the
efforts that had been made to check it having been unavailing.
Dr. H. was not present when I reached the place, but in a note
which he had left for me, he desired me to do what I could for
the little patient, and stated that he had already used, unsuc-
cessfully, cold applications, a variety of styptics, lunar caustic,
the ligature, and the actual ciutery.

The child was already very greatly reduced, from loss of
blood, which was continuing to ooze out from the cut edges of
the wound.

I procured from the father of the child (who was a deer-hunt-
er), a few buckshot, and flattened two of them out into disks, or
round plates, by means of a hammer, using the side of an axe
as an anvil. I then pierced each of these through the centre,
with a common sewing needle. Then taking a piece of anneal-
ed silver wire from a double canula in my pocket-case, I tied a
knot on the end of it; and having split, with a pocket-knife,
halfway through another shot, placed the wire I*1 t.b** !*** ~*>

340 Hysteric Condition of Joints. [^ay

of the slit, the sides of which were then firmly pressed together
with a pair of tonsil-forceps, care being taken at the same time
to draw the knot, on the end of the wire, close to the shot. The
free end of the wire was then passed through the hole in one of
the plates, which was drawn close against the shot. The other
plate was now passed up to within a quarter of an inch of the
first, and a second shot, previously split like the first, placed
against it, but not pressed so tightly upon the wire, but that it
could be moved with a moderate force.

My instrument, which, it will be perceived, formed a clamp,
was now ready to be applied, which was done in the following
manner:

The father, having taken the child in his lap, and held its
mouth forcibly open, I applied the instrument in such a way,
that the whole of the cut fraenum was brought between the flat
surfaces of the two plates. The second shot was now pressed
strongly against the outer side of its corresponding plate by
means of forceps, and by pulling, at the same time, upon the
free end of the wire. The plates were in this manner brought
closely together, and were kept in their position by pressing
together firmly, the split in the second shot. The bleeding was
immediately controlled, and nothing remained but to cut off the
end of the wire, close to the shot.

The child was then allowed small portions of wine-whey,
overy two or three hours; and, at the end of about twenty-four
hours, when the clamp was removed, there was no return of the
hemorrhage.

I think, in case of emergency, the wire might be replaced
with a piece of stout linen thread, although the former is cer-
tainly preferable. [Am. Jour. Med. Sciences.

Hysteric Condition of Joints. Mr. Barwell read before the
Medieal Society of London (November 15, 1858) a paper on
this subject.

These affections, the author observed, are not rare, especially
amongst the more luxurious classes, and they have often been
mistaken for actual joint diseases, when blisters and issues, in-
creasing the evil, have been applied, or even more heroic and
disastrous treatment adopted. It must be confessed that the
literature of the subject, and the cases collected, are meagre and
unsatisfactory, and, therefore, this paper is intended to present
a concise, yet detailed sketch of the disease, and of some new
points in its treatment.

Although in a malady so Protean as hysteria, no short de-
scription of invariable symptoms can be given, yet two peculi-
arities may be fixed upon as especially characteristic ; and these

1859.] Hysteric Condition of Joints. 341

are, the absence of the ordinary signs of inflammation, and
"anomaly." One may be inclined to add to these symptoms,
the hysteric condition ; yet, though such condition is present in
many cases, it is in others quite absent, or so slightly marked
as hardly to exceed the ordinary mobility of the feminine char-
acter. When hysteria breaks out in the paroxysm, it is usually
sated by that manifestation, and produces no such serious effects
as a pseudo malady; indeed, the imitative tendency of hysteria
is often checked by a regular fit, and a simulated disease may
occasionally thus end ; but, in other cases, the imitation may
continue uninterrupted by any other hysteric symptom, and we
are then thrown for our diagnosis upon a purely local investiga-
tion. Let us first take the knee, as the more frequently affected
joint. The pain is, in some cases, so severe as to make the pa-
tient hold her leg constantly semi-flexed and immovable ; in
other cases, it is so slight that the patient, though complaining,
walks about. The pain is not in direct, but rather in inverse,
ratio with any other hysterical symptom. It may be increased
at the menstrual period. It is generally referred to a spot on
either side of the ligamentum patellae, and is increased on the
slightest touch at this spot, but especially if a piece of the sub-
cutaneous fat here situated be pinched. In other cases, the
tenderness is spread over a larger space, but is always superfi-
cial. The articulating surfaces are not tender ; they may be
forced together, by pressing the foot upward, without producing
pain. In the severer cases, when the knee is kept fixed, the
surgeon, if he attempt to change its position, will feel the mus-
cles of the limb thrown into strong action. A striking charac-
teristic is the absence of heat about the affected joint it feels
quite as cool, and sometimes, the author is inclined to think,
even cooler than the other. Swelling, in any marked degree, is
absent in cases of knee-joint disease; if measurements be taken,
the swelling will be found greater than is ordinarily supposed ;
but the hysteric knee, when not inflamed by irritant treatment,
is seldom swollen, and never more than about three quarters of
an inch. The swelling is tegumentary merely ; the healthy parts
may be felt beneath.

When the disease affects the hip, it is, by a skilful eye, even
more easily detected. When the patient is lying down, the limb
is drawn up, the knee bent, and there is great superficial tender-
ness over the whole haunch, hip, and thigh, but no pain on
pressing the articular surfaces together from the heel upwards ;
if the joint be not moved, there is no greater heat-n that side
than on the other. If the surgeon, by perseverance, get his pa-
tient to stand he will observe a marked twisting of the pelvis, in
part an imitation, in part exaggeration, of the position assumed in
hip disease. The glutei may be felt in strong action and the
nates, instead of being flat, on that side are protuberant. Swell-

342 Hysteric Condition of Joints [May,

ing is hardly to be measured at the hip, because it is surrounded
by muscles whose greater or less action must alter the dimen-
sions of the part. That creaking of certain joints which some-
times comes on with puberty may gradually become more fixed,
till it settle down into hysteric joint disease; therefore, there
sometimes accompanies this malady, a parchment-liue crepitation,
which is easily distinguished from the crepitus of rheumatic
arthritis. Besides these signs, it must be remarked that an hys-
teric patient has not the worn aspect of one whose cartilages are
ulcerating.

Now, the peculiarities of hysteric disease impress upon the
local complaint a quality of unreality which requires some ex-
amination. It is not to be supposed that these patients willing-
ly deceive their medical attendant, nor that the pain complained
of has no real existence ; but it is not produced by a local con-
dition the malady is centric, not eccentric. Hysteria has, per-
haps, been too much regarded as the bete noire of medicine, con-
nected with an obscure and sometimes undiscoverable menstrual
disorder, and therefore, to be treated with iron and emmena-
gogues, and such like medicines. Yet, in truth, though the
disease may be originally produced by the circumstances and
conditions of woman's life, it soon becomes independent of
uterine action or inaction ; it becomes a neuropathy which can
be called forth by the feelings and imaginings of the patient,
who is more or less aware of the power she exercises over her
condition, and believing her sufferings real, is yet delighted to
direct them by such mental acts. Thus the malady must be
treated on other principles than such as would follow a mere
uterine pathology. Great harm is done by the indiscriminate
use of steel, ethers, aloes, &c, which are often given when a
lower diet and more exercise would much better cure the disease.
If, however, the above view be correct, the treatment must
rather be directed to the cerebral condition which produces the
neuralgia-like pain, and which has the faculty of swaying the
disease by its own emotional state ; for it must be evident, from
that view, that if this emotional state can itself be dominated,
the disease will be governed with it; if the patient's faith can
be so far mastered as that she shall fully expect to be cured by
any given proceeding at a certain time, she will be cured by that
method at the time specified. The author has tried several
means whereby, the patients1 confidence having been sufficient-
ly gained, he could call away their attention from the part affect-
ed to some distant spot, in which a disorder working its own
cure had been artificially produced. Of all such means, a sea ton
seems in most instances the best; this is to be made of a single
ligature (silk) set in at a distance from the affected joint, and
embracing only a small portion of skin. The placing of a seton
is sufficiently painful and like a surgical operation to attract

1^.39.] Ophthalmia of New-born CJiildren, &c. 343

strongly the patient's attention, and yet not so much so as to
be cruel or greatly repugnant to her feelings. Another advan-
tage is that, besides a distinct beginning, it has a certain end
which the patient is to watch ; and if she believes, as can well
be managed, that as the seaton works through the skin she will
get better, and when it comes quite away she will be well, the
result is certain to follow her belief. Mr. Barwell read several
cases which he had thus treated, and quoted in support a case in
which Mr. Hancock, by giving a patient thus affected chloroform,
and performed a mock operation, had produced a cure. He
observed, in conclusion, that the most essential points were to
be quite certain in the diagnosis, to master the confidence of the
patient, and to place the seton or other agent at a sufficient dis-
tance from the part affected. \London Lancet

Ophthalmia of New-born Children Treated by Chloride of Zinc
and Glycerine. By Dr. Macmillax, Hull, Eng.

Case. A child seven days old. On examination eyelids very
much swollen and glued together; on opening thick white fluid
escaped from both eyes. Inside of the eyelids of the right eye
very vascular and considerably swollen, so much so as to render
the examination of the cornea very difficult, at lower margin of
which a small white spot as if pus were effused between the lamel-
lae of the cornea was observed. General haziness of surface of
cornea also present.

The left eye presents cornea clear, conjunctiva vascular, puru-
lent discharge thick and very copious.

The chance of recovery of right eye was held out to the
parent as extremely doubtful. The following drops to be applied
three times a-day by the aid of a camel-hair brush : Five grains
of chloride of zinc to be well triturated in a glass mortar, with
half an ounce of glycerine. During the day frequent ablutions
of the eyes and application of pure glycerine.

On the following day the mother states that the child had
rested better during the night ; the discharge of matter was much
less, the swollen condition of the eyelids had decreased consider-
ably, and the right cornea was easily exposed to view ; onyx
still present as also haziness of cornea.

Next day much improved ; child opens her eyes and looks
about ; still some purulent discharge ; onyx of right cornea con-
siderably less; surface of cornea much clearer; inner surface of
eyelids less vascular ; continue the application and sulph. quinine
i maneque nocteque.

Seen two days after; eyes all but well ; onyx in right cornea
completely gone; little or no discharge ; general appearance and
health of child much improved. Discontinues the application

314 Ophthalmia of New-horn Children, &c. [May,

of the chloride of zinc, but apply occasionally during the day
a little glycerine by the aid of a brush.

Many cases attended with a similar result might be brought
forward, but the above will be sufficient to direct attention to
the employment of chloride of zinc.

It cannot be denied that the strong solution or nitrate of
silver is generally quite sufficient to cure this disease when had
recourse to, even in the more advanced stages; but its employ-
ment is attended with two or three disadvantages.

In public and private practice it is too frequently found that
this disease is neglected or treated with some useless remedy, as
a little of the mother's milk, simple cerate, &c. ; and that the little
patient is brought to the medical attendant after the lapse of two
or three weeks, at which period, to use the words of that emi-
nent surgeon, Dr. Mackenzie, "I open the lids of the infant
with the fearful presentiment that the vision is lost, and but
too often I find one or both of the cornea gone, and the iris
and humours protruding. In this case it is our painful duty to
say there is no hope of sight."

Let us suppose that the case is not quite so bad, that the
symptoms and conditions of the parts are similar to the case nar-
rated, that an onyx is formed on the eve of bursting, a little
delay and loss of vision is inevitable ; you order the nitrate of
silver to be applied to the eyes every six hours ; you urge upon
the parent the necessity of washing the purulent discharge from
the eyes, and request her to bring the child on the following
day. She does so. On examining the eyes you find little or
no improvement, in the majority of cases decidedly worse; you
are surprised. On cross- questioning the parent or nurse, you
will find that the drops have not been applied ; that the child
cried so much, appeared in such agony ; that a few drops were
spilt on the child's cap, or other portion of its dress ; that the
characteristic stain of the nitrate was observed ; that some busy
neighbor, not unfrequently the one who treated the child's eyes
before it was brought to the medical attendant and glad to sup-
plant him in the confidence of the parent, says it is " caustic,"
the "Doctor is going to burn the eyes out," &c, &c. The poor
mother, ignorant of the true state of matters, and moved by
maternal affection, hesitates, and ultimately resolves not to re-
peat them, the consequences of which may be easily conceived,
the little time for a chance of cure has passed, the sight, per-
chance, of both eyes is gone, and the one application has sufficed
to establish the medical attendant's reputation for "burning eyes
out."

Go to any dispensary, ask the parent of that child with staphy-
loma how the child lost its sight, the answer in nine cases out
often will be the following : "A blast of cold shortly after birth,
and the doctor burnt the eyes out with caustic."

1859.] Changes Produced by Cod-liver Oil. 345

Xow, in the chloride of zinc with glycerine, we have a
remedy as effective as the arg. nit.T and not attended with such
disadvantages. It would appear that the use of glycerine alone
has a beneficial effect as a lubricant, and at the same time dilu-
ting the purulent discharge, and consequently diminishing its
irritating effects on the adjacent parts. ISot a few cases observ-
ed'at the first day or so have been cured by the use of glycerine
alone. I hope at a future period to be able to give some results
of its use in the treatment of gleet, for which I have no doubt
it will be of service, seeing that the disease and the parts impli-
cated are very much alike in both cases. [Med. Times and Gaz.

Changes produced in the amount of Blood- Corpuscles by the admin-
istration of Cod-liver Oil. Dr. Theophilus Thompson read
(Nov'r 18th, 1858) a paper on this subject before the Koyal
Society,

The author had presented to this Society, on the 27th of April,
1854, a communication descriptive of the chemical changes pro-
duced in the blood by the administration of cod-liver oil and of
cocoa-nut oil, and advanced the conclusion, deduced from chem-
ical analysis, that any favorable result derived from the use of
these oils is associated with an increase in the proportion of red
corpuscles. The present communication was an extension of
the inquiry, but was confined to experiments on the influence
of cod-liver oil on the blood. It comprehended the principal
details regarding fourteen patients affected with pulmonary con-
sumption in various stages of progress, and the result of analyses
of their blood. In two instances no oil had been given ; in the
remaining twelve that medicine had been, more or less, freely
administered, and an obvious contrast was noted in the condi-
tion of the blood, the proportion of red corpuscles to a thousand
parts of blood in the two cases where no oil had been given
being respectively 98 '20 and 119'64, and in ten of the other
patients varying from 142*32 to 1 74*76. In these ten cases the
use of the oil had been attended with marked gain in weight and
other evidences of amelioration. In another instance, in which
the disease advanced, and a loss of seven pounds in weight
occurred, notwithstanding four months7 administration of oil,
the proportion was 114*39. In one example only was a favora-
ble effect of the oil accompanied with a low proportion of cor-
puscles, viz. 84-83 ; but in this patient, haemoptysis, so profuse
as to endanger life by increasing the poverty of the blood, had
apparently modified to some extent the ordinary influence of
the remedy. The analyses was conducted by Mr. Dugald Camp-
bell in the following manner: The whole quantity of blood ab-
stracted having been weighed, thecoagnlum was drained on bibu-

346 Treatment of Lachrymal Sac. [May,

lous paper for four or five hours, weighed, and divided into two
portions. One portion was weighed, and then dried in a water
oven to determine the water. The other was macerated in cold
water and it became colourless, then moderately dried, and di-
gested with ether and alcohol to remove fat, and finally dried
completely and weighed as fibrin. From the respective weights
of the fibrin and the dry clot that of the corpuscles was calculated.

Dr. Copland observed that consumption is a disease which
tends to produce a continual waste of blood-corpuscles, and that
whatever promotes nutrition and excites the vital forces must
have a beneficial tendency in such a disease; for with improved
assimilation, there must evidently be a renovation of blood cor-
puscles. On this principle, cod-liver oil, he believed, would be
found efficacious in anaemia and rickets as well as in consumption,
although he was not sure that it had any particular advantage
over iron as a remedy.

Dr. G-arrod thought that any future researches on this
subject would be still more valuable if the analyses were ren-
dered more specific, by ascertaining the proportions not only of
the red corpuscles generally, but also of the constituent parts of
the corpuscles. Without such information, it was difficult to
explain the fact that cod-liver oil is so for more useful in con-
sumption than in anaemia; and it would be desirable to deter-
mine the amount of change produced by such a remedy in the
proportion of haematin, globulin, iron, and fat, entering into the
composition of the blood-cells. [London Lancet.

On Two New Methods of Treating Diseases of the Lachrymal Sac.
By Dr. V. Grafe.

In one of the sessions of the Society of Berlin Physicians, (July,)
Dr. Y. Grafe reported on two new methods of treating affections
of the lachrymal sac, which he considers a decided progress in
ophthalmic surgery. One of them was proposed by Bowman,
and has for its object the restoration of the permeability of the
lachrymal passages by methodic dilatation. It differs from all
the known methods of dilatation in the point that the lachry-
mal sac is not laid open through the skin, but that the instru-
ments are introduced from the mucous membrane through the
inferior punctum lachrymale, which has been previously dilated
by slitting it. Although an experience of only four months
does not permit any positive statement on the permanency of
cures thus obtained, Dr. V. Grafe does not hesitate, even at this
early moment, to pronounce Bowman's method the best of all
used for the restoration of the lachrymal passages.

The second innovation was proposed by Dr. Tavignot, and
has the opposite indication in view, viz., to destroy the lachry-

1859.] Treatment of Lachrymal Sac. 347

mal passages. Believing that the entrance of tears rendered the
obliteration of the lachrymal sac difficult, Tavignot recommends
to cut off the puncta lachrymalia, in order to prevent tears pas-
sing into the sac. The idea itself is correct, but the obliteration
of the lachrymal canals is not effected with certainty by the pro-
cess recommended. Yon Grafe uses other means, for instance
ligation with a suture, gradually cutting through, or cauteriza-
tion by means of a small portes caustiques, which are introduced
into the lachrymal canals. Dr. Leibreich, who assisted in Grafe's
clinic, conceived the idea of coating Anel's probes with nitrate
of silver ; in order to make the caustic adhere, the probes were
first rendered rough by exposing them to the action of nitric
acid ; thus prepared, they were dipped into fused nitrate of sil-
ver. Any silver instrument can be converted by this process
into a caustic body. After permeability of the lachrymal canals
is obtained, the obliteration of the lachrymal sac is easily effected
by gentle caustics. The hot iron, chloride of zinc, Vienna paste,
etc., which often produce circumscribed caries, can be dispensed
with.

By these two innovations the old contest between destructive
and conservative surgery, in the treatment of diseases of the
lachrymal sac, has been revived. According to Dr. V. Grafe's
opinion, the following rules are to be observed in regard to the
indications : 1. In every case in which circumstances offer the
prospect that perviousness may be permanently restored, the
surgeon should endeavor to obtain it by Bowman's method. 2.
In cases where the restoration of permeability is problematic,
and could only be obtained by a tedious cure, it must be ascer-
tained whether the lachymal glands of the patient, after removal
of all causes stimulating them to excessive secretion, furnish a
relatively great or small quantity of tears. Dr. Y. Grafe gives
the necessary rules for making this estimate. In cases in which
the quantity of the secretion is small, obliteration, after cauteri-
zing the lachrymal canals, is preferable to restoration of the con-
tinuity. No stillicidium lachrymarum remains in this case. If,
however, the quantity of the secretion is large, Bowman's
method should be first tried, for fear that the stillicidium might
remain ; only if it is impossible to obtain a permanent cure by
this means, the lachrymal sac should be obliterated. Dr. V.
Grafe communicates the following statistical results in reference
to this operation : Of one hundred patients in whom the lachry-
mal sac has been successfully destroyed, twenty suffer of per-
manent and troublesome overflowing of tears ; seventy are mo-
lested neither at their work nor in the room, but experience
increased moistening in open air, or if excited to tears, etc.; ten
finally do not notice any difference from the normal eye. 3.
In cases of caries, organic obstructions, etc., in which there is
no prospect for restoration of the continuity, the lachrymal sac

N. 6. VOL. XV. no. v. 25

348 Observations on the Treatment of Syphilis. [Ma 3',

should be at once obliterated, as in any case the condition of the
patient is ameliorated by this measure. Thus the troublesome
suppuration is not only done away with, but some of the princi-
pal causes of the hypersecretion of tears are also removed, and
in consequence of it the stillicidium is proportionately reduced.
\_Allgemeine Medezine. Central Zeitung7 and North Amer. Med.
Chir. Review. ,

Observations on the Treatment of some of the Symptoms of Syphilis.
By M. Hervieux.

1. Phagedenic Chancre. M. Hervieux observes that it is very
natural that a disease which produces such rapid local destruc-
tion should have been met by means rivaling it in energy and
celerity of action, such as the butter of antimony, the vari-
ous forms of caustic, the actual cautery, etc. But although all
those means have been successful in some cases, it is certain
that they have still oftener failed, or they would not have been
so generally abandoned. There is one means, however, which
in the hands of M. Eicord, has proved of indubitable advantage,
viz., the carbo-sulphuric paste, prepared by mixing sulphuric acid
with powdered vegetable charcoal in sufficient proportions to
form a semi-solid paste. When applied to the chancre this soon
dries, forming a black crust, which intimately adheres to the
tissues, and only falls off after several days, leaving a clean sore,
or even in some cases, a cicatrized surface. In the authors
practice, pure tincture of iodine^ applied at the commencement,
has proved to be the best means of arresting the progress of the
disease. It induces generally a burning pain, the intensity and
duration of which are in proportion to the extent and debth of
the chancre, as also to the sensibility of the individual and of
the parts affected. Yery well borne by some patients, the pain
induces in others the most horrible torment. Chloroform would
in such nervous and irritable subjects save this suffering. The
pain, upon an average, lasts half an hour. In simple, uncompli-
cated cases, two applications, made by means of a pencil, after
an interval of 24 hours, generally arrests the progress of the disease
into the blood. If, however, the chancre be complicated with
gangrene, hospital gangrene, or diphtheria, four, five or even six
applications may be required. But when two or three of these
seem to be without any effect, there is no use going on with the
iodine, and a solution of nitrate of silver (five parts to thirty)
should be substituted. When the iodine treatment has been
followed, M. Hervieux has never known the worst form of
phagedena persist beyond a week.

2. Suppurating Bubo. The author has never himself treated
bubo by small, single or multiple openings, but he has met with

1859.] Observations on tlie Treatjrient of Syphilis. 349

cases which have been so treated, and which two or three months
afterwards, have exibited fistulous tracks, extensive detachment,
thinning and changes in the skin, together with an utter indis-
position to heal. After waiting two or three weeks in vain for
the spontaneous closure of these fistulas he has had to lay them
freely open. The prevention of deformity by these small aper-
tures, as proposed by Vidal, is frequently not attained, for not
only may fistulous tracks become established, but the apertures
themselves may become transformed into chancrous ulcerations.
As a general rule, M. Hervieux makes a large opening, and that
as early as possible, cicatrization taking place most rapidly under
these circumstances. When the opened bubo is transformed
into a strumous or chancrous ulcer, or the two combined, with
the possible complications of phageda?nism, he treats it by the
application of the tincture of iodine or sulution of the nitrate of
silver, washing it out also with chlorine lotions several times
a day ; and he has never found any ulcer resisting treatment
longer than six weeks, the majority becoming healed in from
eight to fifteen days.

3. Condylomata {Plaques muqueuses.) Although the author
believes the practice he recommends under the former heads may
require additional confirmation from more extensive practice
than his own, in the matter of condylomata he can speak more
positively. If the solution of nitrate of silver is not an actual
specific, it acts with such rapidity, certainty, and efficacy, as to
call for the highest recommendation. However confluent they
may be and whatever extent of surface they may occupy, howe-
ver infectious the discharge they give out, and even when they
have attained a certain amount of thickness, provided that they
are not too hypertrophied and have not undergone some of the
transformations they are susceptible of they will wither, die away,
and disappear in the course of some days, if every part be painted
daily with a pencil dipped in a solution of the nitrate, five parts
to thirty of water. Baths should be simultaneously used, seeing
the part which dirt habitually takes in the production of this
accident. Repeated trials have convinced the author that this
success is quite independent of internal treatment. When, how-
ever, the condylomata have become transformed into a vast
vegetating surface, of great thickness, the nitrate ceases to be of
avail ; and in one aggravated case mentioned, the pure nitric
acid, repeatedly applied, was of service.

i. Syph Hides. Under this head the author gives the results
of his trial, in ten cases, ofM. Cullerier's plan of treating syphili-
tic eruptions by blisters applied to the chest. Although at first
prepossessed against it, he now speaks highly in its favor. Ex-
cluding the slight roseolar forms, which get well of themselves,
the author oftenest employed blistering in the papular form of
the disease, and that is the form in which the remedy best sue-

350 Cancerous Tumour treated hy Chloride of Zinc. [May,

ceeded. A single blister will exert a notable modification on
chronic papular syphilides, which have existed during several
months. One case of syphilitic lichen, which had lasted a year,
and for which all kinds of active internal treatment had been
tried, disappeared in the course of a week, during which three
large blisters were successively applied to the anterior and pos-
terior surfaces of the thorax. The squamous form resisted their
action more, but still in two cases of psoriasis undoubted amend-
ment was observable, and in a fortnight the scales were detached.
In the pustular form, some cases of syphilitic acne were rapidly
cured. M. Hervieux has not tried blistering in syphilitic impe-
tigo of the face and hairy scalp, having found the application of
the nitrate of silver solution, after poulticing off the crusts, very
efficacious, even in very inveterate cases. [Brit, and For. Med,
Chir. Review^ from Bui. de Therap.

Case of Cancerous Tumour Treated by Chloride of Zinc. By
James Alexander, Esq., Wooler.

The following case of cancer does not possess in itself any pe-
culiar interest, and certainly cannot boast of having been suc-
cessful in its result. But it affords an opportunity of detailing
a mode of applying caustic to malignant growths, or indeed to
tumours of any kind, when it is deemed advisable to have re-
course to its use for their removal, not much known in this
country, and which may, perhaps, be found as effectual as any
other, while it is free from various objections on the score of
tediousness and uncertainty of operation, as well 'as prolonged
suffering, to which the ordinary methods of applying escharotic
remedies are justly liable.

Three months ago, a man presented himself to me for advice,
with a large carcinomatous growth, occupying nearly the whole
of the chin and considerable part of the under lip. The tumour
was beginning to fungate on some points, where the skin had
given way, and was covered with diseased integument closely
adherent to the mass below on the remainder of its surface, and
was still moveable, but not freely, on the parts over which it lay.
The patient informed me that a small ulcer had been cut out of
the lower lip a few weeks before, but the tumour on the chin,
which he represented as being then about the size of a small
birdrs egg, had been unfortunately left. Deep indurations could
be felt along the rami of the lower jaw, immovably united to
the bone, and the aspect of the countenance was unhealthy and
cachectic. It seemed a most unpromising case to meddle with,
and should, perhaps, have been altogether let alone. But the
man was clamorous to be relieved, if possible, from the loathsome
incumbrance on the chin, which emitted from the ulcerated

1859.] Cancerous Tumour treated by Chloride of Zinc. 351

parts an abundant and most offensive discharge. His friends
were as eager as himself to have recourse to any means that
offered the slightest prospect of even temporary alleviation ; for
of any ultimate benefit they were most explicitly warned there
was not the faintest hope. It was therefore resolved to make an
attempt to destroy the fungating mass by caustic; and I have
much pleasure in acknowledging my obligations to Mr. Walker
(my assistant), for suggesting to me the method of proceeding I
am about to describe, which he had very recently seen employed
in one of the Parisian hospitals.

Two parts of fine arrow-root were mixed with one part of
chloride of zinc ; and while the paste which such a mixture forms
was soft, from the addition of a little water, it was rolled out
into a thin sheet, and then divided into arrow-shaped pieces of
about three inches long, each tapering to a fine point at one
extremity, and rather less than a quarter of an inch broad at the
other end. After drying, the paste becomes hard, and if the
points are fine, the arrows are capable of overcoming a con-
siderable resistance. After putting the patient under chloroform,
a series of deep punctures were made round the circumference
of the tumour with a narrow bistoury, and one of the arrows
forcibly inserted into each immediately after it was made, where
it was allowed to remain. In four days the whole growth was
completely detached in one very large, black mass. The sur-
face of the sore for a time looked clean and promising; by and
by, however, it assumed an unhealthy appearance, and I cannot
say that any permanent good resulted from the operation. The
benefit derived in this particular case, however, is not the point
to which I would solicit the attention of my professional breth-
ren, but the manner of using the caustic, which I believe though
occasionally practised in France, has been little, if at all, em-
ployed in this country. To do it effectually, one or two pre-
cautions should be observed, which were suggested by the
progress of this case; and if these are attended to, I am inclined
to think they will secure the complete detachment of the part
we wish to separate in half the time which was occupied in this
case. The arrows should be introduced in considerable num-
bers, not more than an inch or three-quarters of an inch asun-
der ; the points from the opposite sides should cross one another
in the centre of the morbid growth, and they should be inserted
as near the bases of the diseased parts as possible, as nearly as
can be accomplished in the line of demarkation between the
sound and unsound parts. The pain from this procedure, judg-
ing from the above case, was not by any means severe; for the
man slept tolerably well the first night after the application of
the remedy, and spoke, and ate, and moved about freely, with
little apparent suffering, much less, certainly, than I ever saw
when caustic was applied to the surface ; and undoubtedly, the

352 Editorial and Miscellaneous. [May,

effect is very expeditiously produced, for the caustic being
applied to the root, and not to the surface of the growth, its vitali-
ty is at once destroyed, and the separation is completed whene-
ver the integument between the punctures yields to the lateral
action of the arrows. I am no advocate for the use of caustic
in the treatment of cancer ; in common with the vast majority,
if not the whole, of the profession, I greatly prefer its removal
by the knife. But there may be cases in which the feelings of
the patient, or, perhaps, other circumstances, may compel us to
have recourse to it ; and when such cases do occur, I venture to
submit to the consideration of my professional brethren the mode
of proceeding I have now detailed. [Edinburg Med. Jour.^ and
Braitkwaits Retrospect.

EDITORIAL AND MISCELLANEOUS.

Meeting of the Medical Association of the State of Georgia.
We present below, the minutes of the late meeting of the State Society.
We have neither time nor space in our present number to give any ex-
tended notice of the Proceedings. It was, however, a most improving,
cheering and harmonious Convention, and the papers presented, when
they are published, will speak well for the industry, zeal and ability of
the Profession in our State.

Report of the Proceedings of the Medical Association of the State of
Georgia, at its annual meeting held in the city of Atlanta, April 13th
and Uth, 1859.

Pursuant to adjournment the Medical Society of the State of Georgia
assembled in the City Hall, Atlanta, at 11 o'clock on the morning of the
13th of April, 1859.

The Society was called to order by the President, Dr. Joseph P. Logan
of Atlanta, and the deliberations opened with prayer by the Rev. Dr.
Wilson of Atlanta.

The Recording Secretary being absent, on motion, of Dr. H. F. Camp-
bell, of Augusta ; Dr. W. S. Meiere, of Madison ; was requested to act
as Secretary, pro tern.

The roll being called by the Secretary, the following members respond-
ed to their names :

S. W. Burney, of Forsyth ; A. Means, Henry Gaither, of Oxford ; Samuel B.
Clarke, of Richmond Factory, Richmond Co. ; J. G. Westmoreland, J. N. Sim-
mons, H. W. Brown, Jno. W. Jones, Thos. S. Powell, B. M. Smith, Jas. F. Alexan-
der, M. H. Oliver, J. M. Boring, Hayden Coe, T. C. H. Wilson, V. H. Taliferro,
of Atlanta ; A. A. Bell, Maxey's ; E. J. Roach, Longstreet, Pulaski Co. ; T. J.
Barkwell, Hawkinsville ; L. A. Dugas, H. F. Campbell, Augusta; L. P. Green,
John T. Banks, Zebulon ; S. H. Dean, Conyers ; F. S. Colley, Monroe ; S. H. Con-
nally, Griffin ; A. M. Boyd, Caye Spring ; A. M. Parker, Salt Spring, Campbell
Co. ; W. S. Meiere, Madison,

1859.] Miscellaneous. 353

Dr. Campbell, of Augusta, then presented to the Society, for distribu-
tion among its members, a supplement to the Southern Medical and Sur-
gical Journal, containing, besides some very interesting editorial and
select matter, the History, Constitution and By-Laws of the Society.

On motion of Dr. Coe, the Constitution and By-Laws of the Society
were read by the Secretary.

The proceedings of the last Annual Meeting held in Madison were then
read aud coniinned.

On written application the following gentlemen were duly elected
members of the Society :

Drs. R O. Ware, Robert Battey, T. J. Word, Rome ; W. A Culbertson, Cave
Spring; J. A. Steward, Convers;* A. S./Whitaker, Jonesboro' ; J. R. McAfee, R,
G. W. Maffitt, Dalton ; W. A. Shelby, AV. V. Aderhold, G. G. Crawford, H. West^
inorland, J. Gilbert, G. W. Humphries, J. D. Bovd, J. L. Hamilton, A- G. Thomas,
W. P. Hardin. R. J. Maaeey, J. M. Session?. X. D'Alvigny, D. 0. C. Heery, B. O.
Jones, B. F. Bomar, Atlanta; C. A. MeKinley, G. L. Hudson, Xewnan; A. M.
Moore, J. C. Avery, Decatur; G. L. Jones, G. il Johnson, Palmetto ; J. T. Slaugh-
ter, Villa Rica ; G. W. Pitts, Star, Butts Co.; B. L. Jones, Savannah ; B. F. Hodnett,
E. Griffin, Rough <fc Ready ; W. D. Cunningham, Jasper, Pickens Co. ; L. S. Cun-
ningham, Big Creek, Forsyth Co.; W. HTWatkins, Franklin; F. O. Donnelly,
Greenville; X. B. Drewry,' Sharon Grove. Fayette Co.; J. P. Taylor, Haralson ;
Johnson Matthews, Yellow River ; S. W. Leak. J. F. Donehoo, Favetteville ; W.

C. Smith, Grantville ; J. Walker, Longstreet ; M. T. Fort, T. D. il Ryan, J. EL
Vakley, Hawkinsville ; Joseph Jones, Augusta ; J. K. Mitchell, Lavreneeville ;

D. A. Matthews, Millstone ; George Lumpkin, Stephens ; W. Moodv, Maxev's ;
Samuel P. Lumpkin, Watkinsville; W. P.4Bond, Lithonia; R. A. T. Ridgley* La
Grange ; W. A. Spier, Grantville ; A. P. Brown, Cumming ; J. Haekenhull,
Dawson ville; S. Malone, Fairburn; C. W. Smith, Jonesboro'; W. F. Thomason,

Sugar Valley ; D. H Payne, Marietta ; H. S. Davenport, ; B. M. Tidwell,

Fairburn ; F. M. Brantley, Merriwether ; D. G. Hunt, Calhoun ; L. H. Jordan,
Coloparchee; D. M. Williams, Griffin.

After the enrolling of the names of new members, the Society adjourn-
ed till 3 o'clock, P. M.

AFTERNOON SESSION.

The Society was called to order at 3 o'clock by the President.

The election of officers being in order, the President ordered a ballot
for President Dr. Banks proposed the name of Dr. F. S. Colley, Dr.
Alexander proposed the name of Dr. L. A. Dugas, Dr. Barkwell proposed
the name of Dr. H. F. Campbell. Before the ballot, Drs. Dugas and
Campbell withdrew their names. Society proceeded to ballot for Presi-
dent on counting the ballot it was found that Dr. Colley had received
all the votes cast. Dr. Colley was therefore declared unanimously elected.

After ballot for 1st Vice President, Dr. R. A. T. Ridley was declared
duly elected. By ballot, Dr. H. Coe was elected 2d Vice President. By
ballot, Dr. A. G. Thomas was elected Recording and Corresponding
Secretary and Treasurer.

On motion, the following committee was appointed to induct the
President elect into the chair: Drs. Campbell, Alexander and Bat-
tey. Dr. Logan in retiring from the Chair delivered an appropriate and
felicitous address, full of interesting statements and valuable suggestions.

On motion of Dr. Banks, the rules being suspended Dr. B. L. Jones
introduced the following resolution, which was unanimously adopted :

*' Resolved, That the thanks of this body be tendered to Dr. Joseph P. Logan for
the faithful, efficient and impartial manner in which he has discharged the duties

354 Miscellaneous. [May,

of President during his term of office, and also for the pertinent and truthful ad-
dress to which we have just listened."

On motion of Dr. Burney, the following committee was appointed to
recommend the names of such members of the Society as the committee
should select, as delegates to the American Medical Association : Drs.
Logan, Battey, Roach, Joseph Jones, Boyd, Taylor and Burney.

Rules being suspended, on motion of Dr. Campbell, Dr. Wm. T. Grant,
of Thomson, was allowed to withdraw his name from the roll of mem-
bers of this Society. After which, on motion of Dr. Roach, Society ad-
journed till 10 o'clock Thursday morning.

Thursday, April 14th, 1859, )
10 o'clock, A. M. J
Society called to order by the President. Roll called ; minutes of the
preceding day read and approved. Rules being suspended, the following
resolution was offered by Dr. J. G. Westmoreland and adopted :

" Resolved, That Dr. R. L. Bozeman of Alabama, be invited to a seat with the
Society to-day."

Rules being further suspended, Dr. Burney moved to appoint a com-
mittee of three to wait upon Dr. Logan and request a copy of his address
for publication ; motion carried. The President appointed as that com-
mittee, Drs. Burney, Coe and Dean.

Dr. Means, after a few appropriate remarks, introduced the following
resolution :

" Resolved, That the name of this Society be altered from the Medical Society
of the State of Georgia, to the Medical Association of the State of Georgia."

Resolution unanimously adopted.

Reports from Auxiliary Societies being called for, Dr. Banks reported,
that an Auxiliary Society had been established in Griffin according to the
Constitution and By-Laws of the State Association ; that the Society
was composed of twelve members, and was increasing ; he hoped that
the Auxiliary Medical Society of Griffin would be acknowledged by the
Association. Dr. Campbell moved that the report be received, and the
Society acknowledged, which motion was carried.

Correspondence called for. No report.

Call for written communications.

Dr. Juriah Harriss, of Savannah, through Dr. J. G. Westmoreland,
offered an apology for not presenting his Essay which he had been ap-
pointed to prepare, stating that unavoidable circumstances had prevent-
ed him from finishing it.

On motion of Dr. Means, Dr. Harriss' apology was received, and he
was requested to prepare the Essay for the next meeting of the Associa-
tion.

Dr. Campbell of Augusta, presented the following, entitled : " An Es-
say on Cholera Infantum," by H. W. DeSaussure Ford, M, D., Prosec-
tor to the Prof, of Surgery in the Medical College of Georgia, and ren-
dered an apology for Dr. Ford for his failure to present the Essay.

On motion, Dr. Ford was requested to have his Essay published in one
of the Medical journals, as written for the Association.

Rules being suspended, Dr. Meiere offered the following resolution which
was carried :

1859.] Miscellaneous. 355

" Resolved, That the President appoint a Committee of Five to revise the Con-
stitution and By-Laws of the Association, and report at next meeting."

The President appointed as that Committee, Drs. Meiere, Banks, Oliver,
Battey and H. F. Campbell. Rules further suspended.

The Committee on Delegation to the American Medical Association,
reported thfc following names of members of this body as suitable dele-
gates :

Drs. West and Sullivan, Savannah; Doughty and Robert Campbell, of
Augusta ; Nottingham and Boon, of Macon ; Means, of Oxford ; Alexander, of
Atlanta; Stanford and Flewellen, of Columbus; McClesky and Carleton, of
Athens ; Roach of Pulaski county ; Stevens, of Albany ; Hillyer and Battey, of
Rome; Donnolly, of Meriwether; Burney, of Forsyth; McAfee, of Dalton ;
Ridley, of Lagrange ; Banks, of Pike ; Brown, of Cumming, and Meiere, of
Madison.

On motion of Dr. Campbell, the report of the Committee was received
and adopted.

Dr. Banks offered the following resolution, which was adopted :

" Resolved, That the delegates to the American Medical Association, this day
appointed, be authorized to select alternates from the members of this Society,
in case of the inability of any of them to attend the meeting of said American
Medical Association."

Dr. Campbell then presented the following title of a paper, with the
accompanying motto :

" An Essay on the adaptation of Climate to the Consumptive, for a permanent
residence ; embracing an Examination of the Climate of certain Localities of fre-
quent resort; and also, an Investigation of the degree of Adaptedness of the
Pacific Climates of the United States. Presented to the Medical Society of the
State of Georgia, at its annual meeting, held at Atlanta, April 13th, 1859. By
Wm. Henry Doughty, M.D., of Augusta, Ga."

Motto " As ' the possible is immense,' so the human mind if the legitimate
object of all science, (which is to observe facts and to trace their relations and
sequences) is kept steadily in view, will be continually verging towards Truth
in the investigation of physical causes." Forry.

He then stated that Dr. Doughty was unable to be present, and hoped
to be excused ; after which he read a portion of the able Essay of Dr.
Doughty.

Dr. Campbell offered, also, an abstract of an

" Essay on Quinine : its therapeutical action being expended solely upon the
middle or fibrinous coat of the blood vessels, by which interpretation alone are
its phenomena satisfactorily explicable. By Robert Campbell, M.D., Adjunct
Professor of Obstetrics and Demonstrator of Anatomy in the Medical College of
Georgia."

On motion, the Association adjourned until 2 o'clock, P. M.

AFTERNOON SESSION.

Association called to order at 2 o'clock.

Regular business being continued, Dr. Joseph Jones, of Augusta, pre-
sented a " Report of a case of Fracture of Neck of the Scapula ;" also,
a " Report of a case of Aneurism in the Gluteal Region." By L. A.
Dugas, M.D., Professor of the Principles and Practice of Surgery in the
Medical College of Georgia." He also presented an essay on " The
Changes of the Blood in Malarial Fevers. By Joseph Jones, M.D., Pro-
fessor of Chemistry and Pharmacy in the Medical College of Georgia."

356 Miscellaneovs. [May,

An abstract of a " Report of fifteen cases of Lithotomy," with the cal-
culi accompanying, was presented by H. F. Campbell, M.D., Professor of
Anatomy in the Medical College of Georgia.

An Essay on "Puerperal Fever," was then read by Dr. Dean, of
Conyers.

An Essay entitled " Quackery and its Cure," was then read by Dr. A.
G. Thomas, of Atlanta.

A " Report of a case of Vesico-Vaginal Fistula," was presented by Dr.
Battey, of Rome.

An Essay on " The Pathology of Phlegmasia Dolens," was then read
by Dr. H. Coe, of Atlanta.

Dr. Taliaferro, Professor of Materia Medica in Oglethorpe Medical Col-
lege, offered an apology for not presenting his essay as requested, stating
he had begun to prepare it, but wras unable to complete it ; subject
" Phthisis Pulmonalis, its Causes and Treatment."

Dr. W. F. Westmoreland, Professor of Surgery in the Atlanta Medi-
cal College, offered an excuse for not presenting his Essay, it not being
in his power to finish it ; subject Pyemia.

Rules being suspended, Dr. J. P. Logan moved that a committee be
appointed to select Essayists for the next meeting. Motion amended by
adding : " and to recommend a place for next meeting." Motion car-
ried Committee appointed by the President, Drs. Logan, Campbell and
Word.

Oral communications called for : no report.

Rules being suspended, Dr. Means, on behalf of the Faculty of the
Atlanta Medical College, invited the members of the Association to visit
their College building.

New business being called, Dr. Battey introduced the following reso-
lution, which was adopted :

" Resolved, That a Committee of three be appointed by the Chair to report, at
our next meeting, upon the evidences of advancement in Medical Science, as ex-
hibited in the literary productions of the medical men of Georgia."

The President appointed on that Committee the following gentlemen :
Drs. Logan, Battey and Sullivan.

Dr. Banks offered the following resolution :

" Resolved, That the Chair appoint a Committee of three members of the Asso-
ciation, to which Committee the Essays and Reports of the Association be referr-
ed for publication ; the same to be published in connection with the other pro-
ceedings of the Association in the form of a report."

A motion to reconsider Dr. Banks' resolution made and carried.
Dr. Battey offered in lieu of Dr. Banks' resolution, the following :

" Resolved, That the Essayists be authorized to present to any of the medical
journals of the State, which they might select, for publication." Resolution was
adopted.

On motion of Dr. Meiere, the Association proceeded to ballot for Ora-
tor at next meeting. On counting the ballot, Dr. H. W. D. Ford, of
Augusta, was declared elected. Dr. Banks was elected as alternate.

Committee on place of next meeting, recommended Rome. Report
of Committee adopted.

Dr. Campbell then proposed that the Sauthern Medical and Surgical
Journal be no longer considered the exclusive organ of the Association,

1859.] Editorial 357

and that all the Medical Publications of the State be requested to pub-
lish the proceedings.* Proposition of Dr. Campbell accepted.
Dr. Word offered the following resolution, which was adopted:

" Resolved, That the thanks of this body be tendered to the Editors of the
Southern Medical and Surgical Journal, the late organ of the Association, for the
kindness done this body, in publishing for several years, its transactions without
cost or charge. Also, to Dr. H. F. Campbell, for the courteous proposition made
at this meeting, to extend to the other medical journals of the State, equal parti-
cipancy in all the publications of the Association in the future."

The President appointed as a Committee of Arrangements, for next
meeting, Drs. Battey, T. J. Word, Hillyer Miller, and R. C. Word, of
Rome.

Dr. Clark, of Richmond, offered the following resolution, which was
adopted :

" Resolved, That we, the members of the Medical Association of the State of
Georgia, tender to our medical brethren of the city of Atlanta, our heartfelt
thanks tor their very generous hospitalities and warm reception in their city,
and that we will ever hold it in grateful remembrance, and that it will form a
most pleasing episode in the history of our professional lives.

"Resolved, That our Secretary be requested to have these resolutions published
in the city papers."

There being no further business before the Association, on motion,
the Association adjourned to meet, in the City of Rome, on the 2nd
Wednesday in April, 1860.

A. G. THOMAS, M.D.,
Secretary of Med. Ass'n of Ga.

The Semi-Monthly Medical News. We have regularly received the
above excellent new journal, from its first to its present (8th) number.
Its Original, Eclectic and Editorial departments evince excellent judg-
ment and rare ability on the part of its distinguished editors.

A peculiarity of this journal is, that its editors have had an opportunity
of manifesting that heartfelt gratitude which ever ennobles both the
donor and recipient, and which we may claim as characteristic of our
Profession. The work is dedicated " To Jacob L. Smyser, Esq., who,
by munificent liberality, sustains this enterprise." How seldom is it,
that the Medical Profession enjoys the meed of thanks from the commu-
nity. How seldom, on the other hand, do they have the opportunity to
thank the people but, when did that opportunity ever pass unimprov-
ed ? Let any man do them a service, and that man's name lives in their
generous hearts, glows in their widely circulating pages, is bound up in
their enduring volumes, and goes down to remote posterity embalmed
in the love and gratitude of a noble and time-honored profession.

This journal presents to its readers thirty-two well filled pages every
two weeks. It is edited by S. M. Bemiss, M.D., Professor of Clinical

* Hereafter, when Essays are read before the Association, the authors of such
Essays will have the privilege of selecting the journal in which their papers shall
be published. Editobs So. M. <fc S. J.

358 Editorial. [May,

Medicine, and J. W. Benson, M.D., Professor of Descriptive and Surgical
Anatomy both, of the University of Louisville. It is published by
Hanna & Co., Louisville, Ky., at three dollars per annum. We are
much pleased to place this work upon our Exchange list, and shall en-
deavor to make it useful, both to ourselves and our readers.

Scraps of Practice.

Diarrhoea. Ordinarily, cases of diarrhoea yield promptly under the
judicious use of stimulants, with moderate dosas of some one or other of
the preparations of opium. Occasionally, however, we find the affection
resist every simple remedy, and persist in spite of all our care. The dis-
charges, under these circumstances, are of a pale clay color, shewing
deficiency of bile, and they are thin and copious something more than
simple astringents seem to be required. It is common to prescribe calo-
mel, or blue mass, in large doses, for these cases. From our own expe-
rience, we are inclined to the opinion that the doses prescribed are
unnecessarily large, and that much smaller doses would better and more
safely accomplish the result. We seldom fail to correct this condition
of the bowels and improve the appearance of the passages by giving, in
addition to the astringents, very small doses of blue mass thus : Divide
xii. grs. of blue mass into twelve minute pills give one pill three or four
times a-day. The passages usually become less frequent, more consist-
ent and of better color, before the twelve pills have been taken. The
practice has the advantage of being fully as certain as the larger doses
of calomel or blue mass, while it never runs the risk of increasing the
disease. And again we are saved from the wholesale administration of
mercury, a remedy which, though one of the most valuable we possess,
is still often, as potent to do evil as it is to do good.

There is another condition of the bowels which requires special atten-
tion, and which we seldom or never find alluded to in books. The
upper portion of the intestines appear to have recovered from the condi-
tion which had given rise to the discharges, the passages have assumed
the normal color, and for a part of the day, viz. in the morning, the
normal consistency yet the rectum is irritable. The patient will state
that in the earlier part of the day, he has no trouble with his bowels,
that the first evacuation is nearly normal, but that, at frequent intervals,
after the first, he feels compelled to have a second, a third, and many
others, each time, the discharges becoming thinner and thinner, till by
night, regular diarrhoea appears to have been established ; next morning
the passages again appear consistent at first, but invariably, at night
have become thin and diarrhceal. Astringents and opiates here appear
to fail. We have known patients completely stultified by laudanum
draughts, and yet weakened and exhausted at night, by the persistent

1859.] Editorial 359

discharges. We regard the true pathology of this form of Bowel-com-
plaint to be the Irritability of the Rectum. Perhaps the mucous surface
of the rectum may be inflamed or abraded, but we think this is, generally,
not the case. The nerves appear to be the true seat of the affection.
The course seems to be this : the frecal mass accumulates in the rectum
during the night, a small quantity at a time, without producing a desire
for action and the patient can often retain it till 9 or 10 o'clock in the
morning without inconvenience, but as soon as the necessary effort has
been made to produce the morning evacuation, the parts become excited,
a sense of irritation is left which excites the peristaltic action of the up-
per portion of the intestine and successive portions of their contents are
brought into the rectum which are expelled by the irritable rectum
this constant irritation is reflected upon the secreting surface of the
small intestines by a true excito-secretory action, and they finally yield
to free, thin and copious diarrhceal discharges, observed in the latter
hours of the day. The sensory nerves, then, of the rectum, are in an
irritable condition, and they, through the spinal marrow, become ex-
citors, to the secretions throughout the whole length of the intestinal
canal, by the influence which they exert upon the ganglionic system.*

We have said opiate-draughts do not arrest these discharges very
large doses of opium often fail, and yet opium is the best and only reme-
dy we know in those cases not given in the ordinary way, by the
mouth but by the rectum, and then one-fourth the quantity is doubly
efficient in giving relief and comfort to the patient. This result might
reasonably be expected ; the irritable excitor surface is now made the
absorbent surface, and therefore the irritability is promptly relieved, and
the diarrhoea consequent upon it, is arrested.

Our advice to patients suffering in the manner above described, is
this : Procure a convenient glass syringe of 1 oz. capacity, also a 2 oz.
vial of water and an ounce vial of laudanum, carry them constantly
about the person so that the injection may be applied at the proper time.
Immediately after the morning evacuation fill the syringe with water,
leaving space for the piston and 15 or 20 drops of laudanum; drop in
that amount of laudanum, shake the syringe to mix it well, and apply.
At first, a slight burning and irritation is felt in the rectum this soon
subsides, and the rectum becomes quiet and remains *o, the patient rare-
ly having a second passage during the entire day until next morning.
If he wishes to test the efficacy of the remedy, let him omit the lauda-
num injection in the morning, and by night the diarrhoea will be as bad
as ever. In a week or ten days the irritability of the rectum is general-

* See Essay on Excito-Secretory System in its Relation to Physiology and
Pathology, by Henry F. Campbell, M. D. 1857.

360 Miscellaneous, [May,

ly removed, and the injection is no longer necessary, the parts resuming
their healthy functions without it.

Many patients fail to retain the injection at first ; then, repeat after
the second passage. Others require more laudanum, even asmnch as 35
or 40 drops others again, require more water, to prevent the burning
sensation at first produced by the laudanum ; but in most cases 20 drops
of laudanum and one ounce of water, we have found to be fully sufficient.
There is no general effect experienced it simply quiets the rectum -
and with it the entire intestinal canal and that is enough for those suf-
ferers whose rec turns, from ten o'clock in the morning till ten o'clock at
night, have been in an habitual daily turmoil and distress perhaps for
months previous to the application.

We intended to discuss some of the peculiarities and remedies of the
Diarrhoea of Children, when the irritation is most frequently at the other
end of the alimentary canal, viz., the mouth, caused by Dentition but
space will not allow. If we indulge in such reflections, our ""scraps"
will become disquisitions, and then nobody will read them. We
defer Infantile Diarrhoea for a future number, h. f. c.

Phosphorus in the Treatment of Phthisis. Nearly a year ago, we
called attention to a new theory respecting the nature of phthisis, and
a new method of its cure. The theory, in brief, was this : that the es-
sential condition of phthisis is a deficiency, in the system, of phosphorus
in a state capable of oxygenation ; the cure naturally followed give the
hypophosphite of lime, or of soda, which offers the double condition of
being immediately assimilable, and at the same time of being in the
least possible degree of oxydation. The remedy has been extensively
tried, but, we believe, with only limited success. We observe that the
editor of the Gazette Hebdomadaire, of Paris, has been publishing the re-
sults of his observations on patients treated by Dr. Churchill himself.
The following translation of his article, or a part of it, is from the Ameri-
can Medical Monthly for January.

" Of the twelve cases of which I have made a statement, there are two
in which I doubted, from my first examination, the existence of tubercu-
lous phthisis, at least as being the chief of the local or general diseases
of which it was necessary to notice the ultimate progress. In one of
these two cases the general condition was improved, and the local disease
remained stationary at the end of four months. In the other, all the
disease had disappeared at the end of four months. Ten cases remained
which can be called tuberculous phthisis, with every appearance of cer-
tainty. Of this number, in one, the local disease was improved at the end
of four and a half months; in one it remained stationary at the end of
four months ; and in eight it was aggravated at the end 4, 2, 3, 5, 4, 3,
4i, and 31 months respectively. As to the general condition, in five
cases there was evident amelioration ; in one there was no appreciable
change ; and in four there was aggravation. In two of these last cases,
it is true, the last note of M. Churchill makes no mention of the general

1859.] Miscellaneous. 361

condition, but my eves assured me that this was far from being im-
proved.

"After these results, it is impossible for me to attribute to the method
of treatment adopted bv M. Churchill any influence over the progre*
tubercles, for we know verv well that in this disease the disorganization
of the lung is far from being continuous, even in the absence of all treat-
ment; that, on the contrary, (he evolution of tubercle usually pres<
periods of repose, during which the rales consequent on congestion of
the tissues or the secretion of liquid products, diminish or disappear.
This is a point on which Dr. Austin Flint lias lately insisted.

" As to the influence of the treatment on the general health, especially
upon the fleshiness of the patient, as well as upon certain thoracic symp-
toms, I ought to say, that it has seemed to be quite apparent. Neverthe-
less, I should not dare to rest my opinion on this small number of facts;
and at any rate, I could not see that there was anything specific in this
result. Many preparations, but especially cod-liver oil, when phthisical
persons first use them, have the effect of at once restoring the flesh, the
strength in a measure, and even of diminishing the cough and the expec-
toration ; but this does not stop the tuberculous disease, which slumbers
for a moment only, to awake and resume its work of destruction."

[Boston Med. and Surg. Journal.

Laryngeal Operations in Paris. These seem to be the order of the
day, and methods of a strange kind are proposed by various surgeons.
"We have already alluded in The Lancet, to M. Bouchut, who leaves for
several days a dilating canula in the larynx. The same operator now
proposes to forestall the distressing symptoms of croup by removing the
tonsils at the outset of the disease. Cases in support are brought for-
ward. On the first of these operations M. Trousseau has just reported,
and eloquently shows that the intra-laryngeal permanent dilatation is
very difficult of application, uncertain in its results, and far inferior to
tracheotomy. The latter operation is shown, when early performed, to
be much less fatal than has been supposed. M. Bouchut, who seems to
be hard at work with croup, has just found that in two-thirds of the
cases the urine is albuminous, and ceases to present this peculiarity
when recovery approaches. This same M. Trousseau uses, in different
complaints of the larynx and trachea, a porte-caustique very similar to
Lallemand's, but much shorter. The nitrate of silver is thus easily car-
ried into the larynx.

M. Loiseau, however, has much popularized, in croup, his injections of
various solutions into the larynx. His mode of operating is simple. The
left forefinger is covered from the metacarpal articulation to the first
phalangeal with a metal ring, which shields that part of the finger from
the teeth of the patient. The finger is then introduced into the mouth,
and the epiglottis pressed against the base of the tongue. Guided by
this finger, a silver tube with two holes at the end is passed into the up-
per part of the larynx. A sponge, fixed to a rod, and previously moist-
ened with a caustic solution, is now introduced into the tube, and pressed
against its end ; through the holes in the latter a regular caustic douche
is applied to the larynx. This operation has been extensively used

362 Miscellaneous.

in Paris, and, though not invariably successful, has proved extremely
useful, and has contributed to the recovery ol a great many patients.

[London Lancet.

Operation in Veterinary Surgery. Considerable interest has been
excited amongst practitioners of the veterinary art by an operation per-
formed by Mr. George Holmes, of Beverley. The subject, a valuable
black horse, had been suffering some time from water on the chest. Mr.
Holmes accordingly operated, and succeeded in drawing from the animal
the enormous quantity of fifteen gallons and a half of the fluid, a result
unprecedented in the annals of the profession. Although only a recent
event, still the horse has perfectly recovered, and is enabled to do the
ordinary field-work with the rest of the team. [Ibid.

V Hotel-Dieu of Paris. This ancient hospital is now being demolish-
ed, to make room for a new institution in a more healthy location, and
for the purpose of providing better sewerage and ventilation, which were
the faults of the old building. The Hotel-Dieu had nearly one thousand
beds, and received annually about twelve thousand patients, who were
nursed by forty Sisters of Charity, mostly Roman Catholics. The found-
ing of this hospital is said to date back as far as the year 660 ; but this
point is disputed. We extract the following paragraph from the Medi-
cal Times and Gazette, which will prove interesting to our readers :

" It is generally believed, but without proof, that the foundation of the
Hotel-Dieu was due to St. Landry, Bishop of Paris, in the seventh cen-
tury. The canons of Notre Dame only possessed at first the half of this
establishment; the other part was ceded to them in 1202, by Renaud,
Bishop of Paris. At that time, the poor sick and healthy poor were ad-
mitted into it ; it was a hospital in the true sense of the word. Phillippe
Auguste was the first king that gave donations to it. We read in one of his
letters : * We gave to the Maison de Dieu de Paris, for the poor there, all
the straw in our room and house in Paris, each time that we leave the town
to sleep elsewhere.' The increase of population brought an increase of
sick, and thus the Hotel-Dieu became insufficient for their accommoda-
tion. InJ2l7 Dean Stephen, conjointly with the Chapter, charged four
priests and four clerks with the spiritual care of it ; thirty priests and
twenty-five clerks provided for the wants of the sick. Under St. Louis,
the hospital was re-built and enlarged. It then took the name of Hotel
Notre Dame, and was exempt from all taxes. In 1511, the Rue des Sab-
Ions was closed, in order to increase its size. In 1531, Cardinal Duprat
built a ward, which was called before the Revolution, Salle du Legat.
In 1602, Henry IV., constructed the Salle St. Thomas ; in 1606, the
Salle St. Charles was finished, through the liberality of Pomponne de
Bellievre. Louis XIV., like his predecessors, favored the hospital. In
1772, the accumulation of sick was so great, that as many as eight pa-
tients were put in one bed; and on the morrow, almost always three or
four were found dead. The mortality rapidly increased, and the Hotel-
Dieu became a permanent source of infection to the city ; and this
brought about an improvement in its administration. Under the Revo-
lution, the Hotel-Dieu was re-baptized, and called Maison de la Humani-
ty. The Hotel-Dieu is now about to be entirely demolished." North-
American Med. Chur. Review.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XV.] AUGUSTA, GEORGIA, JUNE, 1859. [No. 6.

ORIGINAL AND ECLECTIC.

ARTICLE XV.

An Essay on the Adaptation of Climate to the Consumptive, for a
permanent residence ; embracing an Examination of the climate
of certain localities of frequent resort; an^also, an Investigation
of the degree of adaptedness of the Pacific Climates of the United
States. Presented to the- Medical Society of the State of Geor-
gia, at its annual meeting, held at Atlanta, April 18th, 1859.
By William Henry Doughty, M. D., of Augusta, Ga.
(Ordered to be printed.)

(Continued from May No. page 315.)

In the study of medicine, as in all other departments of science,
the necessity for a standard, with which to compare and by
which to contrast the various differences and irregularities,
which are found under the controlling influence of the numer-
ous causes of disease, obtains with peculiar force. Applied to
meteorology, it is possessed of more than ordinary interest and
value, since these numerous causes of diseased action, in a large
proportion of cases, are attributed, more or less, to some aberra-
tion in the natural constitution of the atmosphere, or to a
hurtful predominance of some one or other of the normal con-
stituents of the same. The etiologists of the British Isles tested,
justly perhaps, the salubrity of other climates by that of their
own, as is shown by them in their numerous essays upon the
subject of consumption. However, the greater frequency of
tubercular disease in cold countries, soon inspired the minds of

N, S. VOL. XV. NO. VI. 26

364 Doughty. An Essay on the Adaptation of [June,

the profession of that place with the idea, that the great test of
climatic salubrity to those laboring under pulmonary lesions,
was to be found in warmer regions, where they are of less
frequent occurrence. Greater uniformity of temperature was
enthroned as the principle and element above all others to be
conformed to. At present, the scene has again changed : these
views, after having undergone a practical test, are being revers-
ed. We accordingly find the Englishman rejoicing, that "the
death-blow to the expatriation of invalids afflicted with pulmon-
ary alterations," has been given and apparently in conscious
security believes, "that consumption, the reproach of our fickle
seasons, lurks as fatally in the balmy Italian zephyr or the sul-
try tropical breeze." Being thus reversed in belief, by some
the propriety of a change of climate is denied, whilst others, led
on by the hope of discovery and success, have recommended
cold climates and dry. It is very natural, that the early settlers
of this country should have imbibed their notions of climatic
perfection from their native country, and therefore have deemed
it superior in excellence, to that of their adopted home. But,
as this country has gradually emerged from its native state of
rudeness, into one of high civilization and scientific attainments,
this too has been made a point d'appui, from which to judge of
and estimate the causative relationship of the various meteoro-
logical conditions to consumption. At present, however, we
believe that European and American writers agree upon a less
exclusive ground, i. e., a selection of a residence in cold latitudes
during certain seasons of the year, and a return to warmer ones
during other seasons : thus completely overturning the former
conviction of benefit to be had from a permanent residence in
any particular locality. With the hope of still finding a place,
favorable for a permanent residence, we propose to institute a
comparison, between the continents of Europe and North Ameri-
ca, in reference to those meteorological influences, which are
recognized as causative of this disease.

GENERAL COMPARISON OP EUROPE AND NORTH AMERICA.

Europe. It would seem, that the true standard of comparison,
ought to be found somewhere on the continent of America,
since " it traverses all the climatic zones of the earth," whilst
Europe, " extends through similar climatic zones." Indeed, the

1859.] Climate to the Consumptive, &c. 365

supposition that this starting point ought to be found here,
must, from necessity be so, when we remember that it extends
almost from the Arctic to the Antarctic ocean. " Europe, of all
the continents, is the one whose forms of contour are most varied.
Its principal mass is deep cut in all parts by the ocean and by
inland seas, and seems almost on the point of resolving itself
into peninsulas. These peninsulas as Greece, Scandinavia
repeat to infinity the phenomena of articulation and indentation
of coast, which are characteristic of this continent. The inland
seas and the portions of the ocean, its outer limits enclose, form
nearly half of its surface." "Europe has a northern and south-
ern slope, the culminating point, being the Tyrolian Alps."
The gentle and longest slope is the northern the southern is
everywhere rapid and shortest. It is everywhere, and especial-
ly on the south and west, exposed to the returning trade- wind.
North and east, the polar winds find a wide portal for entrance
and penetrate even to the southern slope ; south and west, the
south-west, the returning trade-wind and the prevailing wind
of the north temperate zone, laden with the warm and humid
vapors of the outspread Gulf Stream, the Atlantic Ocean, and
its great inlet, the Mediterranean Sea, extends its influence
far in the interior, beyond the Alps, and northward to Norway
and Sweden, rendering these countries habitable and compara-
tively mild, in default of which it is said, that their seasons
would be as rigorous as those on the coast of Labrador. The
parching sirocco, from the African desert, also exerts its blight-
ing and burning effect upon a part of its southern* coast. In
Europe, the mountain chains are broken and not continuous,
and take generally a direction with the axis of the continent,
from east to west. It has one mile of coast to 156 square miles
of interior. It has a mean elevation of 671 feet above the level
of the sea.

North America. The forms of contour of North America are
more regular. It has but one indentation upon its western
coast of any importance the Gulf of California, whilst its east-
ern border, though frequently indented with small articulations
of sea and land, has not these latter, so numerous and extensive
as those on the south and west of Europe. Its extensive moun-
tain ranges take a northern and southern direction, dividing it
into an eastern and western slope the eastern, being the long

366 Doughty. An Essay on the Adaptation of [June,

and gentle one to the Atlantic the western, abrupt and short
to the Pacific Ocean. All east of the Rocky Mountains is an
extensive plain, and being the major part thereof, characterizes
it as a region of plains. Towards the north, this plain presents
the large and extensive area, 90,000 square miles, in the person
of the great lakes. On the south, the Gulf of Mexico encroaches
to half its width, and in the intervening space, is the great valley
of the Mississippi, with its vast and comprehensive domain, full
of moisture and verdant with abundant vegetation. On its
eastern slope, it presents no obstacle to the entrance of the polar
winds, with all of their bitterness and severity, marking the
climate of the north with the severity of a Canadian winter, and
guided by the great mountain chain, they extend their influence
in the winter season, even as far south as Texas and Florida.
The equatorial winds have also an unobstructed entrance, over
the Gulf, into the southern portion, conveying their super-
abundant moisture to be condensed by the great condenser, the
Eocky Mountains, destined thereby to aid in supplying the
eternal fountains of "the Father of Waters," and its tributaries ;
and bearing along with them, the heat of the tropics far north,
producing in the summer the greatest height of the thermometer,
and in conjunction with the polar winds, the greatest known
range of the thermometer, from 120 to 130. Those from the
east, having traversed or originated in the region of the Gulf
Stream, find also an easy access, and render sultry, oppressive
and humid the atmosphere of that portion particularly, between
the Atlantic and the Alleghanies. It has one mile of coast to
228 square miles of interior, and is 748 feet above the level of
the sea. In each of these continents, various local circum-
stances conspire to render certain parts different in regard to
fruitfulness, salubrity, etc. The northern slope of Europe is
comparatively more dry, than its southern, while the eastern of
North America, more particularly in the United States, is more
moist than its western.

Now it will be observed, that, taken in the aggregate, these
two great continents, whilst each possesses some slight advan-
tage over the other, yet remarkably coincide in the possession
of those conditions, which are generally conceded to be most
pernicious to the consumptive viz., humidity of atmosphere,
and variableness of climate and seasons. It has been shown,

1859.] Climate to the Consumptive, &c. 367

that the plain east of Rocky Mountains constitutes the great
bulk of the North American Continent ; that portion west of
them, being only a narrow strip, extending from Lower Cali-
fornia to the Polar Sea, This eastern plain is the portion,
which has been emphatically the theatre of operations, and the
study of the profession in this country, in connexion with pul-
monary diseases. The southern and smallest of Europe, on the
contrary, has been to European writers the great field and seat
of their numerous observations and warm eulogies. "With some
exceptions, the northern portion of the latter, has not even
occupied debatable ground in this connexion, being confessedly
too rigid in all of its climatic features. It should not escape
observation, that the comparisons, perhaps invidious, which
have been made between this country and Europe, have been
predicated in error, since they have generally been confined to
that of the southern slope of the latter, with the eastern of
America. It does not even savor of fairness, since the mildest
of the former is contrasted with the severest of the latter. Com-
mercially, it would be just and proper, that the south and west
of Europe, should be compared with the south and east of Ame-
rica (N.), since their more numerous indentations and articula-
tions of sea and land, admirably adapt them for commercial
intercourse with each other and with the world at large. But,
considered with reference to the subject under consideration,
the mildest of the one is brought in contrast, with the severest
of the other.

COMPARISON OF THE EASTERN AND WESTERN SLOPES OF
NORTH AMERICA.

With the view of substantiating this last remark, we propose
to contrast, in the first place, the eastern and western slopes
of North America, in reference to certain general climatic char-
acters ; and then, to institute a comparison of the latter, with
the southern slope of Europe. The eastern slope of the North
American Continent is, at its greatest width, about 1600 miles
the western is 600 miles broad ; the eastern is a great plain,
possessing an alluvial soil with broad and deep valleys, ex-
tending from the Rocky Mountains to the Atlantic Ocean. The
western, on the contrary, is high and elevated a highland re-
gion, with but few important valleys the Columbia, the Sacra-

368 Doughty. An Essay on the Adaptation of [June,

mento and San Joaquin, and the Colorado; the eastern has
large and numerous rivers, extensive valleys, lakes, and inland
seas, and is bounded on three sides by water ; is also open to
the returning trade-wind, polar winds, and the vapors which
accumulate in the east, about the Gulf Stream : the western,
like all parts of continents, occupying the lee- ward side of ex-
tensive mountain chains, has, neither large rivers nor numerous
small ones ; excepting the valleys above-mentioned, which are
small, when compared with those on the eastern side no large
surfaces of water are exposed for evaporation : it has but one
aqueous boundary, and is exposed to the unobstructed action of
but one wind, the west, from the Pacific, being shielded from
the polar and eastern winds, almost entirely, by the Eocky
Mountains, and from the south winds, less effectually, by small-
er and more unimportant ranges, and by extensive highlands.
Aridity of soil and atmosphere also characterizes the latter.
From this comparison, we deduce the following conclusions :
The eastern slope affords enlarged facilities for the generation
of moisture, by the character of its soil, by its general topo-
graphical features, and its exposure to certain winds these
winds, producing also the greatest alternations of heat and cold,
according to their prevalence, frequently in very short periods
of time ; the greatest range of the thermometer ; and in many
places, uniting a high dew-point with a high temperature, but
in as many others, a low dew-point with a considerable degree
of relative humidity. Hence its phases of climate, humidity of
atmosphere, with extreme variability of seasons, together with
its topographical conditions, are, throughout, absolutely injuri-
ous to the consumptive. Some of its localities may appear dry,
when compared with its most humid.

The western slope possesses many circumstances, calculated
to modify the rigors of climate. Its winds come tempered by
the mild Pacific, over which they pass to soften and subdue.
The polar winds, except those due- north, and n. n. west, which
are not the prevailing winds of the north- temperate zone,
being effectually barred an entrance, cannot bring hither their
severity, and when they overleap the high range of mountains
on the right, come stripped of whatever moisture, they may
have possessed, and are moreover counteracted by those from
the Pacific, which are warmer and have greater prevalence.

1859.] Climate to the Consumptive, &c. 369

Besides, being more elevated, the density of the atmosphere is not
so great as in the plain to the east; the general dew-point is not so
high; the average range of the thermometer is perhaps less;
and the seasons, as will be shown in the conclusion of this arti-
cle, more uniform in temperature, and regular in their success-
ion of each other. In other words, lightness, dryness, and
buoyancy of atmosphere, with uniformity of temperature and
regularity of the succeeding seasons would seem to be the mete-
orological record* of this border. This is not absolutely true of
all its extent, because all of the western plateau is not so pro-
tected, but by far the greater portion, is so protected.

COMPARISON OF THE WESTERN SLOPE OF NORTH AMERICA WITH
THE SOUTHERN SLOPE OF EUROPE.

The south of Europe is bounded upon the south and west
by the Atlantic Ocean, the Mediterranean Sea, and numerous
smaller seas ; has multiplied indentations of coast, peninsular
projections of the continent, with bays, gulfs, etc. On the
north, the Cantabrian, the Pyrennees, the Alps and Appenines,
form the chief mountain ranges, taking the general course and
direction of the continent from east to west. These, however,
do not present an unbroken front, but are interrupted by nu-
merous gaps. The south winds transport thither the heat of the
African deserts, while the south-west bears the vapors from the
Atlantic and the Gulf Stream to envelope the land, and to be
precipitated by the various mountain condensers. Moreover,
a high dew-point often coincides with a high temperature, as in
the eastern portion of the United States. The action of the
polar winds, although somewhat intercepted by the mountain
barriers, yet is not entirely so, since their interruptions, or ra-
ther their want of continuity, allow them to diffuse their chilling
and icy influences very far southward the harbors of the south-
ern ports, such is the extremity of the cold, being occasionally
frozen over for some distance. As a consequence of the result-
ing conflict between the northern and southern winds, its
seasons are more or less variable and trying to the invalid, and
its moisture is frequently condensed into mists and fogs. Its
elevation above the sea is not so great as the western slope of
North America, for, as a general rule, those countries washed

* The various terms used above are to be taken in a strictly comparative sensea

370 Doughty. An Essay on the Adaptation of [June,

by the Atlantic are less elevated above its waters, than those
washed by the Pacific. A high dew-point, rapid alternations
from heat to cold, without uniform and regularly succeeding
seasons, would seem to characterize it, notwithstanding its former
high position in the estimation of European writers. Between
this, and the eastern portion of the United States, there is great
climatic similarity, whilst the western part of the latter seems to
possess decided natural advantages over them both.

To sum up : a high dew-point, associated with alternations of
temperature, oftentimes the widest range of the thermometer,
and corresponding fluctuations of the barometer, equally perni-
cious, characterize these two localities ; while a comparatively
low dew-point, rarity, and therefore lightness of atmosphere,
with regular and uniformly succeeding seasons on the western,
combine to effect an elasticity and buoyancy of atmosphere,
healthful to the vigorous and not undesirable for the consump-
tive.

AN EXAMINATION OF THE GENERAL FEATURES OF THAT PORTION
OF THE PACIFIC SLOPE WITHIN THE LIMITS OF THE U. STATES.

Having thus presented the general characters of the cli-
mate of the western slope of North America, we descend to a
consideration of the climatic features of that portion of it, which
is included within the limits of the United States of America.
And under this general head, we include all of that portion of
the continent, situated between the Koeky Mountains and the
Pacific Ocean; and extending from the southern boundaries
of the State of California and the territory of Arizona north-
ward to British America embracing nearly 18 lat. ; 11 long,
at its narrowest point, and about 18 long, at its greatest width ;
and having 1,000 miles of sea-coast. The most prominent
topographical feature, which it presents, is its mountain char-
acter. Upon the right are the Eocky Mountains, 4,000 miles
long and 10,000 feet high; taking at their commencement a
direction south-by-east to a point opposite the centre of the re-
gion we are about to consider, and then assuming one almost
due-south their prolongation southward, being continued un-
der the name of the Sierra Madre, a chain less lofty than the
original, but extending into Central America. To the left, ano-
ther important range, the Sierra Nevada, 15,500 feet high,

1859.] Climate to Hie Consumptive, dr. 371

prolonged northwardly through Oregon and Washington Ter-
ritory, under the name of the Cascade Range, runs parallel with
the Pacific, producing by its height and extent a profound modi-
fication and contrast in the climates of the sea-coast and interior.
Still farther west, another chain, the Coast Mountains in Cali-
fornia, impose themselves upon the view, too limited however,
in their height to modify essentially the climatic features, fore-
shadowed in the above representation of its greatest topographi-
cal element. Between the former of these chains, smaller and
more scattered ranges are found, the country resolving itself
into a high table-land or plateau. Isolated peaks are also found
at intervals, along the great mountain chains, some of which
rise to a great height in the air. For the purpose of a con-
venient and systematic consideration, we adopt the suggestion
thrown out by this part of its physical geography, and divide
it into two parts the sea-coast and the interior. The sea coast,
true to the principle which distinguishes the precipitation of the
western from the eastern slope of the United States, presents
the outlets of but two important rivers, and has comparatively
few small streams : the waters of one of the former, the Co-
lumbia, coming from the far interior and the precipitation on
the western side of the Rocky Mountains; the other, formed by
the junction of the Sacramento and San Joaquin rivers, which
latter are composed of the waters, produced by the local con-
densations along the margin of their mountainous boundaries
and the melting of snow on the summit of the Sierra Nevada,
and also from the natural precipitation into the valleys of the
same name.

Of the interior, it is said* " there is a great area very defi-
cient in atmospheric precipitation, which stretches from the
Rocky Mountains to the great coast range, and from the point,
where the two ranges merge into one in British America, south,
to near the latitude of the city of Mexico. Though both these
great mountain systems are broken down in the vicinity of the
32d parallel, they rise again in Mexico, the Coast range at the
east, arresting the tropical rains from one ocean, and that of the
west, from the other. Within the limits of the United States,
this great arid region may be said to embrace ten degrees of
longitude and seventeen of latitude, drained only by the Colum-

* See Army Meteorological Register, p. 761.

372 Doughty. An Essay on the Adaptation of [June,

bia and Great Colorado rivers in any outlet to the sea. Fully
half of it is the Great Basin of the interior, which does n ot
receive a sufficient quantity of rain to require any external drain-
age. Taking the basin, at nearly eight degrees of latitude by
seven of longitude, we have two hundred thousand square miles
so deficient in rain as to send out no rivers, and to accumulate
no considerable lakes, and this statement places the contrast
with the eastern United States, in the strongest light. The two
great rivers of the whole arid district receive most of their vol-
ume from the mountains themselves and beyond its proper
limits, and their basins might appropriately be added to the
calculation, making nearly four hundred thousand square miles
of surface, which, of itself, would send no rivers to the sea. In
the divisions of rain or hydrographic systems, this deserves a
distinct place, and its basis is in the permanent hyetal condi-
tion, which may or may not here be wholly dependent on
altitude and configuration."

The influence of mountains in the production and modification
of climate, and the great difference between the climate of the
sea-coast and inland situations, find no more fitting examples
in the geography of the globe. The mountains upon the right
shield the interior from those striking vicissitudes, which char-
acterize the eastern plains of the United States and the Missis-
sippi Valley ; and from the moisture of the Gulf of Mexico and
the Atlantic. Those upon the west, shut out the moist winds
from the Pacific, condensing their moisture upon the windward
side of those mountains. Whatever of climatic severity or salu-
brity, therefore, this extensive interior region enjoys must be
due to its own peculiar situation and conformation, and to a
small extent to exterior or extraneous influences. Being almost
surrounded by mountain ranges, high in their elevation, and
continuous in the obstruction which they present to outside
influences, it occupies an anomalous position. The slope of this
interior plateau is towards the north that portion of New
Mexico, which constitutes its most southern termination being
from 5000 to 6000 feet above the level of the sea, whilst that of
the Great Basin is from 4000 to 5000 feet, and the valley of the
Columbia 1000, or less. With this great height will correspond
the barometric pressure, and the other various meteorological
conditions of the atmosphere. M. Guyot* says : "the physical

* See Earth and Man.

1859.] Climate to the Consumptive, &c. 373

position of a place, as I would call its altitude, or its elevation
in the atmosphere above the level of the sea, is then the neces-
sary compliment of its geographical position. In considering
only places situated in a region of small extent, this element is
even far more important to know."

Again, no single precept in comparative physical geography
is more universally adopted, than that of the influence, which
proximity to the sea-coast exerts upon the climate of contiguous
countries. Where the elevation of the continent is but little above
that of the sea, those modifications extend far into the interior,
rendering more or less uniform the temperature dispensing
heat to countries, otherwise frigid and uninhabitable, but at the
same time, increasing the humidity of their atmosphere. Or, in
case of the prevalence of cold waters or currents along the coast,
if any circumstance is present to induce a flow inland, internal
heat is neutralized, by the effort to establish an equilibrium ot
the two atmospheres. Indeed, the sea-air tends to bring the
extremes together, and to maintain at all times a uniformity of
temperature. But where regions more elevated, or those farther
interior but protected by mountain chains from the atmosphere
of the sea, are contiguous, the regulating influence of that air is
lost, because its approach is obstructed, and it loses its peculiar
properties after forcing its way to such region, Do mountains
coast the sea ? The winds from the latter, forced to ascend along
their sides, " are uplifted into the colder regions of the atmos-
phere ; they feel the pressure of the air, which is less there, and
the expansion of the gases, comprising them, further increase
the cooling; the air loses its capacity for holding the same
quantity of vapors as before. The latter are condensed into
clouds, which crown the summits of the mountains, trail along
their sides, and melt soon into abundant rains. If the sea- wind
passes the chain, it descends on the opposite side, dry and cold ;
it has lost all its maritime characters."* "But," continues
M. Guyot, " we have said, that the plateaus also have a marked
effect upon the distribution of the rain waters. Their borders
act as mountains, and their surface, heated more than the layers
of air of the same level, absorb the little vapors which are sent
to this height, without condensing it; their extent finally, and
their elevation tend to impede the access of the oceanic vapors,

* See Guyot Earth and Man, p. 165.

374 Doughty. An Essay on the Adaptation of [June,

and to increase the drought." Examining the climate of the
coast, according to the normal influences of the sea-air upon the
land, we notice a strict observance of those results, which are
the necessary sequences of the reaction of the water upon the
shore. Indeed a higher degree of temperature and greater uni-
formity, from one extremity to the other, than is common to
ordinary sea-coast localities are found here these two relative
conditions, being due to certain peculiarities of the waters of the
ocean here, not prevalent everywhere.

The interior, however, as we have said, anomalous in its situa-
tion, is a plateau, protected by high mountains ; therefore, moist
winds, from whatever quarter they may come, are subjected to
two modifying agencies. First, the mountains, by which they
are deprived of moisture, and secondly, the plateau, whose heat-
ed and rarified air absorbs the little vapor they may still possess
without precipitating it. But, at the same time that a general
plateau conformation favors the dissipation of moisture, in the
day, by the character of the soil and its elevation, it favors a
rapid accumulation of heat, modified alone by accidental breezes
from the mountains. Moreover, it cools as rapidly as it be-
comes warm, upon the withdrawal of the great source of light
and heat, consequently the nights are rendered cool, notwith-
standing the heat of the day. There, as may be inferred, the
regularly occurring phenomena of night and day, become the
antitype of the more prolonged seasons.

SPECIAL CLIMATE OF THE PACIFIC SLOPE.

We will pursue this subject by examining the climatic con-
ditions of the States and Territory upon the sea-coast, proceeding
from south to north, comparing each with its parallel portion
of interior. All that we know of the general climatic condi-
tion of these localities, is deduced from certain general princi-
ples of physical geography, as the relation and effect of winds
upon climates, this latter obtained from a knowledge of the
character of those winds ; and the effects of currents of the ocean,
upon their temperature and hygrometrical condition. Their
special climate is obtained from the observation of their various
meteorological conditions, as determined by instrumental means.
So far as the special climate of the Pacific coast is known to us,
it has been transmitted by direct observation with the ther-

1859.] Climate to the Consumptive, &c. 375

mometer and the rain-guage, whilst the remaining meteorologi-
cal features, its barometric pressure and its humidity, are to be
determined, the first by calculation from its altitude, and the
second, only approximative^, by its exposure to such elements
or circumstances, as influence the same.

We shall notice this region, then, in the following order:

1st. California, as contrasted with that portion of the interior,
embracing Utah and New Mexico territories. Its spring, sum-
mer, autumn, and winter climate, that of the whole year,
together with the winds of each season and the fall of rain.
Finally, its adaptedness to the Consumptive.

2nd. The State of Oregon, and that portion of Washington
Territory upon the coast, as contrasted with the Columbia Valley.
Following the same arrangement as above.

3rd. A comparison of the entire Pacific coast, with the State
of Florida, adopting the most eligible localities of each, with the
view of showing its greater adaptedness, as a resort for the
Consumptive.

THE STATE OF CALIFORNIA.

General Description. " West of the Sierra Nevada, and be-
tween that mountain and the sea, is the second grand division
of California, and the only part to which the name applies in
the current language of the country. It is the occupied and
inhabited part, and so different in character so divided by
the mountain wall of the Sierra from the Great Basin above,
as to constitute a region to itself with a structure and con-
figuration a soil, climate and productions of its own; and
as northern Persia may be referred to as some type of the
former, so may Italy be referred to as some point of comparison
to the latter. North and south, this region embraces about ten
degrees of latitude from 32, where it touches the peninsula of
California, to 42, where it bounds on Oregon. East and west,
from the Sierra Nevada to the sea, it will average in the middle
parts, 180 miles ; in the northern parts, 200 miles giving an
area of about 100,000 square miles. Looking westward from
the summit of the Sierra, the main feature presented is the long,
low, broad valley of the Joaquin and Sacramento rivers the
two valleys forming one five hundred miles long, and fifty
broad, lying along the base of the Sierra Nevada, and bounded

376 DOUGHTY. An Essay on the Adaptation of [June,

on the west by the sea-coast range of mountains, which separates
it from the sea. Long dark lines of timber indicate the streams ;
and bright spots mark the intervening plains. Lateral ranges,
parallel to the Sierra Nevada and the coast, make the structure
of the country, and break it into a surface of valleys and moun-
tains the valleys a few hundred and the mountains two to four
thousand feet above the sea. These form greater masses, and
become more elevated in the north, where some peaks, as the
Shastl, enter the regions of perpetual snow. Stretched along
the mild coast of the Pacific, with a general elevation in its
plains and valleys of only a few hundred feet above the level of
the sea and backed by the long and lofty wall of the Sierra
mildness and geniality may be assumed as the characteristics of
its climate. The inhabitants of corresponding latitudes on the
Atlantic side of the continent, can with difficulty conceive of the
soft air and southern productions under the same latitudes in
the maritime region of Upper California. The singular beauty
and purity of the sky in the south of this region is characterized
by Humboldt as a rare phenomenon, and all travellers realize
the truth of his description."*

The foot hills of the Sierra Nevada, which limit the valley,
make a woodland country, diversified with undulating grounds
and pretty valleys, and watered with numerous small streams
which reach only a few miles beyond the hills, the springs which
supply them not being copious enough to carry them across the
plains. These afford many advantageous spots for farms, mak-
ing sometimes large bottoms of rich, moist lands. The rolling
surface of the hills presents sunny exposures, sheltered from the
winds, and having a highly favorable climate and suitable soil,
are considered to be well adapted to the cultivation of the grape,
and will probably become the principal vine-growing region of
California. The uplands, bordering the valleys of the large
streams, are usually wooded with evergreen oaks ; and the in-
tervening plains are timdered with groves or belts of evergreens
and white oaks among prairie and open land."

Concerning the climate of California, it has been said, that,
"summer and winter, in our sense of the terms, are not applica-
ble to this part of the country. It is not heat and cold, but wet
and dry, which mark the seasons, and the winter months, in-

* See De Bow's Review, page 263.

1859.] Climate to the Consumptive, dr. 377

stead of killing vegetation, revive it, The dry season makes a
period of consecutive droughts; the winter in the vegetation
of this country, which can hardly be said at any time to cease.
In forests, where the soil is sheltered in low lands of streams
and hilly country, where the ground remains moist, grass con-
tinues constantly green, and flowers bloom in all the months of
the year." " Salubrity and a regulated mildness characterize the
climate ; there being no prevailing diseases, and the extremes
of heat during the summer being checked by sea-breezes during
the day, and by light airs from the Sierra Nevada during the
night. The nights are cool and refreshing, as is the shade, dur-
ing the hottest day."

UTAH AND NEW MEXICO.

General Observations. These two territories, which lie contig-
uous, but interiorly to the State of California, present such a
similarity of external conformation, and of general climatic fea-
tures, that, for purposes of convenience, we may unite them
under one general consideration. The former occupies the cen-
tre and widest portion of the great interior western plateau ; the
latter, with Arizona, the southernmost termination of that struc-
ture in the possession of the United States. The consideration
of their climatic meteorology is altogether based upon the data
afforded by the Medical Bureau, made up of the reports of offi-
cers stationed at the various posts in these territories. "East of
the Sierra Nevada, and between it and the Kocky Mountains, is
an extraordinary region, termed the Great Basin." " It is a
singular feature ; a basin of some five hundred miles diameter
every way, between four and five thousand feet above the level
of the sea, shut in all round by mountains, with its own system
of lakes and rivers, and having no connection with the sea.
Partly arid, and sparsely inhabited, the general character of the
Great Basin is that of a desert, but with great exceptions, there
being many parts of it very fit for the residence of a civilized
world, and of these parts the Mormons have lately established
themselves in one of the largest and best. Mountain is the pre-
dominating structure of the exterior of the Basin, with plains
between the mountains wooded and watered, the plains arid
and sterile." u In this Great Basin are situated the vast Salt
and Utah Lakes, besides numerous smaller bodies of water. The

378 Doughty. An Essay on the Adaptation of [June,

Humboldt Eiver, within the same limits, is the most important."
East of the Wahsatch Mountains and the Mormon settlement,
the Colorado Eiver takes its head quarters, bearing upon its
bosom the condensed vapors, precipitated on the western side of
the Kocky Mountains, following the most direct route to the
sea, through western New Mexico to the Gulf of California a
land-locked projection of the sea. " The heat and rarefaction of
the surface generally, render this local atmosphere dispropor-
tionately arid over the whole Basin region, notwithstanding the
frequency of rains at all seasons. A very rapid evaporation is
in progress apparently at all times, and it can hardly be other-
wise, when even in the early spring the saline plains glitter
with crystallizations ; dissolved on one day perhaps by the rain,
yet formed again almost immediately by its evaporation. Very
few of the localities have external drainage, or unite their sur-
plus waters with any stream or lake. Since the rains are fre-
quent at some points, and for some parts of the year, this must
be conclusive evidence that the evaporation is very rapid."*
The average differences " between the wet and dry thermome-
ters the direct test of the local condition in respect to moisture
are twice as great as in the Atlantic States." " The cactus and
the artimesia," with many other forms of plants and shrubs,
"particularly adapted to arid and alkaline soils," are the conspi-
cuous forms of vegetation.

Spring of California. The western or Pacific part of this
continent is much warmer during the spring season, than the
eastern or Atlantic. Indeed, if it were not for the interposition
or obstruction of the thermal lines, which occurs from the high
range of mountains and the extensive mountain plateau, these
lines would observe a comparatively uniform course across the
whole. But in consequence of these obstructions, these lines
are made to vary their course, and present upon inspection a
feature of variability and changeableness of climate, equalled
only by the completeness of those obstructions. " The principal
lines of the Isothermal chart differ five degrees of temperature,
and east of the meridian of 100 they divide distance on the
meridians with great uniformity. On the Atlantic side the
range is thirty-five degrees of temperature for twenty-two de-
grees of latitude, or, excluding the lower part of the peninsula

*See Climatology of the United States, by L Blodget, p. 188.

1859.J Climate to Lite Consumptive, dc. 379

of Florida, thirty degrees of temperature for seventeen of lati-
tude, which is very nearly a decrease of temperature of one
degree for forty miles of distance northward. The same de-
crease is found in the Mississippi Valley, and on these lines, the
altitude does not attain sufficient importance to sensibly affect
this result. The Pacific side is too irregular to give comparable
measures, but from the parallel of 30 to Astoria, the same dis-
tance which was taken in the first case, there is but one-third
the difference in temperature, or one degree for one hundred
and twenty miles northing. If the comparison was carried to
Sitka, latitude 57, but five degrees of temperature more are
lost; and the same proportion or rate of diminution is still
maintained."* As in the spring, the sea within the Gulf Stream
is colder than the continent generally, especially in the months
of April and May, reducing the temperature at St. John's to
32.3 (the mean spring temperature for five years' observation),
so, " on the Pacific," a diminution in the temperature of the
sea- waters occurs, especially in May. In March, as is also true
of the winter months, the water temperatures are greater than
the land. ' For some hundreds of miles, on the 40th parallel,
there is very little difference in the sea-temperatures for the en-
tire year; and in spring, such observations as we possess, show
them to be quite the same between the 35th and 40th parallels
for thirty degrees of longitude westward from San Francisco.
The observations given in Maury's Chart furnish about twenty
measurements for each area of five degrees extent, in both lati-
tude and longitude, and the means are 56 to the 125th meridian,
55.4 to the 130th, 55.5 to the 135th, 56.4 to the 140th, 57.2
to the 145th, and 56 for the last observed area, bounded on the
west by the meridian of 150 west longitude. These successive
results are substantially identical, and they confirm the records
at the military posts of the coast, explaining the cause of the
singular contrast of these temperatures with those of the interior,
in showing very little increase of heat as the summer approach-
es. It will be seen, by reference to the analysis of the summer
distribution, that the sea then remains nearly at the same tem-
perature for seven or eight degrees of longitude ofY the coast,
while beyond that point, it shows some increase of heat for Ma}',
and a rapid change for the months of summer. From this evi-

See Arniv Meteorological Register, page 691.
v. b. vol. xv. yo. vi. 27

380 Doughty. An Essay on the Adaptation of [June,

dence, the isothermals would apparently, extend in right lines
westward, on leaving the coast in spring, while in summer, they
course abruptly northward, after passing the cold mass of waters.
The Pacific climates appear to be distinguished for the identity
of the air and water temperature, so far as observed ; at least the
differences are so small that it is not necessary to separate them
in the purpose of this comparison."*

The temperature of the spring months at California is such,
that a very gradual increase occurs of every succeeding month
over its preceding. Thus, at San Diego the mean temperature
of March is 56 (the mean of the water temperature) the ad-
vance of March to April is 5.2 that of April to May, 1.5, and
that of May to June, 4.6. At Monterey, the mean of March,
being 51.4, the advance to April is 2. 3 of April to May, 3,
and of May to June, l.l. At San Francisco, the mean of
March, being 52.8, the advance to April is 2. 5 of April to
May, 0.0, and of May to June, 3. 5. This limited number of
observations is sufficient to show the truth of the general propo-
sition stated above, each succeeding month showing a relative
and somewhat uniform advance over that immediately preceding,
except the months of April and May, at San Francisco, when
an apparent arrest takes place, in consequence of the intensified
physical agencies at work here, not found so operative at any
other post.

Looking to the interior, to the west of the Sierra Madre and
Rocky Mountains, we find at the single post of Fort Defiance,
situated at the head waters of the Rio de Chelly, the mean tem-
perature of March to be 38.3 the advance from March to
April, 8.3 that of April to May, 4.4, and that of May to June,
13. 00. Here is presented a striking contrast with the former,
for neither regularity nor uniformity characterize the rate of ad-
vance. Doubtless these differences are attributable to the alti-
tude and continental position of the latter, and the regulating
influence of the sea-waters at the former. In the next place, let
us examine the general range of the mean temperatures of the
spring months.

* See Army Meteorological Register, page 690.

1859.] Climate to the Consumptive, d-c. 381

The General Range of the Mean Temperatures.

MEAN TEMPERATURE.

March.

High't Low't. Range, High't Low't., Range

San Diego, California

San Francisco, i4

Fort Defiance, N. Mexico,

>P.6
56. 61 490.79
40.28 37.04

3o.8 |63Q.7 570.7 I 60.OO

May.

High't Low't. Range

66Q.0 ft"*. 7 t 5o.3
0-.02 uo'.n o+".*o i.oo 5>j 38 K.."
3Q.24 4>Q.15 4oo. 06j 3o.09 52o.72 49o.10, 30.56

From this table, we observe the limited range of the mean ,
monthly temperatures, both in the interior and along the imme-
diate coast, which secures to them an unusual degree of uniform-
ity of temperature. Taking the entire season at each of the posts,
the interior has the greatest uniformity in this respect, although
this observation might be reversed if we were in possession of a
longer series of observations, for this part of the western slope is
infinitely more susceptible and liable to such influences, as are
the ordinary causes of wide ranges of temperature. At the post
of San Francisco, it is somewhat remarkable that the ran^e of
March is so much greater, than that of April, and May this fact,
however, is easy of explanation. It is at this period, that the
replacing of the warm waters off the coast by the colder masses
of summer, is taking place, which leaves the coast more open to
impressions than at other times* Their uniformity in this re-
spect will farther appear, if we contrast them, with the most
uniform southern posts on the eastern slope. At Fort Brooke,
Florida, the range for March is 16.90; for April, 14.41 ; and
for May, 5.01. At Key West, the range for March is 6.28;
for April, 5.02 ; and for May, 4.20.

A remaining feature is "the range of single observations
through the individual months." For " it is important to know
to what degree we may expect the temperature to fall, at any
single observation, in each of the spring months, in the several
districts, or the mean of the maxima and minima, and also to
know what is the very highest and very lowest point possible to
be attained in a series of years. The line of 32, as a minimum
for each month, is also quite necessary in a practical climatolo-
gy/' " On the coast of California an examination of the minima
for five years affords but two instances of the observation of
32 in March ; while in the interior and in Oregon, it may be
anticipated several times in this month, though the lowest observ-
ed points at stations not much elevated is 19. In April it is
never reached in California at the sea level, or near it, and rarely

382

Doughty. An Essay on the Adaptation of [June,

in Oregon at Puget's Sound three times in six years. In May,
there are no instances of its occurrence on the Pacific coast,
except at stations elevated two thousand feet or more. At Fort
Yuma, in the valley of the Colorado, the freezing point never is
reached in the spring. At all the stations of New Mexico the
temperature constantly falls below 32 in every month of the
spring, and at Fort Defiance, it usually does so in June."*

3rd. The extreme single observations in each individual month,
at the different posts.

MARCH.

APRIL.

MAY.

o

00

o

CD

o

cc

O

c

CO

o

CD

p

a

CD

o

cr

OR

o
a>

CD

O

CD

d

o

.<*

a

05*

cr
a

CD

o

cr

CO

78
81
89

H
o

a>

CD

o

cr
a

8

d

San Diego, California,

San Francisco, "

84
80
69

34

34

8

50
46
61

93

84
75

40
42
14

53
42
61

39
43
19

39
38

Fort Defiance, N. Mexico,

70

We perceive, from this table, that at least once in five years,f
the thermometer, in the month of March, at San Diego, will stand
at 34 the same point, as at San Francisco, some degrees of
latitude farther north, during the period of observation there.
The opposite extreme for the same month, is also four (4) degrees
higher than the corresponding observation at the latter place, there-
by producing a possible range of the thermometer four (4) degrees
greater. In April, at San Diego, we may expect additional incre-
ments of heat, though they are not expended in rendering more
uniform and less extreme the temperature; for the possible range is
increased to fifty-three degrees (53). A range, from the frost
temperature, almost to blood heat, may be experienced at some
time during the month at this place. Passing thence to May, we
find a decided diminution in the temperature, the highest record-
ed during the whole period, in that month, being 78, fifteen de-
grees less than that of April and six degrees less than that of
March. The lowest extreme also slightly retires from that of the
preceding, being one degree less, although five degrees above that
of March. However, May presents less extremity under this head
than either of the other months, the possible range of which is only
thirty-nine degrees (39Q). At San Francisco, for April, the very

Army Meteorological, Reg., p. 697. f This is the greatest time observed.

1859.]

Climate to the Consumptive, &c.

383

lowest recorded point is the same as at San Diego, although far-
ther northward, while the highest is four degrees less, in conse-
quence of which, the possible range is reduced to forty-six de-
grees (46a). April shows a marked tendency to the laying aside
of the first extreme, for the lowest degree observed is eight
degrees (8) above that of March; and at the same time there is
an addition of four degrees to the opposite extreme, by which
the greatest possible range of the thermometer is reduced to forty-
two degrees (42) a position eleven degrees lower than the cor-
responding observation for the same month, at the post farther
southward, and four degrees less than the first spring month.
Passing now to the last spring month at this place, we remark a
still nearer approach to conservatism in temperature condition,
for a retreat of three degrees from the highest of April occurs,
and also an increase of one degree over its lowest. By this dif-
ference, however slight it may appear, the possible range is
reduced to thirty-eight degrees (38). May, therefore, presents
the least extremity of temperature condition of the season. Fur-
thermore, a progressive tendency towards the bringing together
of these extremes, is manifested from the first to the last month
of the season, April being less variable than March, and May,
than either.

The contrast, between the two coast stations and the interior
post, is so palpable, that we shall not stop to remark upon it, but
leave it to the readers of the paper to institute.

4th. The mean of the monthly maxima and minima.

MARCH.

APRIL.

MAY.

San Diego, California,

59. 00
57. 00
38. 50

66. 50
63. 00
46. 00

58. 50

San Francisco, "

62. 00

Fort Defiance, New Mexico

54. 00

Under this representation, the second spring month, at San
Diego, has the most elevated mean of the two extremes, while
May has the least. And at San Francisco, while April still
shows the highest, March has the least. From a careless general-
ization, it might be concluded that these thermometrical ex-
tremes were observed in May, at San Francisco, advancing
steadily from March, but such is not really the case, for when pro-
perly understood, the fact of a steady decline in the extent to

38i Doughty. An Essay on the Adaptation of [June,

which the thermometer may fluctuate in the month, is manifest
the highest mean at this place, being the most favorable, and the
lowest, the least so. But the great practical inferences from the en-
tire premises, are the commencing recession from the higher spring
temperatures of the first and second months along the coast, as
the approach to summer is made, and the steady increase from
the first spring month to the summer months at the interior post.
Both of which find their explanation in the difference of the phy-
sical agents at work at the two places. These agents, being, in
the first case, the absolute temperature of the sea-waters during
the summer and the approach thereto, and in the second, the in-
creasing elevation of temperature throughout the northern hemis-
phere.

5th. Winds and Weather for the Spring Season. One would
suppose, from the difference in the topographical and geographi-
cal positions of these respective localities, that quite a material
difference in the direction of their prevailing winds, would equally
characterize them. But, according to the recorded observations
at the posts which we have selected as typical of the general cli-
matic condition of these regions, this difference is more apparent
than real. Indeed, the greatest difference exists, perhaps, in the
degree of circulation of the atmosphere, and not in its manner.
It appears from the record, that, at San Diego, for the month of
March, during a period of five years, the greatest number of ob-
servations were recorded under the south and west winds those
from the north and east being greatly inferior. At San Francis-
co, for three years, while the northwest winds were most fre-
quently observed, yet, those from south to west inclusive, were
predominant. And at Fort Defiance, the south and west winds,
for the same month, were still ascendant. For the month of
April, at San Diego and San Franisco, the same winds still pre-
vailed, although at the latter, of the other points of the compass,
those from the northwest were most frequent. Fort Defiance, for
this month, still manifested great prevalence of the southern and
western winds. May. at the former places, maintained the same
general characters already assigned them for the preceding
months, although the northwest wind prevailed more at San
Francisco, than at any other time during the season. At Fort
Defiance, this month gave the same result as the others.

1859.] Climate to Uie Consumptive, dx.

The folowing table will enable us to form some idea of the
weather at these places :

DAY;

San Diego, (5 years
San Francisco, (2 years.).
Fort Defiance, (2 years). .

n - - j

5" =^ =

JLJL

Mat.

7.5, 0 17.5,12.5, 9.0j 0 16.J
3.5 4 26.51 3.5! 1.5 2.5 27." 4.'

The respective means for the entire season, are as follows :

San Diego, (5 years) Fair days, lou.iv. 14.6. Rainy, 5.46.

" Francisco, (-J. years) " " 16.33. " 14.33. " 7

Fort Defiance (2 rears).. ' " 26.5U. 4.16. M 3.33. Sn'y 2.5.

From this, we perceive, that the fair days at San Diego, barely
exceed the cloudy, but are nearly three times greater than the
rainy ; and that the cloudy days are more than two and a half
times the rainy. At San Francisco, the number of fair and
cloudy days sustain a similar relation to each other, as at San
Diego, although the proportion of each to the number of rainy
davs, is somewhat reduced, bein^ as two to one. A slight in-
crease in the number of rainy days for the season also occurs here,
over those at San Diego. But, at Fort Defiance, a very great
proportional increase of the fair days, over the cloudy and rainy,
is manifested, the fair being more than six times the cloudy, and
eight times the rainy days. However, the proportion of rainy to
cloudy days, has greatly increased, over that of the coast stations,
being about three-fourths of the latter. The proportion of cloudy
davs here isgreatlv diminished from that of the' coast, beinp: about
three and a half times less; although we have superadded a ratio
of 2.5 snowy days, no record of which is made at either of the
coast stations during this season.

But what importance is to be attached to the prevalence of the
south and west winds? and what are their effects upon their
climatic condition ? The measure of their importance is alto-
gether proportional to the degree of their effect. In California,
the prevalence of these winds produces a totally different effect,
from that upon the climate of the vast interior. To the former,
they bring warmth and moisture ; but to the latter, being forced
to overleap the lofty Sierra, they descend cold and dry thus es-
tablishing the fact, before alluded to, that the same winds may
have different influences upon different regions, those influences
being essentially modified, and in many cases, altogether deter-

386 Doughty. An Essay on the Adaptation of [June,

mined by the freedom of entrance to such localities. So far as
the interior is concerned, it would appear, that winds, from what-
ever quarter they may come at this season, should be cold in
their nature and chilling in their influence, since from west to
east, circumferentially, the snow-capped mountains must impart
such a character to all winds passing around and above them ; and
again, those even from the south, blowing fresh from the high
table-land of Mexico, itself cold and of rare atmosphere at this
season, must also be more or less of a similar character.* The
land winds of California claim but little attention at our hands,
for those which have been already mentioned as the prevailing
winds of the season, are from the sea, in fact, the range of the
sea- winds in regard to the points of Ihe compass, may extend
from north -north-east to perhaps due south. But however rare
may be the prevalence of the continental breezes, yet they pro-
duce quite a marked effect during their limited continuance.
They bring down with them upon the expansive valley of the
Sacramento and San Joaquin, and upon the contiguous shore
line, the chilliness of the mountains, and condense the existing
moisture of the atmosphere at the particular place into the more
sensible conditions of mists, fogs, etc. Indeed, at the close of this
season, when the sea-waters act as a refrigerator to their own at-
mosphere, and by the general atmospherical circulation, this is
borne inland, that state is induced voluntarily and without the
intervention of cold mountain breezes, which we have supposed
the latter likely to produce.

It is important to know the number of fair, cloudy and rainy
days of these localities, because they influence, to a great extent,
the amount of out-door labor and exercise, that may be enjoyed
by a resident a point, which is considered by many writers as
the sine qua non, in the management of the consumptive. They
are the more noticeable at this season, because of its known va-
riability and changeableness at most places, and for the various
perturbations of mind and body, which they produce in the well
and the sick.

6th. Rain in Inches. As the eastern part of the United States
is termed "an area of constant precipitation," so the Pacific

* To this assumption a partial exception may be found in such winds, which,
having their origin about the Gulf of Mexico, follow the Rio Grande Valley to
the southernmost part of the interior valley, which we are considering.

1859.] Climate to the Consumptive, &c. 387

or western portion is appropriately characterized, as an area of
periodical precipitation the usual mode of distinguishing its sea-
sons, being that of the wet and dry. Indeed, so prominent and
powerful is this division, that it is said to be the great reason,
why the man from New England expresses such dislike of the
climate of this western state. Having been accustomed to the
regular succession of the four grand divisions of the climatic year
in the temperate zone generally, it is difficult for him to become
pleased with this sudden change to a uniformly and constantly
precipitating condition, regularly alternating with one of great
dryness. It would appear from an inspection of the hyetal chart
given in the Army Meteorological Register, by the shading
which is so graduated as to represent those regions, having the
least and greatest precipitation at this season, that, as the sun
crosses the equator and commences his circuit through the north-
ern hemisphere along the ecliptic, the dry season of the Pacific
slope commences. The degree of precipitation retreating north-
ward as he advances in his majestic course to the tropic of Can-
cer, and in turn with his retreat from this point, it advances
southward. The spring months would seem to be, both the ter-
mination of the wet season and the beginning of the dry, for more
rain falls during the first month of the season along the coast,
than in the remaining two, which have an extremely small
amount. In the interior, as at Fort Defiance, less rain falls at
this season, than during the summer and autumn, the rainy and
dry seasons, being reversed here which fact is accounted for,
by reference to the local disturbances that occur to the equilibri-
um of the atmosphere, in consequence of the structural conform-
ation of the territory in other words, the rains are more the
result of those local condensations, which take place around and
about high mountains, than of any general hyetal distribution.
According to our reasoning upon the influence, which the winds
exert upon the climate of these localities, we should expect less
rain in the interior, than along the coast. Accordingly we find,
that at San Francisco, the mean for the whole season, is 881
inches, and at San Diego, 2'74 inches, while at Fort Defiance it
is 291 inches.

Considering the various data presented, we arrive at the con-
clusion, that the degree of humidity of atmosphere indicated at
these places, is not relatively high, and cannot therefore be enter-
k. s. vol. xv. no. vi. 28

388 Battey, on Pharmaceutical Education. [June,

ed as an objection against them, as places of resort for the con-
sumptive. If we regard the fall of rain along the coast, and
compare it with that along the west coast of Florida at this sea-
son, it will be seen, that it is comparatively less. The humidity
of atmosphere is certainly not excessive, for its sources are limit-
ed, when compared with other regions. If, then, we assume a
moderate dew-point for the coast stations, and take in connexion
with it, their mild and equable temperature condition, we think
that no available objection can be urged against their spring
climates.

(To be continued.)

ARTICLE XVI.

Pharmaceutical Education for Medical Students. By Robert
Battey, M. D., of Rome, Ga.

Pharmacy, which for ages occupied the position of a mere
art, and a very simple one at that, has, during the past
half century, gradually aroused itself from this long sleep and
is now making giant strides towards a degree of perfection
little dreamed of in the philosophy of its ancient votaries.
The elixirs and amulets of our fathers are remembered only
with a complacent smile in our conscious superiority ; ignorance
and superstition have given place to the light of reason and
inductive philosophy. A commendable industry and zeal is
manifest among pharmaceutists all over the world, vieing with
each other in ransacking the nooks and corners of the great
storehouse of nature, in quest of hidden treasures to be added to
the rapidly augmenting fund of the Materia Medica; while,
foremost among the evidences of progress in manipulatve phar-
macy, we have the isolation of the distinct active proximate
principles of plants from the inert and valueless ligneous fibre,
and the substitution of small doses of these refined materials, for
the former large draughts of nauseous infusions and decoctions.
The hidden and mysterious action of amygdaline upon emulsion,
which goes on, all quietly and unobserved in the moistened
cherry barks, has been industriously ferretted out, and for our
reward, we have the elegant Symphus Runi Virgin, with its due
proportion of the potent hydrocyanic acid.

1859.] Battey, on Pharmaceutical Education. 389

While physiological chemistry and analyses of the blood and
urine in health and disease, point out the deficiency, pharmacy
proffers the remedy, combining the needed elements in due and
proper proportions. Well may pharmacy point with pride to her
triumphs in the careful proximate analysis of organic drugs, the
judicious selection of suitable menstrua, and the isolation of
all valuable principles from them, in that most elegant and
desirable class of preparations the fluid extracts. The resins
resinoids and oleo-resins also evidence laborious and successful
research. Time would fail us to mention a tithe even, of the
long list of alcoholic and their derivatives (among which are
sulphuric ether and cholorform) as well as the multifarious
preparations from the mineral kingdom.

Not only has pharmacy thus distinguished herself in her chemi-
cal capacity, but she has been equally busy in the improvement of
her extemporaneous and more mechanical departments. The sub-
tile aeriform spirit, so full of death to any who breathes it, has
been chained down in its watery bed by strongest bonds of iron,
whence from time to time it issues forth under the guiding hand
of the master, in the sparkling and healthful mineral water. The
disgusting epsom or glauber salt no longer distorts the visage of
the invalid but he drinks his glass of effervescing citrate with
as much gusto as he would take his champagne or julap, when in
health his* castor oil or copaiba glides smoothly along his
alimentary canal, securely stowed in the hold of a tiny gelatine
boat ; his pill no longer offends the palate nor sticks fast in his
reluctant throat, but with its firm casing of purest sugar, slips
swiftly down ; and, if he be a miser at heart, he may have it at
his bidding, clothed in all the charms of glittering silver or still
more precious gold.

The Philadelphia College of Pharmacy has contributed largely
to this reform ;. many of her graduates have gone forth in the
land bearing the torch from her altar to kindle yet other beacon
lights, and dispel the darkness which had enshrouded pharmacy.
Some of her alumni have reached our own Sunny South, and
with their little sheep skins, scarce bigger than an ordinary
window pane, unadorned by any high sounding doctorate, have
made their influence felt and acknowledged among us. With the
other legitimate offspring of this pioneer institution, stands the
American Pharmaceutical Association, which holds its anuual

390 Battey, on Pharmaceutical Education. [June,

deliberations, and already publishes in its proceedings an octavo
of size and matter well worthy a place in every medical library.
The scientific papers discussed at its meetings, for originality and
enlightened laborious research, will compare favorably with like
contributions to the American Medical Association ; and it is not
too much to ask and expect, that the former body will be admitted
to a full participation in the deliberations of the convention to be
called for the next revision of the national Pharmacopoeia.

The spirit of the age is progress upward and onward is the
watchword we catch on every hand; in perhaps no department
of natural science is this progressive disposition more manifest
than in the one under consideration. Scientific pharmacy is no
longer a mere abstraction it is full of practical results ; nor
is its advancement premature the people have kept up fully
with the times, and eagerly seize and appropriate to their
comfort and advantage the new remedies as fast as they are
brought forward. Its products are not to be confined to the
more refined and opulent denizens of our larger cities, for the
humble settler in his backswoods cabin is beginning to hear the
sound of glad tidings, and already demands that the more palpable
impositions upon his gustatory nerve shall cease, and calls for
less bulky nauseous remedies. The voice of the masses is loud
in favor of the reform, and the old fogy, or his 3rounger pupil,
who refuses to inform himself that he may keep up with the
improvements, while he continues to laugh at the disgust and
wry faces of his patrons, will find his more enterprising and
worthy competitors sweeping by him in their onward march to a
deserved fame and popularity.

Who that has observed the career of that system of arch
humbuggery Homcepathy can fail to have learned that much,
very much of the popular favor to which it has at times attained,
is due to the palatableness and supposed refinement of their little
sugar pillets. That more pitiable form of quackery pitable on
account of the gross darkness and ignorance which has invested
it Thompsonianism, was forced to abandon its feeble battery of
huge quart mugs, and beat an inglorious retreat before the popular
frown, until lucky hit ! donning some of the borrowed plumes of
progressive pharmacy, and armed with its crude reisnoids and

" essential ines," it is still able to wage a fitful, skirmishing

warfare sometimes, indeed, successfully overcoming the more
ignorant and weakly members of a higher and nobler band.

1859.] Battey, on Pharmaceutical Education. 391

It would seem that the importance, yea, absolute necessity, of
a more thorough pharmaceutical education for the physicians of
our country, and particularly of the South and West, would
scarcely need argument ; indeed the bare mention of the subject
should meet a hearty approving response from every medical
man. Who among the multitudes of physicians, spread far and
wide all over our land, is not subjected to the frequent annoyance
of failure in the actions of the remedies he employs, from their
impurity or want of strength, growing out of ignorance, careless-
ness, or cupidity on the part of his druggist? Who is there
that does not almost daily feel the want of requisite knowledge to
supply the demands of the peculiar indications and idiosyncracies
of his varied cases? Who is ignorant of the fact that, while our
drug law has wisely interposed its arm of power to protect us
from foreign adulteration and sophistication of remedies, the
examiners who are chosen to execute it. are chosen more for
political effect than for any competency they may possess for the
discharge of this responsible duty ? Who, moreover, can be
uninformed of another fact, that while foreign villany is thus,
in some degree, held in check, a wide door has been open
for wholesale adulteration at home ? Who is not already aware
that hundreds, perhaps thousands, of our countrymen annually
reach an untimely grave from the criminal ignorance of both
physicians and apothecaries? It is, indeed, but too true
lamentably, shamefully true ! Within the limited knowledge of
the writer, on many such cases, the unwitting substitution
of poisonous doses of sulphate of morphia for the quinia salt,
arsenious acid for emetic doses of tartarized antimony, corrosive
sublimate for calomel, careless preparation of strychnia pills, and
other such examples of the shedding of the innocent blood of the
unsuspecting patient; like the maniac loosed from his bonds,
they go about with deadly weapons, shooting in the dark, they
care not where, and know not who. The heart sickens at these
deeds of mental and moral darkness, and cannot brook an
argument upon the question.

So generally is the want of pharmaceutical knowledge among
physicians felt and appreciated, that many are induced to seek
the schooling of the apothecary's shop prior to entering upon the
study of medicine ; while others, already practitioners of phar-
macy, are led to graduate and enter the medical fraternity, as a

392 Battey, on Pharmaceutical Education. [June,

means of greater professional elevation and emolument. It is
evident that very few, comparatively, of our medical men can
obtain this schooling in the shops, requiring, as it does, a series
of years before an apprentince is judged competent to execute
the more responsible manipulations. However well this appren-
ticeship system may work in England, and however desirable so
thorough pharmaceutical attainments may be to the medical man,
there is too much valuable time consumed in the pupilage to suit
the fast ideas of our aspiring young men.

The office of the preceptor might be, and ought to be, a
valuable preparatory school of pharmacy, as well as of other
branches of medical science. What are the facts ? The
observation is common, that the medical instructions of the
majority of perceptors amount to little more than the use of a
few text books from their too meagre libraries, with an occasional
explanation, and a rather semi-occasional examination upon the
leading topics of study. Pharmacy as a science, or even as an
art, is very rarely mentioned, and seldom, perhaps never, taught ;
and if we ask the reason of this, we shall not be at a loss for an
answer. The preceptor himself knows little or nothing of the
subject, and of course cannot be expected to teach it what little
he has acquired has been the result of hard earned experience ;
let his student dig it out as he did.

We next look for the attainment of this instruction to the
medical colleges of the country, and with what better success ?
With, I believe, but one honorable exception (the University of
Michigan), no distinct chair of pharmacy is to be found. In most
instances it is attached either to the chair of chemistry or materia
medica, and in some of these a meagre outline of the subject is
given, while the majority, perhaps, retain only the name, and find
no time for the practical instruction ; some few, it is believed, do
it not the honor of even mentioning its name in their annual
announcements. In some of the larger cities this deficiency is
in admeasure supplied by public or private pharmaceutical
schools, but from inability or indifference Fthe great majority of
students do not avail themselves of these extra privileges, while
much the larger number of colleges are located in cities where
these private schools are not accessible and cannot be main-
tained. Besides, it is unquestionably the right of the student to
look to the regular course for this indispensable knowledge ; as well

1859.] Battey, on Pharmaceutical Education. 393

might the school refer him to the hospital for his instruction
in surgery ; to the private anatomical room for his anatomy ; or
to the private laboratory for his chemistry.

If, then, this almost total neglect of pharmacy be an admitted
evil, one which should be removed and who will gainsay the
assertion where are we to look for the'remedy ? If I might be
permitted to express an humble opinion in the matter, and sug-
gest the probable means, I would say, let our older practitioners,
who have leisure and application, together with their younger
brethren, who desire to keep pace with the times, possess them-
selves of a copy of some standard work upon pharmacy ; and
this, not as an idle tenant of the bookshelf, but let them study
its precepts closely, and put them in practice in the routine of
their daily business. Let them learn these precepts, and the
practice to their pupils, before sending them to college.

There is, perhaps, no work upon the subject for physicians
published in this country, or indeed, abroad, so richly laden with
sound practical knowledge as that of Edward Parrish, of Phila-
delphia a name which is as a " burning and shining light " in
the firmament of American pharmacy. Of the work itself it is
not too much to say, that studied and properly appropriated, it
is cheap though it should cost its own weight in fine gold. In
the graphic language of the venerable Dr. Meigs, used upon a
lecture occasion with reference to a work of perhaps equal
intrinsic value, I would say to every medical student, " when
you shall have possessed yourself of your sheep skin, and are
about to take your departure for home, if you shall have but
two shirts to your wardrobe, sell one of them and buy the book11
what matter if you go home with a dirty shirt upon your back
so you but carry in your hand the means of your professional
elevation.

In our college courses upon chemistry much valuable time is
spent upon the laws of heat, light and electricity important
and interesting topics not perhaps too fully taught, but yet it
may well be questioned, whether the more practical details of
pharmacy, bearing, as they do, upon the every day experience
and wants of the practitioner, are of greatly more real value.
It is well to have the ability to discourse learnedly upon the laws
which govern the imponderables, but it certainly more prac-
tical to be able to dispense an eligible and scientific compound

394 Battey, on Pharmaceutical Education. [June,

for the relief and cure of one's patient. By devoting one half
or more of the time usually allotted to these to pharmacy, much
valuable instruction could be given, and the profession thereby
greatly benefitted. The chemical chair, however, is already
overburdened; time cannot ordinarily be found in our short
terms to so far elucidate the various topics as to give the class
any adequate knowledge of the subject. It is notorious that few
know anything practically of the science, nor do they pretend
to any degree of proficiency. The mass of the candidates single
out this branch as their lame one, and more than all else usually

dread the ordeal before "old " (the chemist) in the green

room. The subdivisions of organic and physiological chemistry
are daily becoming more extended in range of topics, and more
useful and important in results it is highly desirable that the
standard of education should be more elevated in this direction.
Look now to the chair of Materia Medica, and we find medical
botany, together with the varieties, physical properties, qualities
and adulterations of drugs so inadequately taught, as to leave
but little lasting impression upon the mind of the hearer. The
whole subject is exceedingly dry and uninteresting and why ?
Not always from want of ability on the part of the professor,
but rather from the hurried manner in which the subjects must
be discussed, from which cause the student gathers an insuffi-
cient amount of information to appreciate and enjoy.the lecture;
so he must often go forth into the world dependant upon the
interested drug man for the selection of his medicines, and
perchance to mourn over the dead bodies of his victims through
his want of attention to the study of these subjects.

The only efficient mode of teaching these several branches, and
giving them the position, which their practical utility, as com-
pared with the other departments of medicine, demands, would
seem to be the addition of a chair of pharmacy, to lighten the
labors of the other two, as well as to teach extemporaneous and
manipulative pharmacy proper. Such an innovation upon old
usage, would not only be productive of much good to the pro-
fession in elevating the educational standard, but would like-
wise equip our medical colleges with all the facilities and
advantages of a well regulated college of pharmacy, and enable
them, in the three chairs alluded to, to extend facilities for
education to such pharmaceutists, and their clerks and appren-

1859.] Lecture on Asthma. 305

tices, as have not enjoyed these advantages, in places where no
regular organization exists for their benefit. The question of
policy might also be entertained whether or not diplomas, or
certificates of proficiency in their branch, such as are granted
by the Philadelphia College of Pharmacy, should be bestowed
npon these pharmaceutical students after examination at the
close of a second course. Next to a well educated medical
profession, we need intelligent and professionally accomplished
apothecaries; and it is, perhaps, worthy of thought, whether
the general adoption of this system, of educating apothecaries
in conjunction with students of medicine, would not have a
tendency to infuse a more high minded and professional spirit
into the former, and, perhaps, in a measure, wean them off from
their quacking proclivities, by attaching them more strongly to
our profession.

Lectures on Asthma. Delivered at Hotel Dieu, by Prof. Trous-
seau. Translated from the Gazette des Hopitaux of Septem-
ber 23d, 1858, (for the Boston Med. and Surg Journal).

Lecture IV. Examination of the opinions of the medical

PROFESSION AS TO THE NATURE OF THIS DISEASE.

Accepting the ideas of M. Louis, M. Rostan admits that asthma
may be associated with pulmonary emphysema. This opinion
is presented under a very specious aspect. Always finding pul-
monary emphysema in asthmatics.. M. Louis has concluded from
this fact that this organic lesion is the cause of the malady ; to
him dyspnoea and asthma are one and the same thing. Whene-
ver an individual is presented to him affected with essentially
nervous asthma, he diagnosticates emphysema, of which percus-
sion and auscultation, it is true, often reveal the existence. At
the same time it would be easy to show him cases in which the
nervous affection does not coincide with the pulmonary lesion in
question. Thus, for example, in the case of the patient Iving in
bed No. 10 of our Saint Agnes ward, who has been asthmatic for
many years, there exists, at the same time, emphysema with pul-
monary catarrh ; there is also an asthmatic woman in No. 6 of
Saint Bernard ward. In her, as many of you have personally
observed, there is not a single symptom of emphysema ; respira-
tion is everywhere free and full.

Nevertheless, the facts quoted by M. Louis have been rigorous-
ly observed, but their import has been exaggerated. I shall pro-
ceed to explain to you how he has arrived at his conclusions.

396 Lecture on Asthma. [June,

Under what conditions is emphysema produced ? Is it a pri-
mary or secondary affection? For my part, I do not comprehend
how it can be a primary condition, and I cannot make you un-
derstand how it is an effect, not a cause of asthma, without enter-
ing into some details relative to the mechanism of its production.

And in the first place, what is the mechanism of cough ? After
an inspiration the glottis is convulsively closed; the expiratory
muscles are brought into play to expel the air or mucus from the
bronchial passages, the blood or the pus which they may contain.
It is often only after most energetic efforts that these powerful
expirations triumph over the resistence opposed to them. But
what is taking place during this effort? There is a pressure in
operation from within outward, acting on the bronchial tubes and
the pulmonary vesicles. This pressure is transmitted outside of
the chest by the swelling of the vessels of the face and neck, to-
ward which the blood is forced by the compression of the vascu-
lar ramifications which are distributed in the lungs. The air im-
prisoned in the bronchial apparatus struggles against the elasticity
of the walls of the pulmonary vesicles, and when the pressure is
continued for a long time and energetically repeated, when the
resistence opposed by the obstacles which prevent the exit of the
air contained in the chest is too great, the walls of the vesicles
are stretched, and emphysema is produced. Sometimes even the
pulmonary vesicles burst, and there results an interlobular emphy-
sema, with which we will not occupy ourselves at present.

When we think of this mechanism of the production of pul-
monary emphysema, we are no longer surprised at finding it in
infants who have had a violent whooping cough, in individuals
subject to catarrhal affections, &c. Now pathological anatomy,
in showing us the frequency of this lesion as opposed to the rarity
of asthma, furnishes us with arguments against M. Louis's opinion ;
in fact, vesicular emphysema is observed in autopsies of indi-
viduals who have never experienced anything like asthma.

Everything, then, proves that pulmonary emphysema cannot
be the cause of asthma. On the one hand, there is no relation
between the organic lesion which necessarily remains, or at least
does not disappear for some hours, and the transient symptoms
which characterize the access of the malady, on the other, the
symptoms exist without the lesion, and still more the latter may
exist without the former even having been manifested.

But, if it is not the cause of asthma, emphysema maybe the
effect, and I proceed to explain how.

On the one hand, in the asthmatic, inspiration is more slow,
more full than in an individual whose breathing is free, notwith-
standing that expiration, instead of occurring passively, as it ordi-
narily does physiologically, in virtue of the simple elastic force of
the lungs and the relaxation of the muscles which have been
brought into action during inspiration, in this case is active, more

1859.] Lecture on Asthma. 397

violent; and yet, notwithstanding these efforts, the air is expelled
more slowly than it is in the normal condition, by reason of the
obstacle opposed to its passage through the spasmodically contract-
ed bronchial tubes. We can comprehend by this how, the mala-
dy continuing for a greater or less length of time, these efforts of
expiration being repeated at each attack, returning at longer or
shorter intervals, during one, two, ten or more years we can un-
derstand how, these attacks being thus accompanied by a cough
which gives rise to expiratory efforts more and more energetic,
pulmonary emphysema is the result.

According to M. Beau, asthma is the result of a chronic catarrh
of the small bronchi, in which the sputa are of a density and vis-
cidity which are only found in this complaint. The dyspnoea is
caused by the interruption to the exit of the air from the bron-
chial vesicles, caused by the presence of this thickened mucus in
the ultimate ramifications of the bronchi. Laennec had pointed
out the existence of these sputa, which he called pearly sputa
(cr achats perles,) in this variety of catarrh, to which he gave the
name of dry catarrh, and which is nothing but asthma. These
sputa, which the asthmatic expectorates in fact after his attack,
appear under the form of mucous globules of the size of a grain of
hemp seed. Never mixed with air, semi-transparent, of a greyish
tint, sometimes blackish, a color due to the presence of black
pulmonary matter, they sometimes lose their globular form, their
density, and become slightly pearly.

M. Beau, who was familiar with the ideas of the illustrious
author of mediate auscultation, who had himself observed facts
agreeing with his theory M. Beau goes on to say, that in asth-
matics there is in the bronchial tubes an accumulation of this ex-
cessively plastic secretion ; that we ought not, therefore, to be as-
tonished at the distress suffered by these patients, the products of
the plastic secretion acting as plugs in the bronchial tubes as com-
pletely as the false membranes in croup, or as foreign bodies
beans for example which have entered the air passages. The
loud and sonorous rales which are heard in auscultating these
patients, are caused by the vibration which the column of air
experiences in passing the mechanical obstacle opposed to it by
the plastic mucus which it meets. This theory is somewhat
specious; nevertheless, it is easy to combat it and to overthrow it.

Let us suppose an individual affected with croup, in whom the
bronchial tubes are obliterated by diphtheritic false membranes;
will this individual show us paroxysmal attacks of dyspnoea, such
as we find in the asthmatic? Observe what takes place in the
patient No. 19 of Saint Agnes's ward, and who is affected with a
bronchial catarrh with a most abundant secretion. In this indi-
vidual, who raises from time to time an enormous quantity of
purulent mucus, filling his cup, the mucus evidently accumulates
during a certain time in the bronchi, and yet he experiences

398 Lecture on Asthma. [June,

nothing which resembles the attack of dyspnoea of the asthmatic.
But, it will be said, in him the secretion takes place in the large
ramifications of the bronchi, and consequently there is no obsta-
cle to the passage of the air, since the trunk of the bronchial tree
is large enough, notwithstanding the presence of the catarrhal
matter within it to allow the air to circulate with sufficient free-
dom. What proves that the accumulation takes place in the last
ramifications is, that on auscultation you hear perfectly sonorous
and very fine mucous rales. In regard to the abundance of the
expectoration, it is evident that in this individual the obliteration
of the bronchi is far more general, far more complete than it is in
those who only raise little mucous, pearly sputa ; and yet, I repeat,
our patient experiences nothing analogous to the attack of dyspnoea
belonging to asthma.

But, supposing that these pearly sputa are the cause of the dif-
ficult respiration which characterizes asthma, M. Beau will allow
that this mucous secretion takes some time in forming. Now, the
invasion of the attack of asthma takes place with a rapidity which
has no. relation to the existence of the cause summoned to explain
it. The influence of a moral emotion, of dust, and of dust of a
nature peculiar in its effects on particular individuals, in one case
the powder of ipecac, in another of oats, &c, which is sufficient
to provoke immediately an attack of asthma is it sufficient to
excite as promptly the mucous secretion in question ?

Further, there are individuals who, subject to what Laennec
designated under the name of dry catarrh, raise, by coughing,
mucous and pearly sputa, and raise them with extreme difficulty.
They have most violent fits of coughing, brought on by a sensa-
tion of oppression, of tickling in the chest and at the orifice of the
larynx, and yet these people never have dyspnoea, never an attack
of asthma.

Finally, there are astmatics, few in number it is true, in whom
you will seek in vain, either at the beginning, during, or after an
attack, for signs of catarrh.

Thus, in an etiological point of view, the theory of catarrh is
as inadmissible as the theory of asthma exclusively symptomatic
of an affection of the heart or great vessels, or the theory of em-
physema. These theories are also much more inadmissible in a
therapeutic point of view. When the question of treatment arises,
I shall tell you that in a few moments an inhalation of the smoke
of the datura, or of the vapor of nitre, is sufficient to cut short
completely the attack. Now, Irask you, would it be so, if we ad-
mitted that the disease is exclusively dependent on material lesions
or mechanical causes ?

Nature of Asthma.
In considering the facts which I have rapidly and briefly unfold-
ed to you, when we come to ask what is, definitely the nature of

1859.] Lecture on Asthma. 399

asthma., one is tempted to compare it to the other spasmodic dis-
eases of which the pulmonary apparatus is the seat. Whooping
cough immediately occurs as an analogous disease.

An individual is taken with a catarrh, which during seven or
eight days has no other characters than those of the most simple
bronchitis ; then supervene convulsive attacks, which nothing can
control, returning every hour or two, sometimes at longer inter-
vals, and lasting hardly a minute to a minute and a half. During
the interval the patient suffers from nothing but the symptoms of
a common cold. His expectoration shows nothing peculiar. If
this individual were to cough five hundred times you would hardly
be able to count twenty or thirty fits of convulsive cough.

You are dealing, then, in this case with a catarrh, but a catarrh
to which is added a nervous element, which authorizes you in turn
to characterize the whole malady. This nervous element charac-
terizes it so well that, under some circumstances, rare to be sure, it is
the only distinguishing trait. I have for more than twenty years
called attention to this capital fact, of the spasmodic element be-
ing able to exist alone. Among other examples, I have cited that
of a child in my service at the Necker Hospital, who, for the first
eight or ten days, presented nothing else as a symptom of whoop-
ing cough but a hiccough, which returned eight, ten and fifteen
times in the course of twenty-four hours. He had not coughed
before, and he did not cough yet. After eight or ten days he had
some fits of coughing, and soon presented all the symptoms of a
catarrh, which from that time kept pace with the spasm.

I have already said, and I repeat it, the case is the same with
those affected with asthma; if most frequently they present all
the phenomena of catarrh, and sometimes of a violent catarrh, in
a certain number of cases there are no such symptoms.

We are right then in admitting with Willis, that asthma is a
nervous affection, that the paroxysms of dyspnoea which charac-
terize it are the result of spasm, which, by closing more or less tran-
siently the bronchi, interferes with the free circulation of air in
the lungs, and causes all the symptoms.

The labors of Reisseisen, the more recent labors of others, par-
ticularly of M. Gratiolet, who had an opportunity of studying the
anatomy of the lung of an elephant which had died in a menage-
rie, have demonstrated the muscular structure of the bronchi.
By what right, then, shall we refuse to these muscular tubes the
possibility of being the seat of spasms, when we admit the possi-
bility of their occurrence in other organs having a similar ana-
tomical structure? By what right shall we deny the existence of
bronchial spasms, when we admit the possibility of vesical and
intestinal spasms, spasms of the stomach and urethra ?

If physiology leads us, a priori, to the possibility of their pro-
duction, we can no more withhold our belief when we study
the pathological facts. Consider what occurs during an attack of

400 Lecture on Asthma. [June,

asthma. The patient feels a sense of constriction in the chest
The energetic efforts of the inspiratory muscles are ineffectual to
facilitate the act of respiration. It appears as if there were, and
there really is, an obstacle to the entrance of air into the bronchi ;
for if you auscultate an asthmatic patient during the attack, you
will hear neither rale nor vesicular murmur, which you hear as
soon as the attack has passed off. And meanwhile the inspirato-
ry muscles are in violent action to make a vacuum in the chest,
where the air, nevertheless, does not enter. That which is op-
posed to the entrance of the air is, then, an obstacle in the bronchi-
al tubes. We have seen that it is not a material obstacle, like
mucus ; it is a spasmodic contraction of the bronchial tubes them-
selves.

Other theories have been devised. While recognizing with us
the nervous nature of the disease, M. Bretonneau believes that
the dyspnoea in asthma is occasioned by a violent congestion of
the lungs. According to him, there occurs in asthmatics some-
thing analogous to what happens in the case of the aura epileptic
of the congestive form. Thus, in some individuals, in reality the
aura epileptica is only painful, simply a painful sensation ; which,
starting from some point of the body, the thumb for instance,
mounts rapidly toward the head, and is more or less immediately
followed by a convulsive attack. In others, the aura is accom-
panied by a congestive movement evident to the the sight. If it
start from the hand, this swells, and the fingers are violently con-
stricted by the rings upon them ; this lasts one, two, or three
minutes, and the attack comes on. This congestion is as essen-
tially nervous as that which causes blushing of the face under the
influence of moral emotions. M. Bretonneau believes that in
asthma there is a similar congestion, which, obliterating the pul-
monary vesicles and ramifications of the bronchi, is the cause of
the dyspnoea, and produces subsequently the mucous secretion,
which we generally observe, in fact, at the end of the attack.

However great the admiration which I profess for M. Breton-
neau, my first and excellent master, I have always opposed this
view of the case. I do not comprehend this aura, I do not seize
upon all this ; while I do comprehend, I do seize upon the asthma ;
and furthermore, I do not comprehend how the phenomena could
occur otherwise.

Thus asthma is a nervous disorder ; and furthermore, it is a
nervous disorder of habit. It is very rare, indeed, that this affec-
tion does not depend for its existence upon a chronic diathesis.
It is this which I shall try to demonstrate in another lecture.

S. L. A.

1859.] Treatment of Rheumatism. 401

M. Trousseau's Treatment of Rheumatism.

In the Salle St. Agnes, under the care of the same physician,
(Trousseau,) is a young man, aged twenty, who is just recover-
ing from acute rheumatism, belladonna, one of M. Trousseau's
favorite remedies in this affection, having been, to the exclusion
of everything else, the only medicine employed. The rheuma-
tism was of the articular kind, affecting chiefly the large joints.
The fever ran high, the heart's action was violent, and the " bruit
de soufflet" very distinct, accompanied with pain on pressure
over the cardiac region. Belladonna was administered in the
following proportions : One grain of the extract was given on the
first day ; two grains on the second ; two and a half on the third ;
three on the fourth ; and so on progressively up to six grains per
diem. On the fourth day the constitutional effects of the med-
cine became apparent, as was evinced by spectral illusions, deli-
rium, dilatation of the pupils, foul tongue and parched mouth.
Consentaneous wTith these symptoms, an amelioration in the
rheumatic pains was observed. Notwithstanding this improve-
ment, the belladonna has been continued ; and although the
patient is all but free from pain, M. Trousseau deems it prudent
to prolong the treatment, with a view to the prevention of a re-
lapse. In certain cases, Trousseau, and other hospital physicians
here, are in the habit of commencing with the maximum dose
noted above ; and we have known it prescribed to the extent of
eight grains of the powder or extract on the first day of the treat-
ment.

The rule is, that each day the dose be increased until delirium
sets in ; at this point the same dose is continued for a few days,
then gradually diminished ; it is, however, essential that the
bowels be kept open by the administration of some purgative,
such as calomel and jalap every day. From what we have ob-
served, there seems to exist a kind of antagonism between bella-
donna and rheumatism ; and the same has also been observed in
reference to this same affection and the constitutional effects of
quinine. Without seeking for an explanation of this peculiar an-
tagonism, we must, in the meantime, at least, content ourselves
with the simple observance of the fact, as the very individuals
who are in the habit of employing these remedies do not pre-
tend to enlighten us as to their modus operandi. Trosseau him-
self is of the opinion that, in the case of belladonna, its curative
influence in rheumatism is attributable to its action on the circu-
latory system ; this action, however, being but secondary to the
effect it produces on the nervous system. At one time he is to
be found treating all cases of rheumatism, apparently without dis-
tinction, with quinine, while at another belladonna is his specific,
to the entire exclusion of every thing else. This apparent incon-

402 Fistulas in the Perinazum. [June,

sistency disappears when one really knows and can appreciate
his motives. Close and philosophic observation has enabled him
to recognize something special and peculiar in its character and
form, during certain seasons, which is not to be found in it at'
others ; and hence the treatment, which may be suitable in one
series of cases, he finds does not answer in another. What this
peculiar modifying influence may be he does not of course know.

[ Cincinnati Lancet and Observer.

Fistulce in the Perinoeum. By Wm. M. Eames, M. D.

Mr. M., of Windsor, Ohio, set. 72, received an injury in the re-
gion of the perinaeum, several years since, which caused symp-
toms of stricture of the urethra ; and about five years ago caused
complete retention of urine. All attempts to pass a catheter
proved unavailing, and after several days of intense suffering
the urethra gave way, and the result was that several fistulous
openings occurred in the perinaeum and scrotum. The urine
passed through these openings during the act of micturition
which act was always attended with great pain and scalding ;
and as the patient could not retain his urine, more than from
half an hour to one hour at a time, his life was one of continual
suffering. There was also a profuse discharge of pus, which, with
the pain and irritation, had induced great debility and hectic fever,
and he was obliged to keep his bed most of the time.

When I first saw him, he had been three years in the above-
described condition, and was, as he expressed it, ;'very anxious
to be either killed or cured.1'

The stricture was just below the membranous portion of the
urethra, and seemed to be an inch and a half in length and of a
hard, gristly nature.

I used a small-sized, flexible metal bougie, with the point rather
blunt, and after repeated efforts succeeded in passing it through
the stricture. The bougie was withdrawn in a few minutes and
a small silver catheter introduced, and at least three quarts of
urine came away with a quantity of mucus. The catheter was
retained in the urethra for several days, and only removed to
clean it, and no more urine passed through the fistulae. An in-
jection of a solution of sulphate of zinc and also a weak solution
of nitrate of silver were used three or four times; balsam of co-
paiba and infusion of uva ursi leaves were administered, and the
patient was instructed how to use the catheter, whenever he
wished. The openings in the perinaeum and scrotum all healed
up, and the general health was restored, but he could never pass
his urine without the catheter. This patient died very suddenly
in about one year, of disease of the heart, with which he had long
been troubled [Boston Med. and Surg. Journal

1859.] Erysipelas and Scarlet Fever. 403

Erysipelas and Scarlet Fever. By Edward "Warren, M. D.,
Newton Lower Falls.

In Vol. XL V 111. of this Journal, I gave an account of a disease
which prevailed here epidemically, about the year 1852 and
1853, taking various forms, from that of common inflammation
to those more serious; cellular inflammation, malignant pustule,
erysipelas, &c., all of which I was disposed to comprehend un-
der the general name of irritative fever.

Since that period, there have been no fatal cases until this
last spring. The health of this neighborhood has been remarka-
bly good, although some faint returns of the epidemic have been
seen every summer and winter, about the first of August and
last of February; at seasons, in fact, when the animal system
is relaxed by the continued heat of dog-days, or by the occur-
rence of mild wet weather in winter, after the system has been
strongly braced up by the continued cold.

The malignant pustule is very common at those times, and is
attended with an amount of constitutional irritation perfectly
surprising, as proceeding from a local cause apparently so trivial ;
often from a little blister upon the finger-joint, or a point like
the prick of a needle.

During the general prevalence of influenza last spring, this
disorder again became prevalent. Scarlet fever was also com-
mon, and several fatal cases occurred. In my former commu-
nications, I mentioned several cases which appeared to be very
dubious. I will now adduce several more.

Two patients died of what was considered scarlet fever ; I did
not see either of them. In a neighboring house, a lady, the
mother of a family, had an inflammation of the eyes of an erysipe-
latous character. After her recovery, one of her children was
taken sick with vomiting, slight sore throat, with a rash of
rather dark scarlet, perhaps I might say crimson. This rash
continued out several days. Another child was then taken,
and then a third, with the same symptoms. In the third cnse,
the eldest of the three, the symptoms were all more severe ;
there was a rash covering equally the whole face and body, in-
tense itching and stinging, depriving her of sleep at night, and
more soreness of the throat than in the other cases, but not se-
vere or alarming. In each case, the sore throat was of short
duration.

In another house in the neighborhood of these two, two child-
ren were taken ill of what was considered scarlet fever. They
recovered without medical attendance. While they were reco-
vering, another was seized severely. He had severe sore throat,
rash covering the whole surface of the body, and all the usual
symptoms of severe (but not malignant) scarlet fever. I gave
aim a mixture of muriatic acid with confection of roses aud cocki*

V. B^-VOL. XV. VO. VL 29 *

404 Erysipelas and Scarlet Fever. [June,

neal, with Dover's powder. About the day after I saw him, a
fourth in the same family was taken violently with similar symp-
toms. The sore throat was not severe, the rash was well out.
There was great restlessness and irritation. I gave her the mu-
riatic mixture, and Dover's powders. The next day, I found
her much relieved, and I thought she was likely to recover. On
my visit the next morning, I was astonished to learn that she
was dead. She had suddenly become worse, continued to grow
still worse through the day, and died in the night. In this case,
there was no cerebral affection ; there was not much difficulty
in the throat. The patient died from irritation. According to
her mother's account, " she wore herself out" ; that is to say,
she became exhausted by constant tossing and restlessness. The
other patient, a boy of about four years old, recovered gradual-
ly under the use of quinine j and in none of these cases were
there any sequelae.

In another house in this village, on low ground, in which
took place the fatal case of puerperal peritonitis described in the
communication above alluded to, a house in which a tendency
to erysipelas always exists, there occurred several cases, taking
precisely the same form as those first described. The elder mem-
bers of the family had attacks of erysipelas to a greater or less
degree ; the oldest of the children, aged about thirteen, had sore
throat with a slight eruption, and recovered in a few days.
After this, a boy of about five or six, was taken ill, had rather
a dark- colored rash all over the body, and slight sore throat.
He recovered after a few days, under the use of quinine, and
began to go freely about the house. In the mean time, his sister,
about two years older, was prostrated by the same disease. Her
body was equally covered with a dark rash ; she had slight sore
throat and great prostration. She recovered very slowly, but
was finally restored to good health.

Whilst she was confined to her bed, her brother was again
seized with violent symptoms vomiting, apparent pain which
he could not describe or fix, and whose situation could not be
ascertained by examination, swelling of the bowels and of the
lower limbs. Despite of all remedies, he became worse, and had
all the appearances of extreme agony screaming, tossing in
the bed, and never sleeping or lying still. He was perfectly
rational, taking what was offered to him, and answering ques-
tions when spoken to. He died about forty-eight hours after
this second attack, retaining his senses and a good deal of mus-
cular power to the very last moment.

In ordinary cases of scarlet fever which prove fatal, there is
extensive ulceration of the fauces, destroying life by affecting
respiration ; there is a determination to the head, producing
delirium, with intense heat of the surface and full rapid pulse.
In the fatal cases above described, the affection of the throat

1859.] Erysipelas and Scarlet Fever. 405

was very slight, the pulse small and slow, and the brain un-
affected.

About the last of November, the patient first mentioned, in
this same house, was taken ill with vomiting, sore throat, and a
scarlet rash covering the body. She was not very ill, and re-
covered under the use of the muriatic acid mixture and quinine.
The second was next taken, and got through well. The third
a girl of about four, had the disease more thoroughly, the rash
very full, but the throat not very sore. The rash lasted about
the time of the eruption in scarlet fever, and she began to recov-
er without severe symptoms. In about ten days, however, she
was again seized with vomiting, which continued without cessa-
tion. She continued to grow worse for twenty-four hours. I
found her in a state of partial collapse, vomiting everything
given her, the abdomen tense and full, and the lower limbs
swollen. Her pupils were fixed inward. I now directed all
other medicine to be stopped, and alternate doses of spirits of
nitrous ether and wine given freely, with strong beef-tea. I left
her, with little hope of finding her alive at my next visit.

Contrary to my expectation, I found her rather better. After
commencing the wine, the vomiting had ceased, and the other
symptoms were no worse. At my next visit, I found a slight
improvement, and this went on for some time. The wine and
beef-tea were continued, without medicine. Shortly after, she
had another attack similar to the preceding. I now substituted
brandy in place of the wine, and continued it for a week or two,
after which I dropped it, and gave the wine of iron. Her re-
covery has been very slow, but progressive. She had, for the
time, entirely lost the power of walking, and could not even
bear her weight on her feet. When I last saw her, however,
about the first of January, she was beginning gradually to walk
with considerable help.

About the first of December, a boy of ten, was seized with
the common symptoms of scarlet fever vomiting, a rash over
the whole body, sore tjiroat, &c. He was not very ill, and re-
covered with little difficulty. After his recovery, his sister,
about two years older, was seized with vomiting, slight sore
throat, and catarrhal symptoms. A rash appeared upon the
knees, which gradually extended over the whole surface of the
body, attended with intolerable itching and stinging, and this
rash, on minute examination, was found to consist of fine blis-
ters.

After a day or two, small pustules appeared upon the foot
and ankle, closely resembling the vaccine pustule, but with the
apex circular, instead of oval. These were attended with in-
tense irritation. The rash continued out over the body for four
or five days, the pustules on the foot, in the mean time, slowly
running together, and forming an abraded surface. The patient

406 Erysipelas and Scarlet Fever. [June,

slowly recovered, became well enough to play about, the room,
and even to go out; and I ceased my attendance. A few days
after, I was called to her again, and found the other foot swol-
len and inflamed. The inflammation now extended over the
whole body and face, assuming the usual form of erysipelas.
She was not, however, compelled to take to her bed again, but
was able to occupy herself in sewing, reading, &c. I now
placed her upon a more stimulating course of diet, and gave her
quinine and wine, with beef-steak once a day. I should have
mentioned, that her appetite was capricious ; she relished no
other food but boiled cabbage, probably for the sake of the acid
used with it, and very likely, also, because it was refused her at
first. She recovered very slowly. In the mean time, her
brother had a troublesome sore appear upon one heel; and the
mother who took care of them both, had a regular pustule upon
one finger.

A rather singular case occurred about the same time, in a dif-
ferent locality. A family of four young children had succes-
sively the usual symptoms of mild scarlet fever, commencing
with vomiting, catarrhal symptoms, slight sore throat, and a
rash covering the whole body. They scarcely required any
medical attendance. After they had recovered, the father came
to me one evening. He had, the day before, had slight catarr-
hal symptoms, but had continued his usual occupation through
the day I saw him. In the afternoon, some nausea and very
slight sore throat came on. A rash had appeared on one arm,
attended with considerable irritation. I gave him a mild sopori-
fic, and advised him to keep his house the next day, and com-
menced the sulphate of quinine. I visited him the next morning,
and found him completely covered, from head to foot, with a
crimson rash. He said he felt quite well. He did not keep his
bed at all, and was at work in a day or two.

In these cases it is exceedingly difficult to distinguish between
ervsipelas and scarlet fever. In fact, as far as the patients and
their friends are concerned, it is useless to make the distinction.
The friends pronounce the disease to be scarlet fever, " whatever
the doctors may say" to the contrary.

When the disease is fully formed, there is indeed very little
external difference, at least upon superficial examination. The
history of the case affords one diagnostic. If it occurs in a lo-
cality where there has been no genuine case of scarlet fever, and
the patient is not known to have been exposed to it if any one
of the family has had erysipelas or malignant pustule if the
rash first appears upon a limb, or the hand, the foot, in the eye,
or ear, or on the face, there are strong indications of erysipelas.
rJV soi e throat, which occurs on or previous to the onset, hard-
ly lasts more than twenty-four hours, while the rash is rather
darker, than in scarlet fever. Above all, the criterion of erysi-

1859.] Erysipelas and Scarlet Fever. 407

pelas given us by Sydenham, a stinging like that of bees, is as
good now as it was in his day. I believe, also, that on minute
examination, the rash will generally be found to consist in a sur-
face of minute blisters congregated together.

In severe cases, one or more of these blisters progress to the
state of pustules. They either run together and form one ulce-
rated surface, or one takes the lead and becomes developed into
the malignant pustule, while the rest dry up and disappear.
The malignant pustule may be considered as erysipelas conden-
sed in a single point. I may name one more distinction between
searlet fever, and the case I refer to. The former disease, as is
well known, seldom occurs twice in the same individual ; on the
contrary, in the other disease, the person who had once had it
is always more liable to it again.

Although the common locality of malignant pustule is the
finger or hand, it not unfrequently takes place in the ear, and
the suffering is then intense. In a former paper I have describ-
ed the sensation, from my own experience, as resembling that
which might be produced by a bee with a long sting extending
from the pustule to the heart or stomach, while a fine iron wire
heated to a red heat was boring by the side of this sting. In so
sensitive a part as the ear, we may easily imagine how great
the suffering must be. One treatment I have found successful
in all the cases in this neighborhood. It is, to apply nitrate of
silver daily upon and around the affected part give a pill of
antimony, opium, and submuriate at night, or one grain of blue
pill, with half a grain of opium, for two or three nights, and a
full dose of sulphate of quinine three times a day. A bread and
milk poultice is also applied to the affected part.

Although these pustules generally appear after a wound, blis-
ter or abrasion of the skin, I have had ample evidence that they
often arise without any such lesion, and undoubtedly from mias-
matic influence upon the whole system. If erysipelas is produ-
ced by a poison in the blood, as modern authorities, I believe,
allow, then malignant#pustule is produced by the poison con-
densed in one minute point; while in diffuse inflammation, puer-
peral fever, &c, it may be supposed to act upon an aggregate of
minute points; the poisou being thrown out by the minute ves-
sels upon a thousand minute points.

I find from Braithwaite, that Mr. P. H. Bird describes erysipe-
las "as merely an example on the skin, of that diffuse inflam-
mation which in other tissues constitutes diffuse inflammation
of the mucous membrane, diffuse phlebitis, puerperal fever all
of which have a common origin, a poison in the blood, are in-
fectious and contagious, and may mutually produce each other."
He thinks the term erysipelas should be confined to diffuse in-
flammation of the skin and subcutaneous cellular tissue. If so,
then we want a more general term for all varieties of the disease

408 An Imperfectly-known Function of the Pancreas, [June,

produced by erysipelatous poison, inhaled, or imbibed, or gen-
erated. Whether the term of irritative fever, employed by Dr.
Butter, is suitable on not, I will not undertake to decide.

It has occurred to me of late, in observing the close resem-
blance between the cases described and scarlet fever, whether
the former failures in the treatment of the latter disease, did not
arise from its being treated by depletion and antiphlogistic regi-
men ; whether the same treatment found beneficial in erysipelas
would not be equally beneficial in scarlet fever ? nourishing
diet, stimulants, and opiates. Is not scarlet fever caused by a
poison in the blood, as well as erysipelas?

I find again from Braithwaite, that Mr. Meade, Senior Surgeon
of the Bradford Infirmary, in a town where scarlatina has lately
been frequent and fatal, describes the symptoms as in many
cases bearing a close resemblance to erysipelas : and that he treat-
ed them in the same manner, with tonics and stimulants. After
having employed ammonia, and the mineral acids with quinine,
with success, he subsequently used the tincture of sesquichloride
of iron ; and this he has employed with great success in scarlet
fever.

"When I have employed the preparations of iron in erysipelas,
I have found them less successful in this neighborhood than
quinine. Many physicians, I know, place great confidence in
iron. Different constitutions and different localities require, of
course, different treatment. Whatever may be thought of the
expediency of commencing at once a stimulating course in scar-
let fever, I feel confident that a generous diet and stimulating
treatment is required during convalescence ; and I believe that
thereby the formidable sequelae may be avoided.

In the cases I have alluded to, whether they are called erysi-
pelas, irritative fever, aut quocunque alio nomine, it is necessary
to continue the quinine for some length of time. Otherwise, as
soon as the quinine is abandoned the disease returns, unless the
patient changes his residence. [Boston Med. and Surg. Journal.

On an Imperfectly-known Function of the Pancreas,
viz: Digestion of Nitrogenous Food.

General Propositions, forming the Summary of an Essay published
with the above title and read before the Academy of Medicine of
Paris ; the first part in 1857, and the second in February, 1858.
By L. Covisart, M. D.

Very little is known about the manner in which animal or
nitrogenous food is digested in the bowel; and science has not
advanced one step since the discovery of Purkinje and Pappen-
heim (1836) respecting the dissolving action which the pancrea-
tic juice may exercise on such food a discovery which has in-
deed remained almost unnoticed.

1859.] An Imperfectly-known Function of the Pancreas. 409

The pathological and experimental investigations on the se-
cond digestion, (intestinal digestion,) of which I have given an
account, (in the before- mentioned essay.) have led to the follow-
ing important results: These are twofold: One group, of a
physiological and direct character, are deduced from actual ex-
periments. The other, of a pathological and indirect nature, are
deductions or corollaries, which, as it seems to me, throw some
light on clinical medicine.

I. Physiological Propositions.

1. Nitrogenous food is digested both by the stomach and the
pancreas.

2. The pancreas is, as it were, a supplementary organ, whose
action after copious meals, is added to that of the stomach.

3. Both digestions are of the same nature, as any article of
food subjected to either is transformed into the self- same nutri-
mentive product (albuminose or peptone.)

4. The pancreatic juice has peculiar reactions under the in-
fluence of heat or certain agents, which reaction the gastric juice
does not present. As this difference in the juices is found when
they are both charged with peptones, after digestion, it has erro-
neously been supposed that the peptones also differed. This
pardonable error, being pointed out, will hardly again be fallen
into.

5. When an article of nitrogenous food, or a portion of it, has
undergone a thorough gastric digestion, the pancreatic juice no
longer acts upon it, and does not transform it into another pep-
tone.

6. The pancretic juice is intended to act upon that part of
albuminoid substances which has left the stomach before being
transformed into albuminose.

7. The amount of action of the pancreas may, in certain,
cases, be equal to that of the stomach.

8. If the mere quantity of secreted fluid were alone taken
into account, the stomach might be looked upon as the more
powerful, for the gastric juice is ten times more abundant than
the pancreatic j uice ; but the latter is, to make up the difference,
ten times richer in ferment (pancreatine.)

9. The gastric juice has the advantage of a prolonged con-
tact and stirring with the food ; but the pancreatic juice has, on
the other hand, the faculty of acting upon azotized aliments
equally well, either in an alkaline, neutral, or acid state; it also
acts three times quicker than the gastric juice.

10. Everything is so disposed in the duodenum, that the
pancreatic juice acts immediately it comes in contact with the
food; and everything is so arranged in the stomach that a large
part of the food is transformed into peptone, the remaining part

410 An Imperfectly-known Function of the Pancreas. [June,

being, at the very least, so prepared, as rapidly to undergo the
pancreatic digestion.

11. This preparation, which varies according to the quality
and quantity either of the food or the gastric juice, &c., consists
sometimes in a simple imbibition, sometimes in a dissevering or
an extreme division, and sometimes in a solution. Pancreatic
digestion, being forcibly very rapid, is usefully assisted by this
preparation, the stomach acting respecting the pancreas in the
same manner as the teeth do representing gastric digestion.

12. It is, however, to be noticed that the pancreatic juice is
able to accomplish, unassisted, the digestion of food which has
not been subjected to that gastric preparation or division ; in
the same way as the gasiric juice can digest food without extra-
neous help. Hence, pieces of albuminoid substances, being
directly placed into the intestine in a raw state that is to say,
without any preparation are perfectly and completely digested,
the process being, however, somewhat slow. The pancreatic
juice can, by its own unassisted energy, carry on the digestion
of nitrogenous food, without requiring the adjunction either of
the intestinal juice or the bile, to gain digestive properties. The
digestion ofazotized food, performed in glass jars over the water
bath, by means of the pancreatic juice or isolated pancreatine,
goes on in the same manner as in the duodenum.

13. When the gastric and pancreatic juices are separated,
and act in succession, each performs its function completely, and
the quantity of albuminose produced may thus be doubled.

14. But it is a remarkable fact, that when these two digestive
ferments meet in a state of purity, the two digestions are no
longer freely carried on. The mixture, far from doubling the
produce, may reduce it to nought, for pepsine and pancreatine
destroy each other under these non-physiological circumstances.

15. Nature, in the normal state, prevents this conflict by
three distinct means lstly, by the pylorus, which separates the
two ferments; 2ndly, by the very gastric digestion through
which pepsine" exhausts and abolishes itself in the formation of
peptone 3dly, by the bile which destroys the activity of the
gastric ferment, as has been shown by Pappenheim.

16. Bile does not precipitate the peptone produced by the
influence of the stomach so as to destroy digestion and necessi-
tate its being again begun. On the contrary, the bile itself is
precipitated by the acid of the gastric juice or of the chyme.

17. The nature of the nitrogenous food has much to do with
the quantity of peptone which the two successive digestions can
produce for the requirements of the economy. I have thus
found in my experiments, that whilst musculine and casseine
yield almost one ounce of perfect peptone, albumen, or gelatige-
nous textures, though given in the same quantity, yielded hard-
ly half an ounce.

1859.] An Imperfectly '-known Function of the Pancreas. 411

18. At the outset, gastric or pancreatic digestion destroys the
most characteristic properties of the various albuminoid substan-
ces. It liquefies insoluble ones, deprives albumen of its coagu-
lability, and caseine of its property of coagulating by rennet. It
also deprives gelatine of its property of turning into jelly, and
musculine of being precipitated by chloride of sodium, &c. In
short, it transforms all the substances into albuminose and pep-
tone.

The different kinds of albuminose, although their individual
reaction are much less marked than those of the albuminoid sub-
stances whence they are derived, have, nevertheless, distinct
characters.

19. The nature of peptones varies as the nitrogenous sub-
stances from which they are derived. This variety satisfies the
different (plastic?) requirements of the economy.

20. The peptones which are most alike and most difficult to
distinguish from each other, are, the albumen-peptone, muscu-
line-peptone, and strange to say, gelatine-peptone ; just as if
the articles of food from which these peptones are derived were
less different from each other than is generally supposed. Fi-
brine-peptone and caseine-peptone are more easily distinguished
from each other, and from the substances above named. From
the slight differences existing between azotized articles of food,
or peptones, there arises a kind of unstable equilibrium, favora-
ble to the work of assimilation performed by the tissues of the
body.

21. The generic character of peptones is, that they are always
soluble in water, be the latter acid, neutral, or alkaline, which
circumstances secures an easy circulation in the organism. Heat
does not coagulate peptones, and hardly any of them are precipi-
tated by acetate of lead. Besides, they resist insoluble metallic
combinations a great deal better than nitrogenous articles of
food.

22. Peptones form a genus, as well defined as the albuminoid
genus. It is, however, evident, that by the progress of science
their nature will eventually be more exactly determined than
can be done at the present period.

23. Some physiologists persists in the erroneous belief that
the stomach merely swells or divides the food without dissolving
it. How can they, however, withstand the testimony of the
scales, which plainly show that, even where the weight of the
food is considerable, every albuminoid article of food subjected
to the action of the stomach is not merely divided, but dissolved,
passes through the filter, and is absorbed by the membranes !

24. Others have maintained that the gastric juice, acting on
nitrogenous food, produces only gelatine. They, however, lose
sight of the fact, that the characters which place gelatine in a
peculiar albuminoid class, have never been discovered in the

412 An Imperfectly-known Function of the Pancreas. [June,

chyme after a digestion of fibrin e, casein e, musculine, or albu-
mine, even when the chyme was neutralized; and that, moreo-
ver, gelatine itself completely loses its specific characters, in con-
sequence of undergoing digestion in the gastric juice.

25. Others, finally, resting on the hypothesis, that the albu-
men of the blood is nothing but the digested matters themselves,
maintain that the peptones are reduced to albumen, by losing
their acidity viz., by being neutralized. Such an error can
hardly exist, except albumen and fibrine be alone taken into
account, excluding all other aliments; as an incomplete diges-
tion of the albumen and fibrine may lead to confusion. Crude
albumen, in fact, always partly escapes gastric digestion; ill-
digested fibrine is transformed into albumen only (caseiform ;)
these two cases excepted, if experiments be made on the produce
of concrete and washed albumen, of caseine, musculine, or gela-
tine, regularly digested by the stomach, no doubt can any long-
er be entertained. These gastric peptones never contain any
albumen.

26. The peptones, either received or produced by the pancrea-
tic juice, do not, any more than the latter, form any new albu-
men, and whether they be primarily or consecutively acid, alka-
line, or neutral, do not increase by an appreciable weight the
coagulable albumen which the pancreatic juice, pure and- with-
out peptone, normally contains.

27. During the three hours which follow a meal, (when di-
gestive solution, transformation, and absorption are not much
advanced,) the blood of the vena portae (compared to the venous
blood generally) does not become charged with a noticeable
quantity of nitrogenous matter through digestive absorption ;
whilst on the other hand, the elements of the blood, globules
and fibrine, become changed into albumen (caseiform) by a com-
mencement of digestion, either in the intestine or the water-bath
under the influences of the alkaline pancreatic juice.

28. Now, if it be considered that, during the first three hours
of digestion lstly, the pancreatic juice poured into the duode-
num remains therein in a pure and active state ; 2ndly, that
this juice- can pass into the vena portas, (for absorption by the
mesenteric veins is not suspended ;) 3rdly, that this same juice
can act in such an alkaline medium as the blood; if, moreover,
it be considered that during those very three hours, a large por-
tion of the globules and fibrine of the blood of the vena portae
is, weights remaining equal, transformed in that vein into albu-
men, (which is a commencement of transformation similar to
that which they would have undergone in the intestine under
the influence of this same pancreatic juice,) we can hardly refuse
our assent to the hypothesis true intra-venous digestion, which
hypothesis I confidently put forward.

29. No actually differential character has ever been pointed

1859.] An Imperfectly-known Function of the Pancreas. 413

out between the nitrogenous matters which go by the namo of
extractive, and the albuminose which is generated by gastric or
pancreatic digestion. Now, it should be noticed that the lacteals,
the vena portai, and the hepatic veins, which are its continuation, or,
in other words, the vessels which most directly receive the pro-
duct of digestion, are by far richer in extractive matter (albu-
minose) than the rest of the blood. It may, moreover, be noted
that they are also richer in glucose.

30. The nutritive richness of the hepatic vessels (albuminose
and glucose being contained in them) may be explained by the
gastro-intestinal absorption, to which is energetically added pro-
longed intra- venous digestion, although the liver has no share
in the process.

II. Corollaries, vel Pathological Deduction.

A. We may take it as almost certain that there exists (as re-
gards albuminoid aliments) a duodenal dyspepsia, caused by the
vitiation, insuficiency, or absence of the pancreatic juice, the
symptoms of which appear only from the second or third
hour of digestion; with a deeper-seated pain than is felt in gas-
tric dyspepsia. (See Propositions 1, 2, 3, 6, 7.) The internal
use of pancreatine is indicated* in cases of pancreatic duodenal
dyspepsia.

B. Secondary duodenal dyspepsia may be the result of an
almost total absence of that kind of division which food, under
the least favorable circumstances, undergoes by means of the
gastric juice before that food has been transformed into peptone.
Pancreatic digestion is then slower, just as gastric digestion is
slower, when the teeth have not duly performed their functions.
This secondary pancreatic dyspepsia may be cured by the treat-
ment suited to the primary gastric dyspepsia.

C. Another secondary duodenal dyspepsia may arise, either
from an excess of gastric juice, or from a patency of the pylorus ;
for in these two individual cases the gastric juice reaches the
duodenum in unfortunately retaining all its active properties,
which latter are prejudicial to the action of the pancreatic juice.
(See Propositions 13, 14, 15, and 16.)

D. A third duodenal dyspepsia may arise from deficient
biliary secretion, this deficiency being followed by the same un-

* Last year Dr. Corvisart made some clinical experiments on the therapeutic
use of pure pancreatine. The difficulties he met with are recorded in the Gazette
Hebdwnadaire of Paris, May, 1857, pp. 321, 322. Dr. G. Harley, who read a
paper on Digestion (just twelve months after the above date) at the meeting of
the British Association for the Advancement of Science, seems never to have heard
of Dr. Corvisart's article on the subject. Dr. Harley maintains, in opposition to
the latter physician's statements, that in the administration of duodenal ferment,
it is not necessary to imitate nature, who prevents pancreatine from passing into
the stomach. For the causes of the difficulties met with by Dr. Corvisart, and
the means to overcome them, see Propositions 13, 14, and 15, paragraphs C and
D of the summary, and page 51 of the Essay.

414 An Imperfectly-known Function of the Pancreas. [June,

pleasant effects as are noticed in the two preceding cases, on
account of the non-destruction of the activity of the gastric juice
in the duodenum.

E. A peculiar kind of dyspepsia, which might be called of
the portal vein, or hepatic, may arise from the vitiation of the
intra-venous digestion.

F. Certain symptoms of dyspepsia, gastralgia, enteralgia, or
hepatalgia, may erroneously be attributed to the stomach, the
intestine, or the liver; these symptoms may simply be the result
of the absorption of the two abundant, too active, or too irrita-
ting pancreatic juice by the vena portse.

(j. Bile, when it reaches the stomach, destroys the activity
of the gastric juice within that organ, whether it penetrates the
cavity pathologically through the pylorus or by the mouth and
cardia. The knowledge of this fact may lead to the employ-
ment of bile to counteract the morbid superabundance of the
gastric juice.

H. The economy is supplied with a variable weight of pep-
tone, through the weight of different kinds of nitrogenous arti-
cles of food and digestive force remained the same, the weight
of the peptones varying according to the kind of nitrogenous
food. It is a great error in hygienics to esteem the trophic, or
nourishing power of a nitrogenous article of food, simply by
the amount of nitrogen it contains. The trophic, or alimentary
standard of food is not so easily fixed.

I. When it is more urgent to allay pain and irritation about
the digestive organs than to restore muscular energy, the food
should consist of that kind of aliment which is most quickly and
completely dissolved, whatever be the amount of peptone it
yields.

J. But when it is more important rapidly to restore muscu-
lar force than to allay gastro-intestinal pain, we should, on the
contrary, give such food which, the digestive force being the
same, yields the greatest weight of peptone, though that food
be likely to dissolve and digest slowly. (See Proposition 17.)

K. He who digests with one organ only, (stomach or pan-
creas,) is thereby put on half allowance as regards peptone; and
'he who eats only albumen or gelatinous tissue, (instead of caseine
or musculine, which yield double as much peptone,) is also put
upon half allowance; and with a normal and equal digestive
force, is only half nourished. (See Proposition 17.)

In the two preceding cases, an over-activity either of the one
organ (first case,) or of both organs (second case,) may occur,
and extract from the food the full allowance of peptone. But
we must not long trust this extreme functional exertion ; for any
persisting over-activity must sooner or later end in exhaustion.

L. We should not give for a long time one kind only of ni-
trogenous food, not only, because one kind of azotized aliment

1859.] Tonics and their Administration. 415

is not capable of repairing the waste of the organism, but also
because the same article of food given exclusively and con-
tinuously (for a week for instance) no longer excites gastric se-
cretion, and no longer fully undergoes the digestive transforma-
tion.

M. Most of the peptones upon which I have made experi-
ments, have the peculiarity of not being precipitated by neutral
acetate of lead. Now, in all cases where the albuminoid mat-
ters of the urine happen to be of the albuminose kind, they re-
main in solution, in spite of the accetate of lead used to precipi-
tate them. They therefore mask the sugar more effectually than
all other ingredients of the urine when the potash and copper
test is employed. The presence of sugar may thus be overlooked
when it really exists in the urine. [London Lancet.

Tonics and their Administration a Clinical Lecture. By Dr.
Gull, Guy's Hospital.

Gentlemen : I wish to speak to-day, in form of clinical lecture,
of a subject that to use a common expression has been weigh-
ing on the mind of myself and more than one of you for some
weeks; it is what may be the nature of the "general debility"
that has been so prevalent during August this summer, in al-
most all our patients in this hospital? I told you in the wards
I should take the first opportunity I could, to enlarge on this
point, and strive to explain its value or signification.

We have passed through a curious phasis of belief in the me-
dical schools, that purging and bleeding were necessary to stop
inflammation, and now we are fluctuating towards the opposite
extreme, or all travelling on an opposite road. It is now
thought that the chief diseases are due to debility, and inflamma-
tion must be stopped by stimulants. It was at the confluence
of such logical cross-roads, Lord Bacon set up his crucial instan-
ces, or finger-posts, or crosses to direct inquiries. That case
which occurred to us this week is a case in point. I said I
thought it softening of the brain, to be treated by generous diet
and stimulants; but it turns out, on the post mortem table, a case
of sthenic inflammation. I told you at the time of the autopsy
I should make some observations on stimulants and their value
in cases of debility. I will make a few observations on this
term "debility," as I know it quite falls in with your wishes,
as expressed in the wards. Does this debility really and posi-
tively exist, or is it a cloak for our ignorance ? We hear it said
every day, " What did he die of?" " Ob, general debility !" I
believe the term is a lazy one ; it is an indefinite term, it is a
negative term, and so it is a dangerous term for us to use. Do

416 Tonics and their Administration, [June,

negative thing is one of the most difficult things possible to es-
tablish, or to argue about. I find diseases of the circulating
system especially connected with what is called general debility ;
then again, I meet patients sent to me dying of this general de-
bility, but I find albumen in their urine ; this directly weak-
ens them. I find in another that he has decided urea in his
blood ; some change going on in his system, for which I advise
change of air, and he gets well. A lady called on me yesterday,
suffering from " general debility," but I detected that she had
been suffering from a ''miasm ;" in two other cases I found the
general debility to arise from slow poisoning by lead. Dr. Ad-
dison was so struck by this asthenia, or debility, that he was led
to examine all the organs very closely, and only then found the
supra-renal capsule diseased this disease probably interfering
with the ganglionic nerves and function of healthy blood! You
will not be long in practice, depend on it, when you will be
consulted about general debility the cause of which you must
find out for yourselves, if you intend to remedy it. It may
have its seat in local pleurisy or consolidated lung, and your
patient becomes weaker on any extra exercise having been
taken. The existence of such a disease leads to errors or circu-
lation, or sanguification, with which, no doubt, you are all fa-
miliar. But in whatever mode the disease is caused, I wish es-
pecially to fix your attention on the fact that the disease will be
presented to your notice as what the French call malaise, but
patients term general debility. "Only cure them," they will
say, u of this general debility and sense of sinking, and they are
sure they will get well." This is why sea air is so useful in
August and September.

What is strength or life ? A child is comparatively weak,
or not strong, as compared with an adult, but we do not call
that debility ; the tissues that exist may be in full activity, but
the tissues, quoad function, are not yet fully developed. Old
people, again, are weak, but here the tissues are debilitated, or
becoming worn out. I do not think in adult people all the tis-
sues are changed every seven years, as popularly believe to be
the case. Now, I should ask, especially in adult patients,
What is strength ? and you at once see it is a very complex
thing. When the patient advancing in years says he is suffer-
ing from general debility, you will probably find also some
local disease re-acting on his organism. Our tissues repre-
sent to us curious and beautifully elaborate parts in a state
of vital " tension." A spring of a watch and its wheels are
elaborate, but of no use till the spring be placed in a state of
tention. Food (and vegetable food especially) supplies the
something we call tension, but in the healthy capacity of each
we find in the dead-house any disease that Dr. Wilks could term,
pathologically, "general debility?" Certainly not! Now, a

1859.] Tonics and their Administration. 417

patient to exhibit or sustain this tension consists in strength ; in
a word, the power of assimilating food through all its different
stages. Xow, we koow that the impure, close air of cities, in
August and September, is very unhealthy, whether from ab-
sence of oxygen, or from the vegetable world being in abeyance
as regards its function of absorbing sewerage gases, we do not
know ; but the impure close air of London in August and Sep-
tember keeps the spring unbent-, children especially do not
take their food, and debility with them becomes very prevalent,
with diarrhoea, etc.

I am often reminded (in practice) of an excellent observation
also, by my friend Mr. Hilton ; he says: "If limbs remain not
used, they waste away thus, by contracting the muscles ; this
very functional activity necessitates their nutrition.'' Now,
amongts young ladies, in private practice, you will find the
limbs and muscles remain not used ; their tissues do not waste
enough, and they may be actually debilitated or weak, because
they appear so strong ! Waste of tissue and nutrition, by some
wonderful law, go together. Exercise in open air also get rid
of excreta that lurk in the system and cause debility. Lying in
bed is a very common cause of debility a proper waste of tis-
sues does not go on.

Patients often come to you also with some obscure but active
inflammation in the chest a common cold or influenza and
they invert the old rule, as they " feed a cold, but starve a fever."
They are wretchedly debilitated, though, perhaps, taking beef
steaks or porter. You prescribe for such cases a saline with
antimony, and vegetable diet, and mild starvation for a few
days, and they will grow strong, which they would in vain strive
to do previously by taking food that was never assimilated. In
the same way, you may have good nutrition, but too much ex-
ertion of muscle and waste of tissue, as in the very poor class of
patients that come to hospital. Lying in bed is a cause of de-
bility, as I have just said ; hence, surgeons put on starch banda-
ges in fractures, and send such poor patients into the air. If you
find in a patient a very irritable nervous system, you will have
also waste going on, waste even during sleep. Excessive exer-
cise also waste the muscles, but proper or moderate exercise
strengthens them. In London, one finds both extremes one
set of people all idle or sedentary, especially patients of the up-
per classes, or of the female sex ; their general debility is cured
by prescribing exercise. They tell a good story of Dr. Jephson,
who used to cure his delicate lady patients at Leamington, by
taking them out in a carriage, but, suddenly, something hap-
pening which obliged the debilitated patient to walk back over
a rough road, three or four miles. TVe have, then, patients also
of the other extreme, who are " walking off their legs" by the
toil of business. A few glasses of wine, or a little bark and am-

418 Tonics and their Administration. [June,

monia, does much good in such cases as tonics. You see at once,
therefore, that it is a tedious process to find out if a patient owes
his or her debility to waste of "tension," or diminished "ten-
sion," or whether you are to over-rest or to over-exercise. Sleep
too, I may tell you (at least, healthy sleep,) very much depends
on healthy waste of tissues and their normal reparation.

Now, about tonics. You naturally will say, what about qui-
nine? Mullersays, we know of no "direct tonics." I believe,
also, there are no tonics but those which wind up the "tension"
of our tissues. Whatever will do that has, for all practical pur-
poses, been regarded as a tonic. Well, iron and quinine are the
favorite tonics, but in some cases, wine is a direct tonic, or food.
A gentleman recently came to me suffering under "general de-
bility." I saw at once his liver was the diseased part. Some
small doses acted, as I call it, as a direct tonic. In another case
of debility, I detected "Bright's disease," with intense debility.
Well ! we " snuffed the candle." The flame thickening, and
dull from excess of effort, tissue was changed by one or two
doses of elaterium into the cheerful glow of comparative health ;
elaterium here I call a tonic. We took away what prevented
the tension of the vital forces, and the elaterium produced a
state of strenght; in short, acted as the very best sort of tonic.
We may scientifically vary our medicine, but I call them all
"tonics," as establishing the normal "tension" of the constitu-
tion adapted to health.

In the recent "blood-letting controversy," or discussion as
to the nature of what is called inflammation, almost every thing
turns on the meaning of the terms " debility," or asthmatic
power, etc. Want of power, or debility, is even oftener seen in
surgery than medicine as exhibited in want of " tension" of
the system to carry patients through a formidable operation, and
the subsequent reparation of the injury. Surgical erysipelas,
for instance, is a disease of debility, and wine one of the cbief re-
medies. In the daily practice of medicine, I find wine to be our
almost single direct tonic, and to act as a food, or, at all events,
to economize food. I agree with the views of Dr. Todd on this
subject. Of course, wine is only adopted to some cases, such as
wasting fevers, or surgical cases, for instance. Wine stops de-
bilitating diseases like erysipelas, etc. Exercise may be a tonic.
Iron may act as a tonic, or even minute doses of strychnine.
But if you will apply the observations already made, you can
not be at a loss to find why they are tonics, and the best kind of
tonics.

1 have done enough to-day, however, if I have indicated a
certain line of thought for you to follow. I could have wished
that I could offer you something more of the vast number of
facts bearing on this subject, and leading to this doctrine of de-
bility depending on want of vital tension in the animal tissues.

1859.] On the Artificial Production of Bone, &c. 419

" It is not wings, but rather lead and weights," says Lord Bacon
(anon pluma sed plumbum potius et pondera") that the human
understanding wants ; something to restrain its tendency to
leap and fly at once from particular facts to universal principles.
You must not, therefore, from a few facts take these principles
for granted till you have calmly worked them out for yourselves,
in the practice of the wards of the hospital, if the subject is left
with you in a fragmentary or imperfect shape observed once
of a lecture by Mr. Astan Key in this theatre it is with the
intention that you may go over it yourselves, and fill in the out-
line. One thing is, at least, quite certain that the medical
schools are passing out of the old doctrine of heroic blood-let-
tings and antiphlogistics ; and the treatment by stimulants of
this "general debility," of which I have spoken, has become a
reigning fashion. Still, as I said already, the term "general
debility" is a negative term, a lazy term, an indefinite term, ex-
cept we examine it below the surface, and prescribe according-
ly. [Medical Circular, and N. 0. Med, Journal.

On the Artificial Production of Bone by means of Displacement and
Transplantation of the Periosteum. By M. L. Ollier.

The researches of Duhamel, and more recently those of Heine
and M. Flourens, have demonstrated the importance of the peri-
osteum for the reparation and reproduction of bone. Our own
experience has led to similar results, and we have endeavored by
experiment still further to demonstrate its truth.

"We have dissected up portions of periosteum, and transplant-
ed them in the midst of tissues normally foreign to ossification ;
and wherever we have engrafted them, new bone has been de-
veloped.

We have made three series of experiments. In the first series,
we dissected long bands of periosteum from the tibea, (leaving
one end adherent to the bone,) which were entwined in various
ways around muscles of the leg. The result was the production
of so many circular, spiral, and figure of 8 formations of bone.

In a second series we excised the adherent end or pedicle of
the band of periosteum three or four days after the operation,
and in spite of this interruption to the primitive circulation of
blood, the transplanted periosteum continued to produce bone.

In a third series of experiments we completely detached the
bands of periosteum from the bone at the time of the first opera-
tion, and immediately transplanted them in regions more or less
removed under the skin in the groin, on the back, etc. ; and
even under such circumstances ossific secretion was obtained,
and true bony tissue was the result.

These experiments were made upon rabbits of different ages.

k. s. VOL. XV. NO. vi. 30

420 A Suggestion to Life Insurance Companies. [June,

Advanced age diminishes but does not destroy this property of
the periosteum. The osseous tissue thus obtained possesses the
structure of true bone: the fundamental elements consist of
bone corpuscles, in every way similar to normal bone. On the
surface is a layer of compact substance studded over with Ha-
versian canals. On the interior is found, at the end of a certain
time, a medullary cavity, containing a reddish substance of simi-
lar anatomical characteristics, under the microscope, of normal
marrow ; and one or more foramina are seen to transmit blood-
vessels.

This new bone is formed from the sub-periosteal blastema
which is in part carried away attached to this membrane when
it is dissected from the bone.

Our experiments demonstrate that bone will be obtained
wherever one succeeds in engrafting the periosteum ; they prove
that a membrane may preserve its essential properties in spite
of its removal and transplantation in the midst of foreign tissues
and, as a practical consequence, it extends the field of anaplasty.
[Gazette Medicate de Paris, and Nashville Med. Record.

A Suggestion to Life Insurance Companies.

We have long been of the opinion that it is the duty of those
having charge of the business of life insurance to inquire some-
what into the character and standing of the medical attendants
of those applying for risk on their lives. It needs no argument
to prove that the Jives of those who place themselves under the
care of well educated and scientific physicians, are, humanly
speaking, safer than those who employ ignorant empirics or un-
scrupulous mountebanks. This must necessarily be the case if
medicine has conferred any benefit whatever on mankind, and
there are few, we presume, stupid or prejudiced enough to deny
but that it has.

Not only are these remarks true of the grosser forms of empi-
ricism, but they apply equally to the more refined and popular
systems of modern quackery ; and it is to the latter that we more
especially allude, as those who insure their lives are are more apt
to become the dupes of these than of the former.

Practitioners of Homoeopathy are ordinarily ignorant of the
very first principles of Medical science, and their treatment gen-
erally inefficient absolutely so if they adhere to their system.
So that a person in good health, who takes out a risk on his life,
and subsequently becoming diseased places himself under Ho-
moeopathic treatment, necessarily cuts himself off from all the
benefits to be derived from judicious medication, and in some
instances may even suffer a loss of life for the want of timely and
proper medical attendance. We submit it, therefore, whether

1859.] Editorial. 421

it would not be wise in life insurance companies to direct their
inquiries into this matter, and require applicants to state whether
thej are in the habit of being attended bj regular physicians,
homoeopaths or other irregular practitioners ; and if one of the
latter, it seems to us, that this fact should at least be taken into
account in passing on the application. This would certainly
be as pertinent and as pregnant an interrogatory as many
that are now insisted on,- and would put the company in posses-
sion of a fact which they have a right to know. [St Louis Med.
and Surg. Journ\t. ' % "

EDITORIAL AXD MISCELLANEOUS. . >

Meeting of The American Medical Association, and The Conven-
tion of The Colleges.

Both the above important Conventions -were held in Louisville, Kv.,
early in-May last We have space only for the Teachers Convention,
in our present issue.

Medical Teachers Convention.

The Convention of the Colleges, assembled on the 2nd of May, in
Mozart Hall, at 10 o'clock A. M. Twenty-two Colleges were represent-
ed, by the following gentlemen, Professors in the respective Institutions : .

Dartmouth College, Xew Hampshire. Professor Dixi Cros:

Shelby Medical College, Tennessee. Professors E, B. Haskins, and D.
F. Wright.

Missouri Medical College. Prof. J. X. McDowell.

8t Louis Medical College. Prof. M. L. Linton.

I iical College of South Carolina. Prof. Henry R. Frost.

Medical College of Georgia, at Augusta. Prof. H. F. Campbell, Prof.
Joseph Jones.

Medical Department, University of Michigan. Prof. Moses Gunn.

University of Louisville. Prof. L. P. Yandell, Prof. L. Powell.

Cincinnati College of Medicine. Prof. A. H. Baker.

Medical Department of the University of Nashville. Prof. J. B. Linds-
ley. Prof. W. K. Bowling, and Prof. P. F. Eve.

Jefferson Medical College. Prof. R. Dunglison, and Prof. F. Bache.*

Lind University. Chicago. Prof. N. S. Davis,

Oglethorpe Medical College, Georgia. Prof A. G. Thomas.

Medical College of Ohio. Prof. George C. Blackman.

Western Reserve Medical College, Cleveland, O. Prof. G. C. C. Web-
er.

* Delegate* not present

422 Editorial [June,

Kentucky School of Medicine. Prof. M. Goldsmith, Prof. G. W. Bay-
Jess.

Iowa University. Prof. McGugin.

Medical College of Memphis, Tenn. Prof. H. R. Robards.

Medical College of Richmond, Va. Prof. B. R, Welford, Prof. L. L.
Joynes.

Atlanta Medical College, Ga. Prof. J. G. Westmoreland, Prof. John
W. Jones.

Medical Faculty of Harvard University, Boston, Mass. Prof. Geo. C.
Shattuck.

Rush Medical College, Chicago, 111. Prof. Daniel Brainard, Prof.
Joseph W. Freer.

The Convention was permanently organised by the election of Profes-
sor Dixi Crosby, President, and Prof George C. Blackman, Secretary,

By a resolution offered by Prof. D. E. Wright of Nashville, it was de-
cided in accordance with the resolution of the me#ing held last year at
Washington calling the present meeting, that the members of the se-
veral Colleges represented might participate in the debates, but that the
Colleges should have but one vote each, in deciding questions.

Dr. N. S. Davis then offered the following, which was adopted :

Resolved, That a business committee of five be appointed hy the
chair to report propositions- for the action of the convention.

The chair appointed Drs. N. S. Davis, Gunn, Frost, Shattuck, and
Yandell. After a short recess to enable this committee to report, they
submitted the following through Dr. Davis, the chairman :

1. Resolved* That this convention recognises the great advantages to
be derived from the action of the American Medical Association in pre-
scribing the terms and conditions on which medical degrees should be
conferred and licenses to practice medicine shall be granted ; and that
an expression of opinion as to methods or periods of instruction from
the American Medical Association should be received with deference
and respect, and that all pains should be taken to enforce any rules and
regulations recommended by that body.

2. Resolved, That this convention earnestly recommend the Ameri-
can Medical Association to adopt such measures as will secure the effi-
cient practical enforcement of the standard of preliminary education
adopted at its organization in May, 1847 -y and that the Medical Colleges
will cheerfully receive and record the certificates alluded to in said
standard whenever the profession generally and the preceptors will see
that students are properly supplied with them.

Z. That no Medical College should allow any term of practice to be
a substitute for one course of lectures in the requisitions for graduation.

4. Resolved, That Hospital Clinical Instruction constitutes a neces-
sary part of medical education ; and that every candidate for the degree
of Doctor of Medicine should be required to have attended such instruc-
tion regularly for a period of not less than five months during the last
year of his period of medical pupilage.

1859.] Editorial 423

5. Resolved, That every Medical College should rigidly enforce the
rule requiring three full years of medical study before graduation, and
that the diploma of no Medical College shall be recognized which is
known to violate this rule.

Prof. Wright, of Nashville, moved that the resolutions of the report
be considered seriatum, and the first being taken up he spoke at length
in opposition to it, giving a history of the previous difficulties between
the American Medical Association and the Medical Colleges. He could
neither vote for such a resolution nor could he take any future part in
the proceedings of the convention which should adopt it.

Prof. Brainard, of Chicago, thought this convention was asked to take
a step fraught with peril to the harmony of the profession and its best
interests ; it should be met on the threshold and a solemn protest enter-
ed against it. The body did not represent the Medical Colleges of the
country with unanimity; New York, Philadelphia, and New Orleans
are not represented here, and he must consider their absence as a pro-
test against the assumption of any power on the part of this body or the
American Medical Association to dictate the terms on which the Col-
leges should confer their degrees or receive their students.

The admission of such a resolution would produce hostile factions
both in the profession and in the Colleges and could never receive the
sanction of those who had independent, chartered rights to fall back upon.
He was opposed to no true improvement in the medical profession, but
he did object to shutting that door upon young men desirous of entering
the profession, through which we ourselves all had entered.

Without definite action on the resolution, the convention adjourned
until 3 o'clock P. M.

AFTERNOON SESSION.

When the convention reassembled, Dr. Bayless offered the following
amendments to the first resolution :

1. To substitute in the third line the word "recommending" for
" prescribing."

2. To strike out all after the words " deference and respect."

A long discussion ensued on the resolution, which was participitated
in by Doctors Bayless, Yandell, Palmer, McDowell, Davis, Brainard,
Shattuck, Baker and Wright.

Prof. L. L. Joynes, of the Medical College of Richmond, Va., then
offered the following preamble and resolutions as a substitute for the
resolutions from the Business Committee :

Whereas, It appears that a large proportion of the Medical Colleges
of the United States are unrepresented in this Convention, and no
changes in the present system of education can be effectual unless adopt-
ed by the schools generally

424 Editorial. [June,

Resolved, That it is inexpedient at this time to take any action upon
the proposition contained in the report presented by the Special Commit-
tee on Medical Education, at the last meeting of the American Medical
Association.

Resolved, That with the view of obtaining a more general union in
counsel and in action, upon this important subject, the Convention do
now adjourn to meet again on the day preceding the next annual meeting
of the American Medical Association, at the place which may be agreed
upon for said meeting, and that the several Medical Colleges in the
United States requested to appoint each one delegate to such adjourned
meeting of this Convention.

These resolutions were amended, at the suggestion of Dr. Wright, to
include the appointment of a committee of five to take into consideration,
during the recess, the various matters referred to in the resolutions, and
to report thereon at the adjourned meeting.

The vote was demanded on this, by Colleges, and resulted as follows :

Yeas Shelby Medical College, Missouri Medical College, St. Louis
Medical College, Oglethorpe Medical College, Ohio Medical College,
Western Reserve Medical College, Kentucky School of Medicine, Med-
ical College, Richmond, Atlanta Medical College, Rush Medical Col-
lege10.

Nays Medical College, S. C, Medical College, Ga., Medical De-
partment University Mich., University of Louisville, Cincinnati Col-
lege of Medicine, Lind University, Iowa University, Medical College,
Memphis, Harvard University 9.

The substitute was declared adopted, yeas 10, nays 9, and so the
Convention stood adjourned until the day preceding the next annual
meeting of the American Medical Association.

The chairmam appointed the following committee under the above
resolutions : Drs. L. P. Yandell, Geo. B. Shattuck, G. C. Blackman,
H. F. Campbell, and Moses Gunn.

Thus has ended the first meeting of the Colleges for the purpose of
establishing a proper system of Medical Education, and of arranging
such matters of general interest as the Colleges themselves, alone can
finally settle. It will doubtless be remarked that very little has been
done at this meeting, but our own opinion differs widely from the asser-
tion. True, nothing final has been determined upon no striking
change has been made and no specific abuse corrected : nor should any-
thing of this kind have been expected, for none of them could have been
effected at this first single meeting, without, in the general movement,
doing violence to some one of the special interests represented. The
colleges of this country, at least in these conventions, must be regarded
as a commonwealth, in which the peculiar interests of each, are to be
considered, and, as far as consistent with the general good, protected.
Changes in the private economy of colleges can only be effected after

1859.] Editorial 425

deliberate action, and when they so nearly affect the interests of the
several schools, much hesitation is to be expected before they are entered
into. Not only one, but probably several meetings of this convention
may hereafter be required to correct even a single abuse.

We consider the meeting just held to have accomplished a great deal,
simply by their organization as one of the established associations of our
profession in this country. Hereafter this junto of Medical Professors
is to become one of the important permanent appurtenances of the
American Medical Association its companion and counsellor in all
matters especially, which refer to Didactic Medicine, or the Education-
al interests of the Profession.

Changes and improvements of the most important character must, in
time be effected, and doubtless there will finally grow out of the delib-
erations of this American body, a model system of medical education,
by which those of older countries, confessedly so imperfect at pre-
sent, may be modified and improved.

If we understand their duties aright, the Committee which has been
appointed by the President of this meeting, will correspond with the
various colleges, in order to ascertain the views of each and to secure
unanimity of action at the next meeting of the Convention on some one
or two points of improvement in medical education. This committee
will report, through their chairman, Dr. L. P. Yandell, at the next
meeting, which will be in New Haven, the day previous to the meeting
of the American Medical Association and their report will be the defi-
nite basis of action for the Convention.

In time, it is to be hoped that the vexed question of medical education
will be settled, and then the wisdom of Dr. James R. Wood's report,
calling this first Convention of Medical Professors, will be apparent to
all, as its benefits will be enjoyed by all.

"The Nights vs. The Days."

We cannot close the account of this meeting without expressing our
grateful appreciation of the brotherly kindness, warm hearted welcome,
and hospitable entertainment of us all, by the Profession, and the Citi-
zens of Louisville.

The days of our sojourn, it is true, were spent in the legitimate and,
sometimes, tedious business of the Association, but festivity and geniali-
ty and abundant hospitality crowned the nights with a u Feast of reason
and a flow of soul," not alone those of our generous and warm-hearted
brethren, but the houses of many distinguished non-professional citizens
opened their doors, and, night after night, until the gray dawn of morn-
ing, the u sound of revelry was heard ;" and as face answered to face and
soul to soul in the joyous gleaming of kindred spirits, few would suspect

426 Editorial. [June,

that, scenes of want and woe, sickness and sorrow, death and desolation
had so often moved those hearts in painful sympathy or darkened those
countenances in despair for " ills they could not cure." But " there is
a time for sorrow and a time to rejoice," and this evidently was the
season of rejoicing, and truly did all rejoice Long life to Louisville and
her Physicians and hospitable citizens, Long live the American Medical
Association ; and long live too, its attendant socialities and festivities.
May its days of wise counsel, and serious deliberation be many, but long
and many too, may its nights be nights of harmless enjoyment, of keen
social pleasure, of cordial intermingling of soul, with kindred soul, and
spirit, with kindred spirit. Give us still these nights these youth-
renewing nights;

" Hang the almanac's cheat, and the catalogue's spite!
Old Time is a liar! we're twenty to-night!
"We're twenty ! we're twenty ! Who says we are more?
He's tipsy young jack-a-napes ! show him the door !
" Gray temples at twenty ?" Yes white if we please ;
Where the snow-flakes fall thickest there's nothing can freeze!"

O. W. Holmes." The Boys."

American Medical Association. The Proceedings of this Associa-
tion are now in type, but our space will not admit of their appearing un-
til our July number.

The New York Academy of Medicine The Whitney Case.

With the above heading, doubtless some of our readers have been
long familiar, as but few of our exchanges have failed to express an
opinion on the subject. Having received many inquiries in relation to
the matter, we shall now present a brief summary with some of our own
impressions in regard to the history of the case, as they have been
gathered from the careful perusal of a lengthy, accurate and very fair re-
cord to be found in the February number of the American Medical
Monthly, published at the very scene of the occurrences.

It appears that Mr. Stephen S. Whitney, the son of a wealthy citizen
of New York, had for some time been affected with serious pulmonary
disease. He, at first was under the treatment of other physicians, but
for about two months previous to his death, was under the occasional
professional care of Dr. Horace Green. His visits to Dr. Green's office
were, it appears, very irregular. Dr. Green's diagnosis divulged ; an
eroded condition of the epiglottis with tubercular deposits in the lungs,
particularly near the apex of the left lung just under the clavicle, "where
a distinct humid rale or click was heard" which, with the accompanying
symptoms presented in the case, was considered by Dr. Green, whose

1859.] Editorial 427

experience is very extensive, as "positively indicative of tubercular
softening."

October 25th. Enlarged and ulcerated tonsils were removed. The
pharynx, the subtonsillary fossae and border of eroded epiglottis were
cauterized and the patient put upon an alterative mixture containing
iodide of potassium and proto-iodide of mercury, which was continued
during the three following weeks.

Occasional applications of a moderately strong solution of nitrate of
silver were made to the epiglottis and glottis, and on the 6th of Decem-
ber, one drachm of a solution of nitrate of silver, 15 grains to the ounce
of water, was injected by " tubage" into the left bronchus. No irritation
whatever followed the operation. The patient at his next call, on the 9th
of December, expressed himself much pleased with the good effects of the
injection. No application was again made until the 14th December,
when, in the presence of a professional friend, Dr. M. E. Foy, who
visited the office to study Dr. Green's method, the throat was again
examined.

Dr. Green had intended to apply tubage on this day, the 14th, but on
account of the non-preparation of the patient, he used only the same
weak solution of nitrate of silver on the ordinary sponge probang applied
by him, as he had done eight or nine times previously. It must be re-
membered that " this instrument was employed, but that the tube was not
used on that day on Mr. Whitney.'''' Tubage was never used but once,
in his case, and that, some eight days before the last operation. The
same probang, the identical instrument which on some ten different oc-
casions had been passed into the glottis and larynx of the patient, was em-
ployed and in precisely the same way, except that when the sponge reach-
ed the glottis, (a thing occurring every day with nervous or sensitive per-
sons and, which every operator knows, without the occurrence of any harm
to the patient,) by which the progress of the instrument was suddenly ar-
rested, so that it did not enter the windpipe at all? The instrument
was at once removed, no more force having been used than that which
is constantly employed every day in operations upon the air-passages.
After talking a while with Dr. Foy and Dr. Green, and remarking that
u the operation hurt him more than usual, or that he felt it more than
usual," M the patient left with the arrangement, that he, should return
next day and have the tube employed." Dr. M. E. Foy, who was
present during this entire interview, remembers vividly, every step
in Dr. Green's procedure, and testifies fully to the accuracy of his state-
ment.

This was Dr. Green's last interview with the patient. He goes home,
and in a short time, the pain increases, difficulty of deglutition and res-

428 Editorial [June,

piration supervene and subsequently, considerable emphysema. The
patient dating the beginning of his suffering from the moment of Dr.
Green's operation, naturally regarded that as the cause, and refused to
see him again. Other physicians are called in, who do not succeed in
quelling the excitement naturally arising from this impression of the
patient and, long before his death, which occurred about eight days after
the sponge application, and fifteen days after the tubage, the most exag-
gerated reports had reached to all, and to the most parts of the
country through the newspapers, that " the death of a prominent citizen
of New York, had been caused by a perforation of the larynx with an in-
strument in the hands of Dr. Green while performing the operation of
tubage." The death of the patient being so long deferred, viz., to
December 21st, doubtless served to intensify the excitement and added
to the condemnation which, in the minds of some, justly fell upon Dr.
Green.

On post mortem examination, at which Dr. Green was not present,
the glottis, epiglottis, larynx and trachea are declared " perfectly healthy
and without an abrasion." But an abscess " about the size of a large
hen's egg and extending a little in front of the pharynx and downward
and below the thyroid cartilage," was now discovered. At the upper
and posterior part of this abscess, there was an opening into the pharynx
large enough to admit the end of the fore-finger. The upper part of the
left lung was mostly, in a state of hepatization and an open cavity was
found here, the size of a walnut, with a small opening through bothpleu-
rce, " at its upper and anterior part.

With these developments, it requires no amplification of reasoning to
account for all the symptoms and the death of the patient the unusual
pain on the last application with the soft sponge, the obstruction on
deglutition and in respiration the emphysema indeed for every thing,
without in any way referring them to any of Dr. Green's procedures.
With the lights before us, there never was a plainer case.

This is, as far as we can gather, a fair summary of the entire medical
history of the case. We have neither time, space, nor inclination to give
even a summary of the painful discussion which has grown out of it.
Suffice it to say, that the medical profession of New York, with a kind
regard for the feelings of Dr. Green, and, being unwilling that such an
imputation should rest upon him, urged the most thorough investigation
of the entire facts connected with the case. The course pursued by the
New York Academy of Medicine, is highly commendable ; during nearly
three entire sessions, the case underwent the most patient and diligent
investigation was thoroughly sifted in all its minutiae.

At the end of this investigation, a unanimous resolution was passed
to the effect that, Mr. Whitney's death " was in no wise, the conse-

1859.] Editorial 429

quence of improper treatment, but was the unavoidable result of a com-
plication of diseases."

" Flat contradiction can you bear,
When you are right and know you are,
Nor flatly contradict again,
But wait and modestly explain,
And tell your reasons, one by one,
Nor think of triumph, when you're done?"

No one can peruse the account of this investigation before the Acade-
my, without being impressed with the highest respect and some admira-
tion for, the calm dignity, the unmoved gentlemanly propriety and con-
siderate forbearance which marked Dr. Green's bearing toward his fel-
lows, even during the most exciting phases of the discussion. This man,
whose labors, during more than twenty years, in a most important field
of medicine, had accomplished so much to whose genius, Science and
Humanity owe so large a debt whose results, could they be estimated,
would doubtless show that, he alone, has been instrumental in appreciably
extending, even the general average of human life, by establishing a new
and valuable treatment for diseases of the respiratory organs whose
name is familiar, not only in every portion of his own country, but is
called with respect and honor by the learned of foreign lands, and whose
industry has done much to gain for American Medicine, the considera-
tion and respect it now enjoys in European countries, finds himself as-
sailed at home, and, in the very community which had witnessed all
his toil and shared the honor of his world-wide fame, he is arraigned in
the-daily newspapers as an unskillful operator and a dangerous specialist !
It would appear that, " Ingratitude more strong than traitors' arms, must
quite vanquish him !" Not so being called upon, he calmly and cour-
teously relates his case before the proper tribunal he listens in quiet
patience to the close inquisition made into his system and his method in-
his defence, he withholds certain revelations because they might wound
the feelings of the surviving friends of the patient, (inimical, as they are
all, to him) though they would satisfactorily explain certain measures of
his treatment, then being severely criticized and, in the adjustment of
the final resolution, fully acquitting him, he nobly asks, that it may be so
worded that blame should fall upon himself rather than upon a venera-
ble and distinguished professional brother who had been engaged in the
case, after it had passed out of his hands.

All this proclaims true greatness of Soul, and vindicates the well-desert
of that brilliant success, which has crowned his life-long career.

American Medical Association Abroad. That our National Medi-
cal Association has influence at home and exercises a wholesome control

430 Editorial. [June,

over the wide-spread bounds of the American Confederacy, no rational
mind will, at the present epoch, for a moment pretend to deny. But
how grateful is it to every true friend of American Medicine, to find the
best Journals of the mother country endorsing us in terms of commenda-
tion, and drawing a most favorable comparison between our National
Medical Congress and their own British Association whose long estab-
lished reputation and world-wide influence are acknowledged through-
out the entire globe. While we select the following from our valued
exchange the Cincinnati Lancet and Observer we heartily commend
the London Times and Gazette for its liberality and justice :

" The London Medical Times and Gazette, in a notice of the Transac-
tions of the American Medical Association, Vol. XL, 1858, speaks in the
highest terms of it, and the Association. It accords to it a position for
influence and scientific investigation far ahead of the British Association.
It says, "Each member of the American Association pays twelve shil-
lings a year as his subscription. The subscription to the ' British ' is a
guinea. The one Association offers prizes, makes grants for the expen-
ses of original enquiries, appoints working committees to investigate
important questions, and supplies its members with the results of all this
work in an annual volume of Transactions, which is a real acquisition to
any medical library. The Association has published carefully prepared
reports of the various epidemics and diseases which have prevailed dur-
ing the past ten years, and of the vital statistics of the principal cities ;
illustrating them by charts, maps, diagrams, tables and plates." Speak-
ing of the British Association, it says, " It has done nothing to check
irregular practice, or promulgate a code of ethics. It is a mere joint
stock company, vainly attempting to compete with this, and the other
weekly medical journals of the metropolis. Its sole vitality is in annual
social gatherings. Let them be kept up ; but in all other respects, if the
Association is to become a useful, influential and respected body, let it
return to its original constitution, encourage experimental investigations,
promote medical science, assume some authority in the sanitary affairs
of the nation, put away discreditable trading competition, and outshine,
instead of being spurned, by its younger and more vigorous brother of
the West."

Death of Sidney S. Browne.

" The fire beneath his crucible is out ;
The vessels of his mystic art lay round,
Useless and cold as the ambitious hand,
That fashioned them" "Willis. " Dying Alchymist"

Though not a member of our profession, Mr. Browne had such a rela-
tion to the publication of this Journal, that, we feel it proper that some
record of his usefulness, his quiet unobtrusive worth should find a place
upon its pages. For several years he has occupied the humble, but
the highly important position of Job Printer in our office ; and daily
and hourly are we reminded of him by the melancholy vacancy, not yet

1859.] Miscellaneous. 431

filled, caused by his sudden death. The click of his ever busy Treaddle-
press, is no longer heard it stands, a cold and silent monument of the
skillful hand which so lately worked it. Mr. Browne was a native of
Charleston, S. C, and has been working in our oftiee for the last three
years. He leaves a large family who were mainly dependent upon his
efforts long shall we miss his kind benevolent face in the scene of our
editorial toils. He has ceased from his labors long and weary have
they been but now " the weary is at rest."

The following from the Savannah News will show our readers the kind
of man we have lost; this period of his life is a good sample of the
whole :

" The deceased was foreman of the News office in 1854, and during the
epidemic of that year remained at his post, a portion of the time with only a
single assistant a faithful little apprentice boy, still in the office with
whose aid he continued the publication of the paper, never missing a
single issue. During the prevalence of the fever, every one connected
with the establishment, with the exception of the deceased and the ap-
prentice boy alluded to, were attacked, and five out of the number died.
Mr. Browne was one of the best and most expert job printers we ever
knew ; as a man he was industrious, amiable, generous, and reliable.
lie had no enemies, and leaves many friends, to whom the announce-
ment of his death will be sad intelligence."

The New Sydenham Society. Messrs. Editors, I noticed, in your
Journal of the 24th ult., an article respecting the uNew" Sydenham
Society. Since this notice, I have received a communication from the
Secretary, Mr. Hutchinson, explaining somewhat the objects and scope
of the tt New" Society. The prospectus, which I have not yet received,
though sent about the same time as this letter, will explain all matters
fully. Mr. Hutchinson says, in his letter, " We have already 1700 mem-
bers, and are steadily increasing. The books will be uniform in size
(8vo.,) type, &c, and the intention is to keep close to those of a practi-
cal class. * * * The number of books issued each year will depend
upon the number of members. If we can gain another 300 this year, I
have little doubt but that we can afford the whole of the six volumes
mentioned for one subscription ; at any rate, five would be certain."

The following notice was issued by the Council, Feb. 1st, 1859. [Bos-
ton Med. and Sure/. Journal.

" The New Sydenham Society. The present Volume Diday on Infantile Sy-
philis is the first published by the New Sydenham Society.

' The following works are in the hands of the printer:

' Vol. II. Gooch on some of the more important Diseases of Women and
Children, and other papers. "With Prefatory Essay by Dr. Robert Ferguson.
Wood cuts. Co be ready in March,

" Vol. III. Selected Memoirs on Diphtheria (Bretonneau, Trousseau, Guersent,
Buchut, Daviot, and others.) With a Bibliographical Appendix. Nearly ready.

** Voll IV. Schroeder Van der Kolk, on the Anatomy and Physiology of the
Spinal Cord. With Plates.

432 Miscellaneous. [June,

" Schrceder Van der Kolk, on the Medulla Oblongata, and on the
Proximate Cause and Rational Treatment of Epilepsy. With plates. These
two volumes will be bound in one.

" Vol. V. Clinical Memoirs on Abdominal Tumors and Intumescence. By Dr.
Bright. Collected and reprinted from the Guy's Hospital Reports. Edited by
Dr. Barlow. With Plates and Wood cuts.

" Vol. VI. A Volume of Translated Modern Essays (chiefly German) on differ-
ent medical subjects. Wood cuts.

" The Council begs to announce to the members, that the first twelve months
having been taken up in the organization of the Society, and the preparation of
the first year's series of books, it has determined that 1858-9 shall count as one
year. The series of books, now commenced, will, therefore, be issued for 1859,
and no second subscriptions will be due until January, 1860.

" The Council confidently trusts that Vols. II., III. and IV. will be in the hands
of the members early during the present year.

"Whether the other volumes (V. and VI.) may be also issued as part of the
first year's series, must depend upon the number of new members obtained.

" A small number of extra copies of the work will be printed for the supply of
those who may join the Society during the current year."

Those desirous of becoming members, are requested to send their names directly
to me, the Local Secretary for this section of the country. It is a labor con amore,
and shall be so executed.

No 1, Stanford-street. R. H. SALTER.

M. Falcony's Powder for Preserving Dead Bodies. The result of a very
successful trial of M. Falcony's mode of preserving dead bodies was seen
at the Grosvenor-place School on Tuesday. A body was brought to the
school on the 24th of September, in a state of decomposition, so advan-
ced, as to be quite unfit for dissection. It was covered with M. Falcony's
powder, and left in an open coffin until Tuesday last, when it was inspect-
ed in the presence of a number of scientific and literary men. There
had not been the least offensive odor in the room in which the coffin was
kept, and the body on Tuesday was quite free from odor. The powder
used contains a large proportion of dried sulphate of zinc ; this is mixed
with common sawdust of white pine, before covering the body. The ra-
tionale of the process is easily understood. The sawdust keeps the oxy-
gen of the atmosphere from access to the body, and the emanations from
the body are oxydized in the sawdust by the atmospheric oxygen. Hence
. there is no escape of the fetid gases. Then internal decomposition is
prevented by the sulphate of zinc absorbing the water of the body, deli-
quescing, and recrystolizing as hydrate, probably with seven equivalents
of water of crystalization. Whether this explanation be correct or not,
there can be no doubt whatever that the process is a cheap, safe, and ef-
fectual one, perfectly fulfilling its intended object; and we feel sure that
the adoption of such a process with all our dead, would tend to protect
the living from cadaveric poisoning of the air we breathe and the water
we drink. [North Am. Medico- Chirurgical Review.

Facile Mode of Cupping. By D. Stewart, M. D. A correspondent
in the Lancet makes an excellent suggestion for the manufacture of
cheap cupping-glasses of common green glass, such as may be readily
and not grudgingly used by any one when leeches are not t be had.

Let me offer a suggestion for a safe and easy mode of exhausting
them, free from all the trouble of pumps and the danger of spirits and
ethers, and which will answer equally well with a wine or liqueur glass
as the best ground cupping-glass.

1859.] Miscellaneous. 433

Wipe the glass you select for use quite dry, drop into the bottom of it
one drop of melting wax from the candle in your hand : on this lay the
smallest imaginable dossil of gun cotton, a morsel not larger than a
grain of rice will be enough. The softness of the wax will suffice to
keep this in situ if but one fibre is entangled. Then set fire to it with a
bit of lighted paper, holding the mouth of the glass up, and its edge
close to the part of the body on which you mean to apply it. At the
instant of the puny explosion, invert the glass on the part. The vacuum
iormed is perfect, and the action immediate. You have no ugly scalds
from half extinguished ether, no flames from its droppings on the
patient's dress, etc. The cotton may be carried about quite safely in
the head of your lancet-case ; and instead of the deep ugly gashes of a
scarificating machine, a few light superficial cuts rapidly made with the
shoulder of a lancet over the part will give less pain, less fright, and
more blood. [N. 0. Medical Neivs and Hospital Gazette.

New Application of the Stereoscope The Boston Journal says: "Mr.
John P. Soule of this city has recently been engaged in taking a series of
photographs from dissections of the human subject, designed for use in
the stereoscope. He has already prepared a dozen or more of these pic-
tures, which exhibit as many different dissections of the muscles, and it
is his intention to continue the series, and to prepare views of the arte-
ries, &c. The pictures are very beautiful, and should the artist succeed
in coloring them satisfactorily, their value will be greatly enhanced."

[St. Louis Med. and Surg. Journal.

Epistaxis. Dr. Buchanan has communicated to the Nashville Med.
Society a case of violent bleeding from the nose, in which, after having
had recourse to all the ordinary methods for arresting the hemorrhage
without avail, he at length succeeded by compressing the carotid. He
put his finger and thumb on the carotid artery of the right side and com-
pressed it against the cervical vertebrae. This stopped the bleeding
almost in an instant. Twenty-five hours after it recommenced, but was
again immediately checked by the same method, and did not subsequent-
ly recur. [Nashville Med. Journal.

Asthma. Prof. Flint reported a case of asthma, which was produced
by emanations from a feather bed. It was a child five years of age, who
had always suffered from asthmatic breathing. The father and mother
were both subject to it in some degree : they had always been accustom-
ed to sleep on feather beds, and on making a change in this respect, ac-
cording to the suggestion of Prof. Flint, there was no return of the diffi-
culty.

Dr. Miner mentioned a similar case ; the patient, in addition, could
never breath where there was any new-mown hay ; the odor from a
horse was. sufficient to bring on the difficulty. He had a son who suf-
fered from the same idiosyncracy. [Buffalo Med. Jour.

Treatment of Ascarides. By Nathaniel Smith, of Bradford couuty,
Pennsylvania. I noticed, a few weeks ago, a call for a cure for ascarides,
or pin worms. In an extensive practice of more than forty years, I have

434 Miscellaneous.

never known assafoetida and aloes to fail of an immediate cure. I have
usually given the medicine in tincture, and in some cases have thought
best to clear the bowels of mucus and other matter, by a dose of calomel
and rhubarb, or some other pretty smart physic. I have treated very
many patients, of all ages, from infancy to old age, and never failed of
an immediate cure. I know not whether I have ever seen these medi-
cines recommended in books. I took them from Dr. Mussey's Lectures
at Dartmouth College, perhaps forty-four years ago. [Boston Med. and
Surg. Journal*

Constipation. Dr. Black attributes many cases of habitual constipa-
tion, especially among infants, inpregnated* and nursing females, to an
undue absorption of intestinal fluids, rendering both the mucous follicles
of the intestines dry, and the foeces hard, dry and scanty. In one case
of a child six month old, he adopted the following treatment :

ft. Ext. Sarsa. 3iss ; Aq. Fervent, gi ; Hydrarg. Bichlor. gr. ij ; Syr.
Simp. 3i. M.

Of this a teaspoonful was to be given three times a day. In a week
or two the dose had to be diminished to one-half, finally to one-third,
and in six weeks discontinued entirely as the discharges were rather too
frequent ! ! He adopts and recommends the same treatment in pregnant
women and other similar cases, and although he had used this mixture
extensively for three years, he has never had reason to fear ptyalism.

[Cincinnati Lancet.

Sir Benjamin Brodie. We extract the following from the London
Medical Times and Gazette for December last : " Honors are falling thick
on Sir Benjamin Brodie. Last week elected President of the Medical
Council, this week President of the Royal Society, he stands in a higher
position than any surgeon has ever attained before in this country."

[Nashville Monthly Record.

A Medical College in California. From a circular which we have
received, we perceive that a Medical School is about to be started in
California, to be known as the Medical Department of the University of
the Pacific. The regular course of lectures will commence on the first
of May next, and will continue for eighteen weeks. There are six pro-
fessorships, and we are glad to see that Dr. E. S. Cooper, formerly of
Peoria, Illinois, is to occupy the chair of Anatomy and Surgery, for
which he is certainly well qualified. [St. Louis Med. and Surg. Jour.

Ludovic Hirschfeld, the author of the beautifully illustrated work on
the Nervous System, and formerly chef de clinique at Hotel- Dieu, Paris,
has been nominated Professor of Anatomy at the Medico-Chirurgical
Academy of Warsaw. [Cincinnati Lancet and Ohserasr.

" There is a great difference between a pathologist and a physician.
The pathologist studies disease for the disease itself; the physician stu-
dies disease for the victim of the disease. One exercises his art for the
sake of art the other exercises it for the purpose of soothing the suffer-
ings of humanity." [L1 Union Med. Cincinnati Lancet & Observer.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XV.] AUGUSTA, GEORGIA, JULY, 1859. [No. 7.

ORIGINAL AND ECLECTIC.

AKTICLE XV.

An Essay on the Adaptation of Climate to the Consumptive, for a
permanent residence ; embracing an Examination of the climate
of certain localities of frequent resort; and also, an Investigation
of the degree of adaptedness of the Pacific Climates of the United
States. Presented to the Medical Society of the State of Geor-
gia, at its annual meeting, held at Atlanta, April 13th, 1859.
By William Henry Doughty, M. D., of Augusta, Ga.
(Ordered to be printed.)

(Continued from June No. page 388.)

Summer of California and the Interior.

The study of the summer climate of this State and the ad-
joining territories, as of the entire Pacific slope, forms a subject
of unwonted interest to the climatologist. The striking con-
trast of the two divisions, more striking than at any other sea-
son ; the high extra-tropical heat, characterized as almost with-
out parallel, in some of its valleys ; the temperature of the
northern districts, equal if not higher, than those many degrees
of latitude farther south ; and also the well-determined influ-
ence of the cold waters of the Pacific ocean, refrigerating the
continent, contribute to enhance the interest of the subject in a
manifold degree. " The cold climates of the Pacific coast in
summer, constitute a general phenomenon of temperature more

N. 8. VOL. XV. NO. VII. 31

436 DOUGHTY. An Essay on the Adaptation of [Jutyj

difficult of explanation than any other, as the degree of refriger-
ation is so very great, and the contrast with interior districts
so extreme over many degrees of latitude. The striking uni-
formity in the measures of mean temperatures here, which has
been alluded to as characterizing nearly all the observed points,
is conclusive evidence of the existence of some general and
powerful agency, other than the immediate one of cold day
winds. The analogies of the coasts of South America, Africa,
and the North Atlantic, would indicate at once a reference to
great polar currents, and to the transfer of large masses of cold
water from the northern parts of the Pacific ; but the ordinary sea
observations have hitherto failed to discover any regular or
marked currents here. Northward and westward from San
Francisco, the surface currents appear as frequently from one
point as another on Maury's Charts, though the existence of a
general movement from the northwest is recognized. There is
apparently a deep-sea current from that direction, of great
magnitude and volume, which appears only by the lifting of its
waters on approaching the coast, and in the general refrigera-
tion of the waters of the whole area, with the consequent effect
upon the sea-winds and on the climate of the land. The water
temperatures noted in the summer months, are less than those
of winter, and their mean is nearly 57 or that of the sea-
winds, and of the summer on the coast. The body of water so
affected is shown by Maury's Chart to extend northwardly
toward the Peninsula of Alaska, and to be strikingly uniform
in its characteristics of low temperature, absence of surface cur-
rents, and continuous northwest winds, so far as observed. This
great mass of cold water, and its attendant cold surface atmos-
phere, developes a strong sea-wind towards the greatly heated
and rarefied interior valleys and plains ; and where these con-
trasts of temperature are greatest, the maximum effect is produced
as at San Francisco and Monterey. It is not strange, therefore,
that the immediate coast is cooled to the temperature of the air
and water of so large a portion of the ocean." "The contrasts
which induce these violent winds, exist only in the summer
months, including May and September, as at other seasons the
ocean is quite as warm and the land cooler, and, whatever the
degree of aridity, the sudden and extreme rarefactions do not

1859.]

Climate to the Consumptive, dc.

437

occur in the winter. As this unusual circulation ceases, the
temperature rises, and the spring and autumn are both warmer
than the summer, on the immediate coast, over a space embrac-
ing several degrees of latitude."

Ariving next to the consideration of the special summer
climate, we will first examine the difference of the successive
months.

June.

Junk to July.

July to Aug't.

Aug't to Sept.

Mean.

Advance.

Mean.

Advance.

San Diego, California,
San Francisco, "
Fort Miller,
Fort Defiance, N. Mex.

67.39
56.86
83. 16
64.00

qo.33
1O.04
7. 08

50.8S

0.96
-O0.68
-70.21
-20.92

-2o. 81

1.04

-6. 94

-100.77

A comparison of this table of advances, with the relative sea-
temperatures at the coast stations, is absolutely necessary to
a correct appreciation of its merits, and to the full comprehen-
sion of the subject. It will be borne in mind, that " the maxi-
mum effect" of refrigeration, is found near San Francisco and
Monterey, those parts of the immediate coast, both northward
and southward of them, being less affected. From the data
furnished us of the measurement of the sea-temperatures below
San Francisco, to the 30th parallel of latitude, it appears that
these cold waters of the Pacific, possess a higher degree of
temperature, at least between the 30th and 35th parallels. We
give the following in substantiation : " Taking the observations
in Maury's Winds and Charts, for these portions of the Pacific,
in mean for areas of five degrees of latitude and longitude, we
find the areas westward of San Francisco, to give 56. 5, 62.3,
64.4, and 68 successively. The areas next southward, or
between 30 and 35 of latitude, decrease in temperature west-
ward from longitude 120, by the successive numbers of 60.5,
63.3, 65.7, and 66.7, to the meridian of 140. South of the
parallel of 30, there are no summer observations on the coast.
Now San Diego is situated between the 30th and 35th parallel
of latitude, consequently the temperature of the sea- waters
nearest the shore, is 60.5, and the mean temperatue of June
here is only 6.89 higher, than that of these waters. The

* See Army Meteor. Register, page 703.

438 Doughty. An Essay on the Adaptation of [July,

advance from June to July is 5. 33, while that of July to Au-
gust is scarcely a degree of temperature. September presents a
decline of 2.81 under that of August, and 1.85 under July.
At San Francisco, we find the mean temperature of the month
of June, so great is the influence of the sea, reduced virtually
to the temperature of the latter, there being a difference of only
0.36 in its favor. This influence of the sea-temperature is still
further exhibited in the trifling increase of July over June, the
advance being only 1.04, and over that of the sea itself only
1.40. August again, while it recedes 0.68 from the mean of
July, is yet 0.36 higher than that of June, and only 0.72
higher than the mean water-temperature. September, instead
of manifesting a decline in its mean temperature, when com-
pared with the two last summer months, at San Francisco, as is
also true of Monterey, shows the highest mean temperature of
the dry season along the coast of California. Belonging, strict-
ly speaking, to the fall season, it nevertheless presents a higher
mean temperature, than either of the summer months, being
1.04 warmer than August, and 0.36 warmer than July. Com-
paring it with the mean of the sea-waters, it is 1.76 higher in
its mean temperature. Finally, the mean advance for the sea-
son of the land temperatures over those of the sea, is for San
Diego, 10.76, and for San Francisco 0.82.

Again, we have added to the above table another station,
Fort Miller, California, not found in the corresponding one for
the spring season, in order that we might bring out more
clearly and forcibly the relation, or rather contrast, existing
between the coast and the shielded interior of the State. This
post is situated at the foot hills of the Sierra Nevada, about the
centre of the San Joaquin Valley, and has an altitude of 402
feet above the sea. In looking over its mean monthly tempera-
tures from January to July, we find a progressive and perhaps
somewhat uniform advance in each succeeding month, until the
culminating point (July, mean temperature 90.24, 2 years
observation.) is reached. It presents an advance of 7.08 from
June to July ; a decline of 7.21 from July to August, and a
further decline of 6.94 from August to September. This post
being shielded from the inflowing of the sea- temperature, enables
us to arrive approximatively at the actual degree of thermome-

1859.] Climate to the Consumptive, &c. 439

trical influence exerted upon the land temperatures of the coast,
by those of the sea (air and water). In other words, the loss of
that influence at this place, is fairly expressed, by the increase
of temperature over that of the sea, per month, namely, in
June 26^.66; in July 33.74; and in August 2 6. 53. It ap-
pears, therefore, that the average monthly reduction of tempera-
ture along the coast, assuming all things the same, for this
season is 28.97 Fahr. We are particular to state this as an
approximation merely, for there are many circumstances, which,
when taken into account, prevent an accurate calculation. For
instance, if the mountainous separation between the coast sta-
tions and Fort Miller, was removed, one great intensifying
agent (the heating and rarefaction which takes place in the
united valleys of the Sacramento and San Joaquin,) would be
removed, and as a consequence, the coast would have a much
higher temperature than it now has, while Fort Miller, being
now influenced to a greater or less extent by the atmosphere of
the sea, would experience a reduction of temperature.

Returning now to the far interior post we observe that the
mean temperature of June is 13 higher than that of May; that
the advance from June to July is 5.88, and also that there is a
decline of 2.92 from July to August and from August to Sep-
tember, a still farther decline of 10 77. July, whose mean is
11.98 higher than that of the same month at San Francisco,
presents the highest for the season.

2d. TJie general range of the mean temperatures for the summer
season.

MEAN TEMPERATURE.

Joe.

JrLT.

Acgcst.

: w't. .Range High't Low't.iRangeiHigh't Low't
MH> 8.40 7>'I'7 67o.S9 6o7^;75o.35 7>o.50

San Francisco, "

Fort Miller, "

Fort Defiance, N. Mexico 1 64<>.&6 62Q-40I 2Q.46 7QQ.95 65Q-161 2--.79.69Q 00 64Q.94

Range
2.S3
1045
1Q.26
40.O6

Taking the entire region under consideration, it appears that
the month of August presents the greatest uniformity, in regard
to the general range of the mean temperatures. Reviewing
the respective stations, we observe that San Francisco shows
the least variation in this particular for the whole season, the
average per month being only 2.34. Next in order of unifor-

440 Doughty. An Essay on the Adaptation of [JulyT

mity to this, is Fort Defiance, whose average per month for the
season is 3.10. But there is one particular feature shown by
this table, that is strikingly remarkable, namely, the high extra-
tropical mean temperatures of this season at Fort Miller. Its
usual mean summer temperature is 85.48, constituting, with the
exception of Forts Mcintosh, Texas, (85.91,) and Yuma, Califor-
nia, (89.95,) the highest mean summer temperature within the
limits of the United States. Indeed, when compared with the
principal cities of the tropical West Indies, it is found to exceed
even them in this particular. The mearl summer temperature of
Havana is 81.3 ; that of Kingston is 81.l ; and that of Matan-
zas is 81.7. This local concentration of excessive heat, is
doubtless attributable to its valley situation.

3d. The extreme single observations in each individual month at
the different posts.

June.

July.

August.

Mean.

Pos.
Range
for the
Seas'n

San Diego, Cal., ('4 years,).
San Francisco, " (5 years,)

Fort Miller, "

Fort Defiance, N. M. (3 y's.)

450.00,990.00 56Q 00
370.00 1 870.00 1 46Q. 00
70Q.00118O.0 590.00
68O00|95c.00|43o.00

930.00 1 48Q.00
840.00 470.00
121.0 Sl'.OO
98U.00|30Q.00

430.00
41O.00
59.00
,00

94.00; 560.00
85o.00 50o.00
1130.0540.00
96o.00|43o.00

880.00 42^.00
35.00 1 370.66
59o.0062o.66
53a.0057o.66

Thus we may expect, that, at least once in four years the ther-
mometer at San Diego in the month of June, will rise as high as
ninety -three degrees (93), and fall as low as forty-eight degrees
(48a). By reference to the record for the month of April, it will
be perceived that some parallelism exists between the two in this
particular their highest observed degree being the same, while
the lowest of the latter is only eight degrees (8) below that of
the former. The possible range of the thermometer, however,
for the month of June, is less than that of April. Farther
north upon the coast at San Francisco, there is a tendency in
the two extremes to come together, the possible range of the
thermometer being thirty-seven degrees (37). And while the
lowest indication is one degree below that at San Diego, the
highest is nine degree (9) under that of the same post. This fact
of itself, is sufficient to point to some local controlling agent,

1859.] Climate to Hie Consumptive, &c. 441

acting here with greater energy; that agent producing some
1 more special action upon the coast temperatures, than is exerted
ordinarily by the oceanic waters upon the climate of its contigu-
ous shores. July, at San Diego, shows a higher degree of
temperature, attainable in four years, and at the same time
raises the minimum observation, consequently the possible
range of the thermometer is reduced to forty-three degrees (43).
At San Francisco, this month is somewhat more extreme than
the preceding, there being an increase of three degrees (3)
in the maximum observation, and a diminution of one degree
(i) in the minimum, so that the possible range of the ther-
mometer is increased to forty-one degrees (41).

August, at San Diego, shows a decline in the highest degree
of temperature from July, but is still above that of June ; its
lowest extreme corresponds with that of July. It would there-
fore indicate a slightly more agreeable temperature condition,
than the other months of the season, having a lower degree of
heat and a reduction of the possible range of the thermometer
to thirty-eight degrees (38). At San Francisco, August has a
higher degree of uniformity than the other two, the possible
range of the thermometer being reduced to thirty-five degrees
(35). The lowest attainable point is four degrees above that of
July, and three degreesabove that of June. There is also afalling
off of two degrees from the highest of the former. The regula-
ting influence of the cold waters of the Pacific upon the climate
of this post, is well illustrated by the gradual reduction of the
possible range of the thermometer for the successive months.
Commencing with March, we find its possible range to be 46 ;
that of April, 42 ; that of May, 38; that of June, 37; that
of July, 41; and that of August, 35Q. It would be very diffi-
cult to find a more gradual and progressive diminution, even
for a more limited period, on any extent of sea-coast. At San
Diego, where the determining physical agents are less operative,
there is more or less irregularity in the spring months. Its
possible range for April is above that of March, and a degree
of abruptness equal to fourteen degrees (14) of temperature,
occurs in the change from April to May.

Let us pass now to the interior region. At Fort Defiance,
we may expect, that at least once in three years, the thermome-

442 Doughty. An Essay on the Adaptation of [July?

ter will indicate a degree of temperature equal to ninety-eight
degrees (98), in the month of June, and will retire to thirty
degrees (30), that being the lowest observed in that period.
The resulting range is sixty-eight degrees (68). Comparing
similar observations of July with those of June, we have a
reduction of thirteen degrees (13) in the possible range, and a
disposition to greater uniformity manifested by the nearer
approach of the two extremes. August here differs but little
from July, sustaining also the same relation to the first summer
month. Compared with the spring season of the same post, we
observe that whilst the two extremes do not reach such exces-
sive degrees, yet the measure of their effects is equally percepti-
ble and disagreeable. For although the thermometer does not
retire in June to the same degree, that it does in either of the
spring months, still its possible range (68) is greater than those
of the first two spring months, and only two degrees (2) less
than that of the third, May. March and April have the same
possible range, (61Q) ; May 67. July and August, compared
with the same, show greater uniformity and less abruptness of
change in the monthly distribution of heat, the possible ranges
of the thermometer being materially less than those of the four
preceding months. But we have said, that the degree of the
effect of the two extremes in the summer, particularly June, is
equal to that of the spring. For example assuming these
monthly extremes to occur within a day in the month of June,
we would have an oppressively hot temperature during the
day, while at night, the thermometer would retreat below the
freezing point, so great is the refrigeration thereby subjecting
the animal frame at once to the heat of summer and the cold
of winter. Indeed, whilst ice forms in the night in one's water
bucket, by the reduction of temperature ; in the day, the softer
solids are converted into liquids by the degree of heat. These
phenomena constitute perhaps the rule, concerning the tempera-
ture distribution of the highest plateaus, for their altitude favors
during the day, a rapid absorption, and a concentration of heat ;
but also favors as quick radiation and diffusion of it upon the
withdrawal of the source of heat. Compared with the coast,
the summer of the interior is marked by greater variability ;
the highest and lowest points observed, being much more ex-

1859.] Climate to the Consumptive, dc. 443

treme, and the possible range of the thermometer far exceeding
that of the former. Indeed the great variability and want of
uniformity of the climatic features here, are as much a subject of
surprise and comment, as is the exceeding great uniformity of
the same at the post of San Francisco.

Passing now from this, the most interior post, to the inter-
mediate one, Fort Miller, we are struck with its remarkable
climatic features. The excessive degrees of heat, almost the
highest recorded for any single observation of any post in the
United States, is an astonishing feature, and this astonishment
is heightened into wonder, when we recollect that this occurs
within a hundred and fifty miles of that coast, whereon are
found the most equable summer posts, and within the same
distance perhaps of those places upon that coast, which possess^
that feature of equability most strikingly. Its highest degree
for the month of June, is 121; its lowest 51, thus giving a
possible range of 70 two degrees greater than that of the
most variable of the season, observed at Fort Defiance, and
twice the range of the most uniform at the sea-coast. In July,
the thermometer may reach to 118, but does not decline to the
degree observed in June. August manifests a slight return
from both extremes. Even for these two last, the possible
ranges of the thermometer are far greater than those of the
same instrument at the coast stations. The degree of heat record-
ed in the meteorological reports of the army, which occurs in
those interior valleys of the Pacific, that are walled in by high
mountains and table lands from the sea, and the more open
interior, is not a little remarkable. As has already been inti-
mated, the degree of concentration gives to those posts situated
therein, a statistical meteorology almost incredible. Indeed if it
were not for many external and physical circumstances, for
" the concurrence of so many records," and also for the assurance
that " the instruments were all carefully constructed and care-
fully compared," it would be difficult to embrace these observa-
tions, as the embodiment of facts. " The valley of the Colorado
river of California, is the district of greatest excess, however,
the summer season here reaching ninety degrees. A considera-
ble portion of the desert bordering the river on the west, doubt-
less is quite the same as the military position at Fort Yuma,

444 Doughty. An Essay on the Adaptation of [July,

though no other part has been observed. West of the Sierra
Nevada, another district of extra-tropical temperatures exists in
the San Joaquin Valley, represented by Fort Miller, at which
post the mean summer temperature for three years is eighty-five
and a half degrees. The lower valley of the Colorado, has few
parallels in temperate latitudes in its measure of mean tempera-
ture, if, indeed, a parallel in the same latitudes, may anywhere
be found. "*

" But this and the other last mentioned extreme districts, are
still more remarkable for the single extremes observed in those
months, and in the mean temperature at the extreme hour of
3 P. M. At Einggold Barracks, in the Eio Grande Valley, the
mean of the observations at 3 P. M., for the entire three sum-
mer months of 1850, is one hundred and one and two tenths
degrees (101n.2), and the single extremes reach one hundred
and seven degrees for each month." "Still higher readings are
recorded in the Colorado and San Joaquin Valleys of California ;
at Forts Yuma and Miller, the highest being 121 at Fort Miller, f
in July 1853, and 116 at Fort Yuma, in June of the same year.
The highest monthly mean for any hour is that at Fort Miller,
for June 1852, of 108.4 at 3 P. M., with a single maximum
reading of 116. There are frequent instances of a mean tem-
perature for a summer month, exceeding one hundred degrees
at 3 P. M., one of which occurred at Fort Gibson in August,
1834, and many within the five years of observations in Texas,
New Mexico and California."

But in conclusion, although the currents and mass of cold waters
of the Pacific, exert a considerable influence upon the climate
of the coast, by their refrigerating power, yet we are taught,
and may readily conceive, that alone and unassisted, they are
insufficient to accomplish that degree of refrigeration, which is
declared to exist by instrumental observation. The physical
structure of the coast, particularly where the cold waters are
best capacitated to operate, namely off the coast of California,
about San Francisco and Monterey, is the additional and pow-

* See Meteorological Register, page 700.

f This extreme is recorded as having been observed in June, instead of July.
As references, see Army Meteor. Register, and Blodget's Climatology of the United
States, page 80.

1859.] Climate to the Consumptive, dx. 445

erful agent, by which the degree of these effects is determined.
The effect of the summer's sun upon the interior valleys and pi
causing them to become greatly heated and rarefied, developes
and intensifies the winds from the cold Pacific towards them ;
thereby enhancing the refrigeration or reduction of temperature
of the coast over which they pass, in the effort to supply the
partial vacuum formed in those valleys, or to bring into a state
of equilibrium the adjacent atmospheres of land and sea. Inas-
much as the San Joaquin and Sacramento Valleys are nearer
the ocean, and become as greatly heated and rarefied, if not
more so than the adjoining districts, these equalizing currents
of air are most intense and powerful at such posts and places,
as are intermediate to them and the ocean. So great are these
effects, that at certain stations, as San Francisco and Monterey,
the mean summer temperature is reduced nearly to that of the ab-
solute sea temperature. Notwithstanding the intensity of these
winds, they accomplish their aim so far as the mitigation of the
atmospherical condition of these interior valleys are concerned,
but partially, because of the interposition of the coast range of
mountains.

4th. TJie mean of the Maxima and Minima Observations.

i June. July. | August.

MEAXS OF THE MONTHLY- Maxima and Minima Observations

San Diego, California,

San Francisco, "

Fort Miller, "

Fort Defiance, New Mexico.

70. 50
65. 50
86.00
64^00

77Q.50
66.50
88.50
69.00

75.00
67.50
830.50
69. 50

This table is the more interesting, because it presents to us in
a condensed form, much of the essential peculiarity of the
climate of these regions. In considering the corresponding
table for the spring, we remarked that one of the practical infer-
ences to be drawn from it, was the gradual recession from the
higher spring temperature by the coast stations, as the approach
to summer was made, or in other words, a commensurate de-
crease of the temperature of the last spring month, under the
commencing operation and influence of those physical agents,
which we have seen, are at work for the prevention of high
heat during the dry season. But we observe as soon as the sum-
mer season is announced at these stations, that the temperature

446 Doughty. An Essay on the Adaptation of [July,

condition of the first, as indicated by the mean of its maxima
and minima degrees, is materially elevated. And again, that at
San Diego, where the forces are less influential, that the degrees
(11.50) of increase is the greatest while at San Francisco,
where they exert a far more intense influence, that the degree
of increase is only eight and a half degrees (8.50). Observing
the advance to the next summer month, we are gratified in
finding a leaving off of this abruptness from month to month,
by the lower station, in regard to its monthly extremes, the rate
of advance from June to July, being reduced four and a half
degrees from that of May to June. And from July to August
a further reduction of two degrees takes place. At San Fran-
cisco, however, in the advance from June to July, we observe
greater conservatism, for the difference of the means of their
maxima and minima is only one degree, which fact speaks
loudly of the increasing intensity of those forces, which are the
actors for its accomplishment. It also appears that their present
degree of intensity of operation is preserved throughout the
month of August, for a difference of one degree only over July
is. manifested. It would seem therefore, that in the passage
from spring to summer, an abruptness of increase of tempera-
ture occurs, but having reached a certain point, this feature is
abolished by the augmented relative refrigeration, even to the
first fall month at San Francisco. Of the interior and interme-
diate posts, we will not stop to remark, as their general features
present no peculiarities, other than those which have already
been hinted at during the discussion of the single extreme
monthly observations.

5th. Winds and Weather. The same general manner of cir-
culation of the atmosphere is observed during this season, as was
noted for the spring, perhaps, the only important difference be-
tween the two seasons in this respect, being the degree of its circu-
lation. In the summer, the relative force of the various winds is
increased, in consequence of the great and increasing distur-
bance of the equilibrium of the atmosphere over the land and
sea. The southwest wind is the predominant one at San Diego.
Ascending the coast to San Francisco, we find that, notwith-
standing more points of the compass are embraced in the plan
of the circulation of atmosphere, yet the general arrangement

1859.] Climate to the Consumptive, Ac. 447

and prevalence differs but little from the former. Here, during
the month of June, winds from southwest to northwest inclusive,
blow the west and northwest being the predominant single
ones. In July, those from southwest to west are most fre-
quently observed, and in August, the extremes of the points
embraced are noted, namely, the southwest and northwest
wirlds. In investigating the winds of this part of this coast
(California), we have been struck with the almost total absence
of winds from all other quarters at this season. A decided
diminution is noted in June, and an absence of them in July
and August. This phenomenon is doubtless attributable to the
difference of the temperature of the sea and land ; and their
respective atmospheres. In consequence of which, the regular
southwest wind acquires a'more direct and westwardly direction
off this coast, while those winds further westward, but sufficient-
ly near to be influenced by this disturbance of their equilibrium,
following the course of the cold currents and mass themselves,
also assume a north- westwardly direction towards the same.
Great analogy exists between the winds of this region and those
regular winds of the Indian ocean, known as the monsoons.
Indeed the same forces are at work, and in the same way, for
their production, for the heat of the interior of this portion of
the Pacific coast, exerts an influence upon the regular south-
west winds sufficient to partially neutralize them, by which they
are deflected and made to assume a more westwardly course
the degree of deflection being proportional to the measure of
that influence. The difference then between the active causes
of these phenomena, and those of the monsoons, is one of degree
rather than of principle. Again, we may further remark, that,
after the south-west wind has become a land wind, in its course
across the State, below and at the southern portion of the con-
joined valley of the Sacramento and San Joaquin, and at that
of the Colorado, it has a more easterly direction imparted to it
by this same agency, and as a consequence the south-east winds
would be often er observed at posts situated therein, as at Fort
Miller in the San Joaquin, and Fort Yuma in the Colorado
Kiver Valley.

At Fort Defiance, it was observed that during the spring
season, winds from the south-west prevailed, but in the summer,

448 Doughty. An Essay on the Adaptation of [July,

the observations as revealed in the army reports, show no
particularly prevalent winds. . It is not improbable, that that
portion of the Pacific slope, immediately interior to those heated
valleys mentioned above, suffers more or less derangement in
its atmospherical circulation from them. This latter proba-
bility, when associated with its own mountainous surroundings,
is perhaps wholly adequate to such a derangement, or rather
want of regularity in this regard.

The weather, as exemplified in the mean number of fair,
cloudy, and rainy days at these places, is given in the annexed
table.

San Diego, California,

San Francisco, "

Fort Miller, "

Fort Defiance, New Mexico.

I Jons. | Jolt. 1 August.

Fair.
17.8
21.0
28.0
23.66

Days.
Cld'y.

Rainy

1.2
0.66
0.5
6.0

Fair.

Days.
Cld'y.

Rainy.
0.2
1.0
2.0
8.66

Fair.

Days.

Cld'y.

8.2
20.83
4.0
5.00

12.2
9.0
2.0

6.33

23.0
12.66
27.00
27.33

8.2
18.33
40
3.66

22.8
10.66
27.0
26.0

Rainy

"To"

0 33

0.0

11.38

The respective mean for the season is, at
San Diego, for 5 years, Fair 21.2 Clo'dy 9.53 Rai'y 0.8
San Francisco, for 3 " " 14.77 " 15.88 " 0.66

Fort Miller,
Fort Defiance,

"2
"3

27.33
25,66

3.33-
4.99-

0.83
8.66

Compared with the spring, the weather at San Diego, as
exhibted in this table, shows a decided increase in the propor-
tion of fair days, and a diminution of both cloudy and rainy
for the season. The fair days largely exceed the others. At
San Francisco, we find scarcely a difference in the mean num-
ber of fair and cloudy days for this season, both however exceed
many times the proportion of rainy days. Compared with the
spring, there is a decrease in the mean number of fair days a
slight increase in the cloudy, and a rapid diminution in the
number of rainy the mean proportion of the two last, being
as 7.00 to 0.66.

At Fort Miller, the greatest number of fair days for the sea-
son, is recorded, and also the least number of cloudy ; the pro-
portion of rainy days however, is about that of the coast stations.
At Fort Defiance, this season shows a slight decline from the
mean proportion of fair days of the spring, a similar increase of

1859.] Climate to the Consumptive, &c. 449

the cloudy, but also gives two and a half times the number of
rainy days. We ought perhaps to draw attention to some
facts connected with the above representation of the relative
condition of the weather, for the individual months. As the
summer progresses, the number of cloudy days at San Francis-
co rapidly increases, and at the same time, no increase in the
proportion of rainy days occurs. If we will examine lower
down along this coast, as at San Diego, a reverse state exists, in
regard to the cloudy days, so that this phenomenon is a local
peculiarity of San Francisco and its neighborhood. Its active
causes, we have already spoken of in other connexions. Even
at Fort Miller, where the same causes exert a very limited
effect, there exists a corresponding condition, for whatever
difference there may be, it is simply in the degree of effect.

6th. Rain in Inches. This being the dry season of the Pacific
slope, the measurements of rain at the coast stations, are merely
nominal, but in the interior, as at Fort Defiance, where, as has
been stated, a reverse condition exists, there is an augmentation
of the precipitation over the spring. The following is a sum-
mary of the measurements at the various posts. At San Diego,
the mean amount for five years is 0.55 inches ; at San Francis-
co, for three years, it is 0.03 inches; at Fort Miller, it is 0.02
inches ; and at Fort Defiance, the mean for three years is 6.41
inches.

Autumn of California and the Interior.

So great similarity exists between the general climatic features
of this season and those of the spring, in relation to temperature
distribution, as to render an extended notice of it unnecessary.
"We had occasion, when speaking of the spring, to call attention
to the uniformity of advance from March to May. Again we
may invoke the same attention to a parallel uniformity of
decline in the fall months. As a general rule of the fall
months, the temperature of September is the highest, a gradual
decline being manifested from it to the winter season, but
marked with greater abruptness, as we retire from the sea coast
or large bodies of water in the interior. At some places, " Sep-
tember is a summer month," indicating the nighest degree of
temperature, reached during the dry season ; " at San Fran-

450 Doughty. An Essay on the Adaptation of [July, /

cisco, one degree warmer than August." " The temperatures
of the Pacific coast are always anomalous, and never more
strikingly so, than in these comparisons of points in the curves
of the successive months. September is seen to be warmer than
July, the whole line from July to October is ascending, and
November falls but little below the July mean. The same
results are found at Monterey, and they appear to belong to
the immediate coast line for several degrees of latitude."*

As indicative of the periods, when a low degree of tempera-
ture may be found, we give the following extracts from the
same source. " In 1852, the stations of the Pacific and New
Mexico, gave temperatures below 40, as far south as Fort
Beading, in California, and at Forts Defiance and Santa Fe, in
New Mexico." " In ] 853, the low extremes of September are
quite the same as in 1852. In 1854, they were observed only
at the extreme northern posts in the eastern part of the United
States ; but in New Mexico and California, there was but little
change from the preceding year." Again, " In New Mexico all
north of Santa Fe and Fort Defiance, and in Oregon at all
points remote from the coast, temperatures below 36 might be
expected in this month for every year." And again, " In all
parts of New Mexico, when September does not bring ice and
frost, they occur in October ; but in California, the coast stations
observe no ice until November, when it occurs at all points,
and as decidedly at San Diego as at San Francisco."

From the tabular statement given, page 713, of the Army
Meteorological Register, showing the time of "the first appear-
ance of frost," it appears that, at San Diego, the earliest date in
five years, was October fourteenth (14), in 1854, but in 1851, it
did not appear until November twenty-eighth (28). At San
Francisco, the earliest date for six years, was October twenty-
seventh (27), 1854, although it did not occur in 1851, until
November twenty-eighth (28). At Fort Yuma, no occurrence
of frost is noted during the fall months, its first appearance being
dated in 1852, at December the third (3), and its latest in 1854,
at December twenty-sixth (26).

The only features of the special fall climate, which we will
notice, may be found in the succeeding tables, together with a

* See Ar. Meteor. Register, page 711.

1859.]

Climate to the Consumptive, &c.

451

cursory notice of its winds and weather. The tables we shall
submit without comment, leaving the reader to draw all infer-
ences, and at liberty to make such comparisons with the other
seasons, as he may see fit.

1st. The extreme monthly observations.

September.

October.

November.

San Diego, California 1101". 0,49". 00 52. 0 99\0 1440.0 |55.0|84o.0

San Francisco, " ' 94O.0 43". 0 .510.0 S5p.O 42. 0 |43.0 74. 0

Fort Defiance, New Mexico, 87. 0 l3l<\0 l56.oi76.0 Il7.0 l59a.0'T2\0

37. 0

38. 0

1.0

47n.O
360.0
71. 0

2d. The rate of decline for the succeeding months.

San Diego, California,

San Francisco, "

Fort Defiance, New Mexico.

MEAN

of
August.

780.68

57" .22
660.96

THE RATE OF DECLINE.

Aug to Sep

2.81
+JO.04
100.77

Sep to Oct

5. 37
00.35
9Q.95

Oct to NovlNov to Dec

8.58

3 60

10O.58

5" .22
3M1

3d. The Mean of the Maxima and Minima Observations.

Sept. | Oct.

Nov.

San Diego, California, ....

San Francisco, "

Fort Defiance, New Mexico.

75. 00
68. 50
59. 00

71. 50
63?.50
46. 50

60. 50
56. 00
36. 50

Concerning the weather of the coast, it may be remarked, that,
as this season is the termination of the dry season, as the ap-
proach to winter is made the mean number of fair days dimin-
ishes ; that of the cloudy increases, together with that of the rainy
days. There are about five times the mean number of rainy
days in November, that there are in September. In reference
to the winds, we remark that, as the approach to the wet sea-
son is made, the continental winds, (N. E., E., and S. E.,)are seen
to blow oftener, although the south and west winds still preserve
the ascendency.

The quantity of rain that falls at this season at the coast sta-
tions, is less than half that which falls in the spring. November
presents the greatest monthly mean quantity. At the interior
posts, the fall months are the termination of the wet season,
instead of the dry, consequently less rain will fall in November

n. s. vol. xv. no. vn.

32

452 Doughty. An Essay on the Adaptation of [July,

than in the other months. The ensuing remarks of Mr. Blod-
get, will serve still further to elucidate this feature of the
autumnal season. " The districts deficient in rain at this season,
are nearly the same as at other seasons. The plains, with New
Mexico, the Great Basin, and California, are all comparatively
dry. In most of California, there is no rain in September, and
for all parts south of San Francisco none in October. In this
northern half, the rains commence in October, though irregu-
larly, and in the south in like manner in November. In Cali-
fornia these rains are rarely continuous for these months, how-
ever, or reliable in successive years. They sometimes com-
mence in the form of the more perfectly developed periodical
rains of the northern coast, or of this district for December and
March, yet they may be as extremely irregular as in any other
part of the United States. If the distinction of this season were
there the same as it substantially is for the eastern U. States, or
denned by declining temperature, and the cessation of vegetable
growths, there would be an almost entire absence of rain
belonging to it, over the great interior and California district.
The heat of summer is in fact, the close of vegetation for most
of this region, because of its aridity, and the autumn has little
in common with that of the Atlantic States."

Winter of California and the Interior.

This season, the one of greatest importance in the search after
places of resort for the consumptive, constitutes the chief
part of the other of the grand divisions of the Pacific shore
climates, namely, the wet season. It is impossible to exaggerate
the importance of a careful study of the winter season, by cli-
matologists, particularly when that study is prosecuted for the
benefit of those, whose organic forces seem to be so easily dis-
turbed by the ordinary severity of our general winter climate.
The acknowledged necessity and the acknowledged difficulty of
finding a suitable winter climate for such, serves greatly to en-
hance the interest of any investigation, however superficial,
which has a tendency of removing these difficulties. Therefore,
in our review of the climate of this season, we shall avail our-
selves of every circumstance at all calculated to influence its ulti-
mate adaptation to persons of consumptive habit. Not with-

1859.] Climate to the Consumptive, &c. 453

standing the high altitude of the Pacific slope, it presents when
examined, especially upon the immediate sea-coast, an equability
and uniformity of winter temperature, truly astonishing. And
although its vertical configuration, thus exalted and prominent,
renders its interior more severe and extreme in point of cold-
ness, when compared with western Europe, yet this same altitu-
dinous interior, serves by preventing the ingress and circulation
of the sea-air, to that interior, to preserve a striking degree of
elevation of temperature along the coast, and an equally recog-
nizable uniformity. " There is further proof that this cause
largely affects the temperature distribution in the high and uni-
form temperatures of the immediate coast of the Pacific, to the
northern limits of these observations. The decrease in the win-
ter mean, is but ten degrees for fifteen degrees of latitude, from
San Diego to Astoria, or two-thirds of a degree of temperature
to one of latitude. Continuing to Sitka, there is a diminution
of six degrees of temperature for eleven of latitude, or nearly
the same proportion."*

This equability of temperature is upheld by a reference to
the isothermals, which we extract from the same authority.
" Of isothermals differing five degrees, but three can be
made to cut the Pacific coast from San Diego to the 49th paral-
lel, while in New Mexico, six such lines are compressed within
five degrees of latitude, and on a central meridian terminating
at the mouth of the Ku> Grande, thirteen isothermals of five de-
grees difference occur, and on the Atlantic coast the same num-
ber from Maine to Florida. The interior line crosses twenty-
three degrees of latitude, and that of the Atlantic coast, twenty-
two, and taking the differences of temperature of the extreme
isothermals, we find the diminution to be at the rate of two and
seven-tenth degrees of the thermometer, to one degree of latitude,
a ratio, in comparison with that of the Pacific coast, of more
than four to one. The compression of lines in New Mexico is
exceptional, because the altitude increases very rapidly, yet the
area so influenced is so large, that it is necessary to represent
the superficial distribution, without reducing the observations
to their equivalents at sea-level."

Again. As in the summer, we found the climate of Califor-

* See Army Meteorological Register, page 719.

454 Doughtx. An Essay on the Adaptation of [July,

ilia greatly refrigerated by the temperature of the sea-air,
rendered so by the coldness of the Pacific waters, so in this
season, when those cold waters are supplanted by warmer ones,
we find a corresponding amelioration of the winter excesses.
During this season, "on the Pacific side, the absolute tempera-
tures are at once higher than those of the land, and higher than
in summer for two or three degrees of longitude next the coast.
The thermal lines bend abruptly to conform to this difference
but it is probable that after changing position, four or five
degrees of latitude, they follow the parallels for an indefinite
distance, towards the central regions of the Pacific ocean. The
mean of a sufficient number of observations to afford a near
approximation to the water temperatures here, gives the num-
bers 56, 59, 57, 57, 58, for successive areas of five degrees
extent, both in latitude and longitude, from San Francisco to
the meridian of the Sandwich Islands. On the next line of
similar areas southward, or between 30 and 35 north latitude,
the numbers taken successively from the coast, are 56.5,57, 63, 64,
and 57." It will be borne in mind, that the general atmospheric
circulation of the Pacific, determines the influence of these sea-
temperatures upon the western shore climates of the United
States, as that of the Atlantic, transports the Gulf Stream atmos-
phere into Western Europe, thereby ameliorating localities,
otherwise excessive in their climatic condition.

Deeming this brief notice of their general winter features suffi-
cient, we pass now to the consideration of its special features,
and first in order, we take up the difference of the successive
months.

MEAN

DECLINE FROM

Temp, of

Nov.

NovtoDec|Dec to Jan | Jan to FebJFeb to Mar

San Diego, CaL...

56, 92

-5. 22

+0.2T)

+K.37

+2. 73

San Francisco "...

540.31

-3. 11

-1.60

+2. 18

Ho. 09

Fort Defiance, N. M.

35. 66

-60.39

-3. 09

+4. 60

7o.52

Fort Miller, Cal

55 .48

-70.47

-0.97

+50.97

+3. 67

Keviewing this tabular statement, we observe at each of the
stations a decided decline from the last fall month to the first
winter ; and also from the first winter month to the second,
except at San Diego ; and in the progress from the second to the

1859.] Climate to the Consumptive, &c, 455

third of the season, a uniformity of advance is observed, caus-
ing a higher monthly mean temperature for February, over that
of January. This latter is the coldest of the season at the three
last posts, while December is the coldest at the other (San
Diego,) by one-third of a degree. From the last winter to the
first spring month, there is a firm advance by all of them, great-
er abruptness being manifested, however, at the interior post,
Fort Defiance, as is the usual characteristic of interior localities.

But one cannot inspect the winter-temperature statistics, with-
out being impressed with the relatively slight decline, that
occurs from the fall months, especially along the coast, and the
early period at which the reaction and advance to spring is
commenced. Indeed the mean of the coldest month of the three
stations of California, noted for a period of years, does not reach

the point at which frost is constantly formed 47o.04, being the

mean for four years observation of January at Fort Miller.

The greatest decline of temperature at San Diego, occurs dur-
ing the passage from October to December, which last having
been reached, the re-action commences and gradually increases
to the spring season. At San Francisco, the period of greatest
decline is from November to January, after the passage of
which, commences the advance to the spring months. But at
the interior post, Fort Defiance, the period of greatest decline
commences at September, and ends with the month of Jan-
uary, after that begins the advance to spring.

A few questions here suggest themselves, which perhaps
would be neither unprofitable nor uninteresting to ask. "Why
should the period of decline be longer at the interior, than at
the coast? And why should the period of decline at San Fran-
cisco, although farther northward, be postponed later than that
of San Diego ? And again, why do these periods of greatest
decline on the coast, occur at this time, and not later in the cold
season ? The first may be readily answered, by a reference
to those agents, which are at work along the coast, to preserve
an elevation of temperature, namely, the existence of the dry
season, with its higher temperatures during the months of
August and September. To the second, we reply that, in
consequence of the fact that the highest temperature of the dry
season is not reached at the former, until September, the period

456 Doughty. An Essay on the Adaptation of [July,

of greatest decline must be postponed at least one month later
than at the latter, where the highest temperature, (monthly
mean), is observed in August. The third query also, finds its
solution in the peculiarities of the coast climates. It will be
remembered, that the dry season here continues from May to
October, and the wet from October to May. During the con-
tinuance of the first, the prevalence of cold masses of water off
the coast is observed, more potent in their influence at San
Francisco and Monterey ; and during the second, warmer
masses of water are circulating in their stead. Now, it is at
this particular time, that the shifting and replacing of these
waters are taking place, so that a neutral influence is exerted
by them upon the shore climate, which leaves the latter more
subject to those atmospherical changes, which are taking place
every where upon the continent. And as the progress through
the winter is made, the warm > waters exercise an increasing
influence upon those land climates, for the prevention of an
extreme declination during the first winter months, and the
subsequent elevation of temperature of the others.

2d. The extreme Monthly Observations.

December.

January.

San Diego, California,

San Francisco, "

Fort Miller, CI

Fort Defiance, New Mexico.

74. 0 |29.0
71. 0 I2SQ.0
72*\00:2sr'.o
65. 0 6.0

45. 0
43. 0
44. 0
59.0

80. 0
69". 0
6S0.O
55^.0

81".0 49o.0

25\0,44<:>.0
23.0 45.0

75". 0 34. 0

84. 0 130". 0

74. 0 132. 0

56. 0 I 2.0

41. 0
54^.0
42. 0
54rt.O

The mean possible range of the thermometer for the entire
season, is at San Diego, 45.00 ; at San Francisco, 45.33 ; at
Fort Miller, 43.66 ; and at Fort Defiance, 62.66.

The coast stations under their present exhibition, show a
comparative freedom from great monthly extremes ; the lowest
observed point for five years at San Diego, being 29.00, which
occurred in the month of December ; that, at San Francisco, was
25. 00 which occurred in the month of January. Even at Fort
Miller, this avoidance of great extremes of temperature is still to
be seen, for the coldest month (January,) was found in three years,
to show a fluctuation in the thermometer of only forty -five degrees

1859.] Climate to the Consumptive, &c. 457

(45) ; the highest attained point being 68, and the lowest 23 .
It may appear somewhat strange, if not paradoxical, to state that
these coast stations show a relative freedom from thermometrical
extremes, and at the same time, show the extreme fluctuation
in degrees for the season, to be on an average at San Diego,
forty-five degrees (45), and at San Francisco, forty-five and thir-
ty-three hundreths degrees (45.33). In answer to this, we remark
that it is not our object to bring forth such thermometrical con-
ditions of these localities, with the view of increasing positively
their climatic conditions in the estimation of the profession, but
to show them in the worst possible light, so that, that enhance-
ment, if it occurs at all, will occur negatively ; and also for the
purpose of future comparison. Moreover, if we allow the record
as it stands, it will support itself, for if we compare them with
similar observations in the interior, or even in the Atlantic
plain, they speak volumes for these places. At Fort Defiance,
the fluctuation for January is 75.00, and the mean possible
range for the season is 62.66. Fort Brooke, Tampa Bay,
Florida, notwithstanding its situation many degrees of lati-
tude farther south, during three or more years of observation,
gave 48 as the greatest possible range of the thermometer for
the month of December ; 50, as that of January ; and 36, as
that of February, thus making the average for the season 44.50 :
thereby showing greater monthly ranges of the thermometer
and extremes of temperature, during the months of December
and January, than occurred at any of the western stations,
which we have selected, except Fort Defiance. The same may
be said of St Augustine,* on the eastern side of the Peninsula,
whose monthly extremes and ranges of the thermometer, are
even greater than at Fort Brooke, the mean possible range for
the season being 49.33.f Again, during three years observa-
tions at Augusta Arsenal, the greatest possible range of the
thermometer for December, was 58 ; that of January, 58 ;

* The observations were taken at Fort Marion, and may be found in th
Army Meteorological Register.

\ A previous reference has already been made to the diurnal fluctuations
of this State, in a quotation from Dr. Kitchen, where a fall of 46
took place in twelve hours, on another occasion, 38 in the same length of time,
and on another, in which there was a depression of 20 in one hour.

458 Doughty. An Essay on the Adaptation of [July,

and the same for February. It is needless to enter into the
more minute comparison of this, with the coast stations un-
der consideration, as the bare mention of these observations
will suffice to render clear the superiority of the latter. We
have selected these three points on the eastern slope, because of
their southern position, and their freedom from those structu-
ral conformations, which individualize the meteorology of many
localities.

3d. The general range of the Mean Temperatures for the winter.

San Diego, California,..
San Francisco, "
Fort Miller, "

Fort Defiance, N. Mex..

December.

January.

Febrdart.

MEAN TEMPERATURES.

High'tiLow'sti Range] High't

53. 52 '48. 69
520. 03 [50. 09
49.10|46o.41
320. 03 1 27. 72

40.83:530.78
lo.94 51o.00
2.69 49Q.75
40.31 29. 47

Low't
50o.ll
470.93
430. 60
240.35

Range

"30767

30.07

6.15

50.12

High't

550.76
540.99
550.74
330.62

Low't

500.30
49. 91
49o.57
280.06

Range

5. 46
5. 08
6.17
5.56

Mean

Range

for the

Seas'n

"40^65

3o.36

50.OO

40.99

Having given the highest and lowest points reached by the
thermometer at each of these places, on a preceding page, the
relatively great uniformity of the mean temperatures of the
winter months, and the high degree of those temperatures, fur-
ther appear from this table. Neither of the coast stations pre-
sent even as their lowest monthly mean temperature, a stand as
low as the point at which frost is commonly formed. The very
lowest recorded is 47.93, in the month of January, at San
Francisco, a degree of temperature not sufficient for the produc-
tion of the lightest frosts. On the other hand, neither of them
show a very high mean temperature at this season, for the very
highest is 55.76, for the month ol February at San Diego.

Turning our attention to the interior post, Fort Defiance, not-
withstanding a considerable increase in the degree of coldness is
found, yet irregularity and total want of uniformity of its month-
ly mean temperatures, cannot be said to characterize the win-
ter, as was found to be true of other seasons, as the spring and
fall. For its extremity of cold being reached, the thermometer
would appear to remain there until the season closes, since
slight differences exist between the highest mean temperatures,
and also between the lowest. We may remark, that as the
lowest mean monthly indications at San Diego and San Fran-
cisco, did not reach the point at which frost is constantly formed,

1859.] Climate to the Consumptive, &c. 459

so the highest at this post, barely exceeded the freezing point,
so that the formation of ice at Fort Defiance, is a constant me-
teorological phenomenon during this season.

Again, the features, which we mentioned above as having
been established by this general range of their mean temperatures,
namely, the relatively great uniformity, and the high degree of
the monthly mean temperatures of the coast, are subjects of great
and abiding interest to one in search of a consumptive sanitarium,
for these conditions are, in fact, the foundations upon which
have been based much of the speculation as to southern emigra-
tion in the winter, and many of the attempts that have had
their origin in such speculation. Although much has been said
by us about the climate of the western coast, perhaps sufficient
to cause the approval of a number of our readers, yet we pro-
pose to elucidate still farther, the value of its meteorological
characters, by comparing them with similar ones of places on or
about the same parallels in the Atlantic plain, and along the
eastern coast, hoping thereby to secure the acquiescence of the
more sceptical, and to increase our own appreciation of it. We
have selected for this purpose, the Army posts at Augusta Ar-
senal, Georgia, and Fort Monroe, Virginia.

December. January. February.

I Mean
MEAN TEMPERATURES. Range

I for the
High'tjLow't IRangejHigh't'Low't : Range 'High'tlLow't [Range I
Aug. Arsenal, Ga.,(18y's) 57\16 87A.23!l^93l54o.41j39o.24li^l7!62^3!89T60;22oT43 -10.17
Fort Monroe, VaM (30 " )|51o.79,2So.97l22o.82i49g.71132Q.93|16o.78i53(>.51|81Q.95|2lQ.56l20t>.33

Perhaps the justice of this comparison may be sought to be
impeached by the greater length of the period of observation at
these posts, than at the others, and while we deprecate the limi-
ted number and extent at the western or Pacific stations, still
we think that the length of time embraced by them, is sufficient-
ly extended, to justify us in assuming their general temperature
conditions well exemplified, by the record of six years. Never-
theless it is true, that a longer period of observation might show
some increase or diminution from the recorded figures. But, on
the other hand, as their temperature condition is principally de-
termined by the action of certain physical agents, constant in
their operation, we may regard them as less likely to suffer
those material changes which would otherwise befall them.

460 Doughty. An Essay on the Adaptation of [July,

Proceeding to the comparison, we perceive at a glance -Aa.
the greater extent and fluctuation of the monthly mean tempera-
tures of the Atlantic posts, when contrasted with those of the
Pacific. Augusta Arsenal has four times the possible range in
its mean temperatures for the month of December, that San
Diego has for the same month, and ten times that of San Fran-
cisco. During the month of January, its range may exceed
that of San Diego, for the same period, more than four times ;
and is more than five times that of San Francisco. During
February, it has four times the range of San Diego, for the same
month ; and nearly five times that of San Francisco. Its mean
range of the monthly mean temperatures for the entire season,
is more than four times that of San Diego, and nearly six
times that of San Francisco. Comparing the extent of the fluc-
tuation of the mean temperatures of Fort Monroe, with those of
San Diego and San Francisco, we find four and a half times the
range of the former, and about nearly twelve times that of the
latter, for the month of December. For January, it is four times
the former, and more than five times that of the latter. And
for February, it is more than four times the range at both of
these places. Furthermore, the mean range for the season at
Fort Monroe, exceeds that at San Diego, nearly five times, and
is more than six times that of San Francisco. If now we extend
the comparison to the interior posts of the Pacific slope, which
are the most rigid in their climatic features, we find much less
irregularity in this respect, than is observed at the Atlantic
posts.

Upon inspecting the temperature data of the eastern posts,
we are readily impressed with the extensive differences, that
may exist in regard to the position of the mean temperatures,
both of the individual months, and of the entire season. For
the high indication of one j^ear or season spent there, affords no
guarantee of a similar degree of temperature, at a future period ;
and the same may be said of the individual months, for the
highest and lowest mean temperatures, given in the table, show,
that from fifteen to twenty -two degrees of fluctuation may
characterize the difference between succeeding months of the
same season, or the same months in successive seasons. To
express it in a different way, a resident of either of the eastern

1859.] Climate to the Consumptive, etc. 461

stations, who is subjected this year to a mean temperature in
December, of 57.16, may the next, experience a mean of 37.23,
in the same month ; or under similar circumstances for Janu-
ary, may experience a temperature of 49.71, and then one of
32.93 ; or under similar circumstances, February of one year
may have a mean of 62.03, and the next, one of 39.60.
Thus at such places, while during one season, the mean ther-
mometrical indication may range far above the frost point; dur-
ing the next, water would be kept constantly upon the point, of
freezing. We conclude therefore, that, whilst irregularity of
temperature condition, and alternations of high winter means
with low ones, showing their unsettled and variable nature,
characterize the Atlantic posts,* the opposite may be legitimate-
ly claimed for the Pacific. For, taking the general range of
the means for the season at San Diego, it is only 4.65, and the
difference between the highest and lowest monthly mean tempera-
tures, during that season, is only 7.07. The same observed
at San Francisco, are still more favorable ; a constant range of
high mean temperatures, being at the same time observed. The
Very lowest at these posts is 47. 93. Hence, a person resid-
ing at either of these places, may calculate with some certainty
and security, upon a recurrence of similar or approximating
temperature conditions, for the next or any coming season.

4th. The Mean of the Maxima and Minima Observations.

| December. | January. | February.
ME AX OF THE Maxima and Minima Observations^

San Diego, California,

51. 50
49. 50
50. 00

35. 50

55. 50
47. 00
45. 50
37. 60

54. 50

San Francisco, "

57. 00

Fort Miller, "

53

Fort Defiance, New Mexico

29. 0o

If we will turn to the corresponding table for the fall season,
and bring it along side of this, much will be discerned to cause
our approval of the course of the thermometer along the coast.
TVe observe a gradual retreat from the higher temperatures of
the first fall months, particularly at San Francisco, to the be-
ginning of the wet season ; which decline in temperature is
owing to the departure of the sun from the northern hemis-

* The same is true of almost the entire slope, from Maine to Texas.

462 Doughty. An Essay on the Adaptation of [July,

pkere, and the continued operation of the sea-temperatures.
The progressive withdrawal of the influence of the former leaves
this coast, subject to the latter only, and those other forces,
which produce the declining temperature of the fall and winter
months in the continent generally. But very soon, another
difference of operating forces is experienced, for these sea-tem-
peratures are being supplanted by those of higher absolute
temperature, and as these last are gradually re-instated, a check is
placed upon the action of those other influences, which we have
referred to. And as this higher absolute temperature, assisted
by the sheltered position of the coast, and the general atmos-
pheric circulation, extends its influence inland, a decided re-ac-
tion occurs early, in the temperature of the winter months,
which re-action is shown by an increase of the mean of the
monthly maxima and minima at San Diego, during the second
month ; and at San Francisco, during the advance from the
second to the third. This re-action occurs later at San Francis-
co, because the action of the sea- temperatures of the dry season
is more intense, and is continued longer here than farther south-
ward ; but at the same time, the changes from month to month,
until the period of re-action, are more gradual and uniform, and
even after the re-action has commenced the rate of advance to
spring, is also more gradual and less abrupt, than where it com-
mences earliest. It may not be amiss to furnish the decline
from the early fall, to this stage of re-action. At San Francis-
co, as indicated by the mean of the maxima and minima obser-
vations, it is as follows : September, 68.50 ; October, 63.50 ;
November, 56.00 ; December, 49.50 ; January, 47.00 ; and
February, 57.00. At San Diego, as follows: September,
75.00; October, 71.50; November, 60.50; December, 51.50;
January, 55.50 ; and February, 54.50. The smaller and
more gradual rate of decline of the former, although farther
northward, is self-evident. Thus it appears, that during the
shifting of the waters off the coast, or during the supplanting
of the cold masses of the dry season, by the warm ones of the
wet, that the continental influences obtain a temporary ascen-
dency, but very soon these are counteracted by the increasing
intensity of action of the water temperatures.
5th. Winds and Weather During five years observation at

1859.] Climate to the Consumptive, &c. 463

San Diego, winds from east to west, inclusive, prevailed ; those
however, from the east and south-west, had the greatest preva-
lence, for the months of December and February. And during
a term of fonr years for the month of January, winds from
north-east to west, inclusive, prevailed ; those however, from
the north-east, east, and south-west, had the greatest preva-
lence.

At San Francisco, during three years observation for Decem-
ber, the, north-east and west winds had the greatest prevalence ;
but, taking the whole number of observations, the south and
west winds exceeded those from the north and east. During
January at this place, for two years, the north and east winds
prevailed ; those however, from the north and north-east, had
the greatest prevalence. Here again, the west and north-west
winds prevailed in February, although with the entire num-
ber of observations for the month, the south and west winds
greatly exceeded those from the north and east.

At Fort Miller, during four years observations for December,
winds from east to south-west, inclusive, prevailed ; those how-
ever, from the east and south-east had the greatest prevalence.
At this place in January, during three years observations, north
and east winds prevailed, although the east and south-east were,
taking the whole number of observations, oftenest observed.
Here again for February, during three years, winds from the east
and west had the greatest prevalence.

In reviewing the winds of this season at the coast stations,
we observe a confirmation of the intimation made by us, when
remarking upon those of the autumnal season, namely, that, as
the approach to winter was made, the continental winds would
be often er observed than in the other seasons, although those
from the south and west would still perhaps preserve a relative
ascendency. Thus at San Diego, we find that, notwithstanding
the north-east and east winds were frequently observed, yet
those from the south-west were as frequently observed. And
at San Francisco, that, notwithstanding winds from the north
and east were increased over the preceding season, still, taking
the whole number of observations, the south and west exceeded
them.

But at the interior post, Fort Defiance, no regularly marked

464 Doughty. An Essay on the Adaptation of [July,

feature of atmospheric circulation is indicated, for during four
years observation for December, winds from the west and
north had the greatest prevalence ; for January, winds
from the south-west and west ; and for February, those from
the south-west and north-west; thus manifesting no specific
circulation, but rather an accidental one, dependent doubtless
upon the configuration of the adjoining country, and its mountain
aspect, with their necessary interruptions of the regular course
of the winds.

In studying the method of circulation of the atmosphere of
any locality, in order to appreciate properly and fully its effects
upon its climate we must necessarily study the source of
its winds, and the regions over which they travel. Thus to
an inhabitant of the eastern plain of the United States, winds
from the north-east and north-west, although productive of cold,
would not only differ in the degree of that coldness, but would^
also produce essential differences in the hyetal, or rather hy-
grometric condition of the atmosphere, for the reason, that their
places of origin and the nature of the regions over which they
pass, would necessarily modify them. The north-west, having
its source about the Polar Basin, and its neighborhood of junc-
tion with the great Cordilleras, has in its course to cross com-
paratively little water, but has strictly a continental one, so that
nothing intervenes to modify the severity or degree of its cold-
ness. It must therefore appear to us, as a severely cold and
dry wind, the truth of which is evidenced in the rise of the bar-
ometer, and the fall of the thermometer. On the other hand,
the north-east having its source about the northern limit of the
Atlantic Ocean, and the west of Europe, has almost a continu-
ous tract of water over which to pass, and that water, as a gen-
eral thing of a high temperature, so that it becomes materially
modified, being rendered less extreme in coldness and more
moist, although the former condition is subsequently, partially
lost, in consequence of its passage over the cold currents along
the immediate coast, and by which it is rendered a cold and
moist wind, particularly at this season (winter). If now we turn
our attention to the western plateau, the reverse conditions
will be found to obtain. Here, the north-east wind, being strict-
ly continental in its origin and course; will have acquired to a

1859.]

Climate to the Consumptive

465

greater or less extent, the properties of the north-west of the
eastern plain. While the north-west wind, although having
its origin in the northern part of the Asiatic continent, yet has
in its pathway the northern part of the Pacific Ocean, by whose
warmth and moisture it becomes influenced, being rendered
less severe in degree of temperature and more moist. Now
applying the principles of their action to California, we perceive
that the north-east and north-west winds, would exert material
differences of effect upon its climate, from that which at first
glance might be carelessly thought. The latter would produce
a warm and comparatively moist condition, while the former
would produce a cold and dry state of the atmosphere. Indeed
if we examine still more closely into the effect of the north-west
wind, we will find that, in the absence of the cold northern or
arctic current which courses along the eastern shore of the Uni-
ted States, whose power to modify passing winds, we have
already recognised, the modification which it undergoes from
its passage over the Pacific waters, is much more favorable to
the climate of this western region, than is the north-east to the
opposite. For along the greater part of this coast, the waters of
the ocean, especially off the Californian coast, where it is even
higher than the land temperatures, is of a high temperature
during the winter season. So that winds from this quarter do
not necessarily exert a hurtful influence upon its climate. The
severest weather experienced in this State, would appear to be
induced by the north east wind.

Of the weather j we give the following summary.

December.

Jascaet.

Februabt.

=i

Q 1 J3

TJ

o

S3

m

*! C -

CO

-

o"

-

P

P

o

?

3

z

fc

=

O

^

<

~

--

VJ

"<

c

<

<

- Z

a

01

o

-

b

a

r

a

? 2

Q "5 < < <

San Diego, California,

19. S 11.2 7.4 0 ,21.0 10.0 3.25 0 117.0 11.2 7.6 0

San Francisco, u

16.3 14.6 11.8! 0 !16. 0 15.0 9.5 0

Fort MilUer, "

19.2 11.7 B.5 0 24.6 6.3 5

Fort Defiance, New Mexico

20.5 10.5, 1.0; 4.5.24.o| 7.0| 0 5.5 0.0.45

The respective mean for the entire season, is as follows :
San Diego, of fair days 19.26 cloudy 10.8 rainy 6.06
San Francisco, of " " 15.86 " 142 " 10.1

467 Doughty. An Essay on the Adaptation of [July,

Fort Miller, of " " 21.8 " 8.2 " 6.36

Fort Defiance, of f 22.33 " 7.66 " 0.5
and of snowy, 4.5.

Here we may remark, that, as the progress into winter is made
at the coast stations, the relative number of fair days diminishes,
although there are a greater number of this character than of
the others ; the proportion of cloudy and rainy days correspond-
ly increase. Taking the mean for the season, a larger propor-
tion of fair days is observed at the intermediate station, than
along the coast, and also a diminished number of cloudy days.
Passing further into the interior, we find a proportion of 22.33
fair days, and a diminution of the cloudy. The number of
rainy days here amounts to only 0.5. Another character, how-
ever, here imposes itself, namely, the days upon which a fall of
snow occurs, of which, there is a proportion of 4.5 per month.
Just here we may add, that no record, we believe, of the falling
of snow in California at the posts which we have selected, is
made during the entire period of observation.

6th. Rain in Inches at California and the Interior. During
five years observations at San Diego, for the month of Decem-
ber, the mean fall of rain in inches, is 3.06 ; for January, during
six years, 0.83 inches; and for February, during the same
period, 2.01 inches ; the resulting mean for the season is 5.98
inches. At San Francisco, the mean of three years for Decem-
ber, is 4.84 inches ; for January, 3.23 inches ; and for February,
3.31 inches the mean for the entire season is 11.38 inches.
The mean quantity at Fort Miller for December, is 5.34 inches ;
for January, 1.34 inches ; and for February, 1.69 inches the
mean for the season is 9.79 inches. At Fort Defiance, the
mean for December, is 1.09 inches ; for January, 1.00 inch ; and
for February, 0.88 inches the mean for the season is 2.97 inch-
es. During this season, the largest measurements of rain are
made at the coast stations, and perhaps the smallest at the
interior post ; the wet season being in existence along the coast,
-and the dry in the interior. A larger quantity falls at San
Francisco, than at San Diego ; indeed nearly double the quan-
tity, the mean of the season being as 11.38 to 5.98 inches.
But more than twice as much falls at San Diego, as at Fort De-
fiance.

1859.] Climate to the Consumptive^ <&c. 468

A Review of ike yearly Meteorological conditions of California
and the Interior. It is unnecessary for us to give in this connex-
ion, an exhibition of the mean temperatures of the individual
months or seasons, all of which have been made to appear inci-
dentally already. We shall therefore, confine ourselves to such
of its general features, as we may think proper to remark upon,
and give no tabular statistics. If however, we inspect a tabu-
lar representation of the monthly mean temperatures of the
coast stations of California, we will undoubtedly observe much
to awaken interest, and to excite our admiration of this feature
of its climatic condition. It has been elsewhere remarked, that
the seasons of the western slope, have been divided very con-
veniently into two grand seasons, the wet and dry. This division
is obviously founded upon the presence and absence of rain ; in
other words, it has a hygrometrical basis. Making a thermome-
trical basis, we may very appropriately divide its seasons, es-
pecially those of the coast of California, into that of an increase,
and of a decline of temperature. The period of increase embra-
ces three-fourths of the year ; that of decline, the remaining
fourth. At San Diego, the former occurs from December to
August; the latter from September to November. At San
Francisco, the first extends from January to September ; the
second from October to December. December at San Diego,
indicates the lowest monthly mean temperature, and the increase
from this to the highest monthly mean (August), is marked by
a very gradual and steady increase of temperature ; the aver-
age rate of increase being about 2.7o, of each month over its
preceding. The period of declination or retrocession, being
much shorter than that of increase or augmentation, the aver-
age rate of decline must necessarily be much greater, being
about 50.49" per month. At San Francisco, January is the cold-
est month, and the increase of heat from thence to September,
the highest monthly mean, although suffering two interruptions
or temporary declinations, is at the very gradual pace of 1.17
per month * The rate of decline is about double that of the

* The interruptions referred to, occur in the months of April and May,

and July and August; the mean of May being slightly below that of April, and

that of August slightly below that of July, although the next in order at the

respective periods, gives an increase over both of the preceding months; June

N. S. VOL. XV. VO. VII. 33

469 DOUGHTY. An Essay on the Adaptation of [July,

increase, i.e. 2.35, per month. Moreover, so little extremity is
observed here, that the mean annual range* of the monthly
mean temperatures, is at San Diego 21.98, and at San Francis-
co only 8.66.

Again, if we turn our attention to the interior post, Fort
Defiance, and examine its features of climate, by this thermome-
tric basis, it will be seen, as might be expected, that the rates
of increase and decline are very irregular. Furthermore the pe-
riod of increase here is shorter than upon the coast, being or con-
stituting only seven-twelths of the year, and the period of decline
which is consequently longer than that of the coast, embraces
the remaining five-twelfths. January shows the lowest monthly
mean temperature, and July, the highest. The average rate
of increase is about 7.28, and that of decline 8. 12. The mean
annual range of the monthly mean temperatures is 43. 70.

There is one fact connected with the tfaermometrical history of
the coast stations, which is so striking as to require mention,
namely, that the mean temperatures of every month of the year
at both stations, with the single exception of the month of Janu-
ary (49. 60), at San Francisco, are above 50 Fahr. It will also
be perceived, that at San Francisco, no month presents a mean
temperature higher than 60 Fahr. Even the lowest of the
monthly mean temperatures is far above the point at which frost
is formed, under the most favorable circumstances. On the other
hand, at Fort Defiance, there are records of monthly means ex-
tending from 26. 18, to within a small fraction of 70. the
range here, being from below the freezing point to summer heat.

The mean annual temperature of San Diego, is 62; that of
San Francisco, 54.88 ; that of Fort Miller, 66.08 ; and that
of Fort Defiance, 46.92. The greatest range of annual means
at San Diego, is 2.3 ; and that of Benicia,f California, 3.2.
The mean daily range of temperature "for the five warmer

being higher than Apvil and May ; and September, than July and August. The
great physical agents at work here, for the production of these phenomena, have
already been discussed.

* This is deduced from the highest and lowest monthly mean temperatures.

fThis post is "thirty miles north-east of San Francisco, with an ex-
posure over water surface and low plains in all directions, except north and
north-west, where there are protecting hills." Army Meteor. Reg.

1859.] Climate to the Consumptive, &c. 470

months, May to September," at San Francisco, for three years,
is 10.o ; and that of Fort Defiance, for the same length of time,
is 29.5.

At San Diego, during four years observations, the mean an-
nual number of fair days, is 235.5 ; of cloudy, 129.8 ; of rainy,
42.8. At San Francisco, during two years observation, the
mean number of fair days, is 182.5; of cloudy, 180; and of rainy,
68. At Fort Defiance, for two years, the mean number of fair
days is 304.5 ; of cloudy, 44; of rainy, 56; and of snowy, 19.

Thus at San Diego, the fair days exceed greatly both the
cloudy and rainy, and also the number of fair days at San
Francisco. The proportion of cloudy days is about three times
that of the rainy. At San Francisco, the mean number of fair
and cloudy days, is about the same, although there are more
than two and a half times the proportion of rainy days. But,
at Fort Defiance, we observe the largest proportion of fair
days, and the smallest of cloudy, although there is a super-ad-
dition of snowy days.

The mean annual quantity of rain that falls at San Diego, is
10.43 inches; at San Francisco, 23.59 inches; and at Fort De-
fiance, 16.64 inches.

The course of the atmospherical circulation at these places,
has been shown, while considering the seasons individually.
Winds from south to west inclusive, have a predominance over
all others, although the north-west wrind is frequently recorded
at San Francisco. " The rains of this best known portion of
the Pacific coast," says Mr. Blodget, "are, as has been said,
peculiar in regard to the attending winds, wrhich from San
Diego to Puget's Sound, are in nearly all cases from the south-
east and south with a strong and steady force. There are also,
simply attendant winds, and not those which may be said to
bring the rains the course of the clouds above the local or sur-
face wind, being quite regular from the wrest. But no sooner
is precipitation begun, than the attendant south-east wind sets in,
to be continued steadily to the end of the rain in most cas
11 The direction of the wind is apparently dependent on the
trend of the coast, and the mountain ranges near it, and where
these are from south to north quite directly, the wind is nearly
from the south. r*
* See Blodget's Climatology of the United States, page 194.

471 Santonine in Verminous Affections. [Jutyj

Finally, any strict regularity of atmospherical circulation is
prevented at the interior post, because of its particular confor-
mation and its altitude.

[to be continued.]

Santonine in Verminous Affections.* (Translated from the Jour-
nal de Medecine et de Chirurgie Pratiques, for the Southern
Medical and Surgical Journal.) By William Farell, M. D.,
of Rome, Ga.

Notwithstanding the great importance once attached to worms,
in the production of diseases in children, it has been contended
that these parasites had no agency in causing the morbid phe-
nomena formerly attributed to their presence in the alimentary
canal. In 1830, M. Guersant here declared, that worms were,
by no means, so dangerous as usually supposed, and that con-
vulsions rarely ever depended upon their presence. He farther
informs us, that, during his long practice, he had met with but
one case, in which death could be legitimately attributed to the
existence of worms ; this was a child in which a couple of these
parasites seven or eight inches long, had become impacted in the
biliary ducts.

At present however, authors are re-establishing verminous
affections. M. Legendre, a regular physician, published an in-
teresting work three years ago in which he demonstrates in a
decided manner, that the taenia gives rise to convulsive affections.
Every body knows that ascarides are extremely annoying in
passing from the rectum to vagina, etc. ; but as the lumbrici are
deprived of teeth and other offending weapons, we are amused
at the pretended aggressions of this class. Our object, however,
is not to treat this subject lightly or critically, but to consider
some of its more practical details, as recently developed.

M. Buchut, believes that he has employed anthelmintic medica-
tion with the most happy results in many cases of digestive
troubles, depending upon obscure causes. He has had recently
under treatment a child four years old, of cachectic habit and

* The above valuable paper has been in our hands some months, but was
crowded out for want of space in our original department. [Edts.

1859.] Pantonine in Verminous Affections. 472

bloated condition without albuminuria, suffering from great dis-
order of the stomach and bowels, characterized by vomiting and
diarrhoea. This little patient having discharged a worm one day,
he took advantage of the apparent indication by prescribing 20
centigrammes (3.0860 grains) of santonine. The next day,
while at stool, the patient discharged a lumbrics followed by the
expulsion of two more, during the day, without faecal discharge ;
treatment continued. The third day, another lumbric was expell-
ed ; the fourth, two others, &c, in all, ten lumbrics. Under this
treatment the vomiting and diarrhoea were promptly arrested.

M. Buchut had a similar case under treatment last year. This
was a little girl suffering with repeated vomiting from an unknown
cause. The pupils were dilated, an insufficient indication of the
existence of worms. A lumbric, having been discharged however,
he determined to employ santonine. As the patient was quite
young, he administered but 5 centigrammes (.7715 of a grain) of
this powder. The next day she discharged thirty-one lumbrics
of different sizes, matted together, and unattended by faecal dis-
charge. The third day, eight more were expelled, and subse-
quently, five at one time, and six at another ; in all, fifty-one lum-
brics. The obstinate vomiting disappeared under the treatment
as by magic.

The morbid phenomena produced by worms are of two orders.
There are the phenomena of local irritation, depending upon the
direct action of the entozoa, and the reflex phenomena, or phe-
nomena of sympathetic irritation. The latter have been mostly
denied or contested. In the cases above cited, there was simply
local irritation, giving rise to diarrhoea and vomiting; but the
annals of science are filled with facts, which equally prove, that
the presence of ascarides lumbricoides in the alimentary canal, give
rise to many serious nervous disorders. Do we not frequently meet
with chorea, nervous cough, catalepsy, and even epilepsy, having
no other cause, and readily yielding to vermifuge treatment ?

M. Buchut has seen, in his practice, a young man of twenty-
two years, who was suddenly attacked with lassitude, cephalalgia,
and free epistaxis, followed by heat of the skin and accelerated
pulse. It was announced that the patient had typhoid fever in
its early stage. Under this belief, an emetic was prescribed,
which caused him to vomit a lumbric ; on the following day

473 Santonine in Verminous Affections. [July*

similar occurrences ; on the third day he was perfectly well. This
fact, with many others, which are not mere coincidences, seem to
prove, that the ascarides lumbricoides, though destitute of offensive
weapons, act as foreign bodies, easily tolerated by some, but im-
patiently borne by others, according to idiosyncrasy, and that
they are capable of producing phenomena of sympathetic reaction
as well as phenomena of local irritation. The above facts being
well established, the important indication is to expel the lumbrics.

M. Buchut has experimented in this particular, with all the
most important vermifuges, employed from time immemorial,
and the result is, that semen cantra appears to him to be the best
anthelmintic ever used, and as chemistry has succeeded in extract-
ing the active principle of this article, an alkaloid appropriately
termed santonine, he gives preference to this substance over all
others of the class.

Santonine, though slightly bitter, is readily administered when
mixed with an equal quantity of sugar or with syrup. It may
also be incorporated in gum-drops, lozenges, or candy. The last
form, however, has the inconvenience of being liable to be at-
tended with errors in the hands of common people. It is better
therefore to use the powder, accurately weighed out in proportion
to the age of each patient.

M. Buchut prescribes this powder in the dose of 5 centigrammes
(| of a grain nearly) for each year of the child's age. For in-
stance, the first little patient above cited was four years and six
months old, she took therefore from 24 to 25 centigrammes per
day, (equal to about 3f grains).

As the stomach might not tolerate this amount if taken at once
it should be divided into four powders, to be administered at regular
intervals through the day, in a little sugar or syrup.

On the Employment of Iodide of Sodium. By Alexander Ure,
Esq., F. R. C. S., Surgeon to St. Mary's Hospital, and Lec-
turer on Clinical Surgery.

I submit to the profession the following observations respecting
medicines, which will, I trust be found useful in practice. Iodide
of sodium is met with in the ashes of sea- weed and of various
plants which grow on the sea-shore. To this source may be

1859.] Employment of Iodide of Sodium. 474

reasonably ascribed the belief entertained in the healing virtues
of sea-weed by inhabitants of the coast in different parts of the
globe. Professor Laycock, in an ingenious address which he
delivered at the pharmaceutical meeting in Edinburgh last No-
vember, and which is published in the " Pharmaceutic Journal"
of the month following, states that " in the pampas of South
America, where goitre is prevalent, the remedy, a so-called goitre-
stick, is nothing more than the thick stem of a sea-weed." Mr.
Cooper, in his "Surgical Dictionary," recommends for some
scrofulous affections the use of poultices of sea-weed.

Iodide of sodium, as a therapeutic agent, is and ought to be
more active than iodide of potassium, since it is richer in iodide.
According to Gmelin, iodide of sodium contains 84*45 parts of
iodine in the hundred, while iodide of potassium contains but74'27,
the portion of sodium, though small, being still sufficient to cover
the irritative quality of its associate.

As far as my experience goes, iodide of sodium is a blander
salt, more assimilable, and better borne by the stomach, than iodide
of potassium. It is, moreover, much less prone to produce symp-
toms of iodic disturbance. Patients under my care have taken
it steadily for weeks together, without suffering the slightest in-
convenience, and with uniform advantage as regarded the morbid
condition. On no occasion, save one, has there been any com-
plaint made of this medicine producing sense of weight or uneasi-
ness referred to the stomach, nausea, impaired appetite and digest-
ion, headache, running from the eyes and nostrils, general nervous
depression symptoms which at. times supervene during the ad-
ministration of iodide of potassium, even in moderate doses. The
instance in question was that of a puny, scrofulous boy, with
disease in both knee-joints.

As a general rule, the preparations of soda are milder in their
operation on the system than those of potash. If, moreover, the
important view, first announced by M. Dumas in the 92nd volume
of the " Annales de Chimie," be accepted, that there are certain
salts which leave the blood the faculty of becoming arterialized,
while others deprive it of this property, and that the salts having
soda for their base are more proper to maintain this condition of
integrity than those of potash or ammonia, it may be fairly assum-
ed that the former are likely to exercise a more favorable reme-
dial influence than the latter, especially if exhibited continuously
for a length of time. Soda, variously combined, is diffused exten-
sively throughout the organism ; fully five-sixths of the saline
constituents of healthy blood consists of salts of this base.

Iodide of sodium may be prescribed in all cases in which the
employment of iodide of potassium is indicated, as antidotal to
various constitutional symptoms of syphilis, chiefly of the so-call-
ed tertiary group, and where mercury has been properly used

475 Employment of Iodide of Sodium. [July,

beforehand ; in certain forms of rheumatism ; in chronic affections
of the joints and bones of a scrofulous character, particularly
where a stealthy inflammatory process had determined copious
fibro-plastic depositions or hypertrophy. If judiciously adminis-
tered, it may be given* in progressively-increasing doses, where
it is desirable to produce a decided alterative effect on the system.
M. Gamberini has furnished a brief notice respcting its use in
the volume Schmidt's " Jahrbucher" for 1858. Reference is
made to 116 cases of constitutional syphilis in which it had been
exhibited, and where it was found to have acted more rapidly
than iodide of potassium, and often proved efficatious where the
latter drug bad been of little or no avail. It is there recommend-
ed to be given as follows : One scruple is to be dissolved in three
ounces of distilled water, and this is to be swallowed in divided
doses in the course of the day. After the lapse of two or three
days, the above amount is to be augmented by the addition of
six grains ; and so on until eventually the patient comes to take
two drachms, or even more, of the salt daily ; the time for taking
each dose being an hour before meals.

Hitherto I have usually prescribed the iodide of sodium to the
extent of five or six grains twice or thrice daily, dissolved in four
ounces of compound decoction of sarsaparilla, which forms a con-
venient vehicle ; occasionally, in pure water, with the addition
of five grains of bicarbonate of soda to each dose ; this serves to
counteract acessancy, and the consequent liberation of hydriodic
acid in the stomach, which is sure to cause headache. In scrofu-
lous complaints, I have given it combined with cod-liver oil, and
with manifest benefit. A remarkable and unexpected effect was
observed in one instance under this treatment for diseased bone,
where a marked improvement of sight ensued from diminution of
a nebulous condition of the cornea. In constitutional syphilis, I
have found it advantageous occasionally to conjoin the use of the
iodide with that of bichloride of mercury, should mercury have
been previously withheld, or imperfectly introduced into the
patient's system.

As a. general rule, the iodide ought to be administered in plenty
of liquid, and not on an empty stomach, as suggested by the above
writer. It is readily soluble in water, has a cooling saline taste,
certainly preferable to that of potassium compound, and by no
means equally persistent in the throat.

Subjoined are the notes of one of the several cases in which
this medicine has been employed by me. Reports of others, still
under treatment, will be duly communicated:

G. W , aged twenty-eight, a footman, was admitted into

St. Mary's Hospital, under my care, on the 15th November,
1856. He was a wan, emaciated, cachectic-looking man. He
complained of pain, referred to the large joints, and of aching in

1859.] Employment of Iodide of Sodium. 476

the back and loins. He was disfigured by patches of rupia, scat-
tered over different parts of the surface ; thus on the right side of
the nose, at the junction of the nasal bone with the cartilage, was
a dark, oval scab, overlying a sore, the size gf a shilling, and which
seemed, as it were, eating its way into the nostrils ; on the tragus
of the right ear was a similar scab, as also over the right eyebrow ;
on the scalp there were several scabs of the same character ; on
the right arm was a prominent, hardened scab, and another over
the left wrist ; behind the inner ankle of the left foot was a round,
excavated sore, of a dusky-red hue, the sequel or inflammation
of the corial tissue. Each scab had been preceded by the forma-
tion of a small vesicle of a punctuate character. This eruption
was of a month's standing. He suffered besides from an affection
of the throat, of three weeks' duration, and which caused great
distress in swallowing. On exanination, it was ascertained that
there was a deep oval ulcer in the left tonsil, covered with greyish-
yellow film, and a similar sore in the mucous membrane of the
back of the pharynx. He had enjoyed good health until five
weeks preceding his admission, when he had an attack of rheu-
matism, and for which he was successfully treated in this hospital.
He denied ever having had any venereal malady ; had been mar-
ried fourteen months, and was the father of a healthy child.

Nov. 18th. After the scabs had been softened and partially
detached by the application of wet lint, I directed the different
spots to be touched with nitric acid ; the sores in the throat to
be swabbed daily with dilute hydrochloric acid; and the patient
to take five grains of iodide of sodium in four ounces of compound
decoction of sarsaparilla, thrice every day. Ordinary diet.

25th. Was improved in all respects, more particularly as re-
garded appetite.

29th. General amendment ; sores in the throat were much re-
duced in size.

Dec. 3rd. Nitric acid was applied to the crusts on the scalp.

6th. The ulcer of the tonsil was healed, and that at the back
of the pharynx nearly so.

8th. The sore on the nose was making favorable progress
under the use of water-dressing; the rupia scabs were all disap-
pearing, and there was manifest improvement of the general
health. The patient was ordered to have a warm bath twice a
week.

15th. The throat was quite well; the sore on the nose, and
that near the ankle, were completely cicatrized ; the rupia was
extinct. The patient had evidently gained in flesh and strength ;
his cheeks were plump, his complexion was florid, and he was
perfectly free from pain in the back, loins, or joints. He was
discharged cured on the 24th of December, 1858, after a sojourn
of thirty-nine days in the hospital.

n. s. vol. xv. NO. VII. 84

477 Lecture on Tetanus. [July,

Nothing could be more satisfactory than the result of treatment
in this instance, which was simply that of uninterrupted progress
to recovery. The case was one of the eroding variety of rupia,
termed by some writers rupia escharotica and which is occasional-
ly witnessed in the persons of those who have been affected with
the constitutional symptoms of syphilis. The man, at the time
of his admission, was in a deplorable state of health; his throat
was the seat of foul ulcers, one side of his nose was on the verge
of mutilation, his body was racked with pain, his countenance
marred by an unsightly eruption. After the lapse of about five
weeks, he had regained his wonted health, and returned home
without any appreciable trace of the disfiguring malady for which
he had sought relief within the walls of an hospital.

\_London Lancet.

Clinical Lecture on Tetanus. Delivered at University College
Hospital. By John Erichsen, Esq., Surgeon to the Hospital

Gentlemen : The case to which I wish to direct your attention
to-day, and to which I propose to append some remarks on the

subject of tetanus, is that of a boy named B , aged thirteen,

who was admitted into this hospital on the 12th of December last,
on account of sacro-iliac disease. I shall defer any observations
which I may have to make on the affection for which he came
to us until a future day, when this case will be taken in conjunc-
tion with other cases of sacro-iliac disease. But this case is of
more special interest, inasmuch as, while here, the boy was seized
with symptoms of tetanus, and eventually died of that affection.

The following are some of the leading facts of the case: The
boy, who appeared healthy and well nourished, and did not seern
to labour under any congenital or constitutional predisposition to
disease, became affected six weeks before admission, with symp-
toms of sacro-iliac disease. On admission, nothing unusual present-
ed itself in the symptoms, and our diagnosis was made at once.
In the ordinary course of treatment, an issue was made, by means
of potassa fusa, over the back of the articulation, in the usual
way. After the separation of the slough (about the fifth or sixth
day,) a couple of issue-beads were applied to the ulcerated surface,
in order to keep it open and cause a discharge. So far, there
was nothing to lead us to suspect the coming evil. On Dec. 24th,
the report states that the patient had some stiffness about the
jaws, and inability to separate them ; there was also some com-
mencing tension about the sterno-mastoid, and some spasmodic
action of the muscles of the neck : in fact, on the 24th he was
seized with symptoms of the invasion of tetanus. These symp-

1859.] Lecture on Tetanus. 478

toms increased, the muscles of the trunk and extremities became
convulsed, symptoms of suffocation appeared, and he died on the
morning of the 28th, in a fit of tetanic spasm, notwithstanding
the treatment adopted.

Now, such an occurrence as this is, I need scarcely say, most
appalling. A patient suffering merely from a local affection, with
constitution unaffected, has an issue inserted in the ordinary
course of treatment, and in a few days gets, as the result of that
issue (and unquestionably it is the result of the issue,) a disease
of which he speedily dies. Such an occurrence would indeed be
as remarkable as it really is mysterious, were it not that similar
ones are by no means infrequent. In fact, surgeons have learned
to look upon tetanus as one of those affections which necessarily
give rise to an appreciable percentage of deaths in patients suffer-
ing from injuries or operations.

With regard to the disease which destroyed the life of this
patient, viz,, tetanus, I shall say nothing concerning the symptoms,
because they exhibited nothing peculiar; but I intend to pass in re-
view a few points connected with its cause, its nature, and its
treatment.

1. Cause. Individuals may, doubtless, be seized with tetanus,
although not having any breach of surface; but, in the vast ma-
jority of cases, the affection comes on as the result of wounds of
some description, and these, very generally, wounds of a trivial
character. Thus it does not so commonly follow compound frac-
tures of the thigh or leg, as it does minor injuries of the extremi-
ties ; nor is it so frequent after amputations, resection of joints,
or the removal of large tumors, as it is after many minor opera-
tions ; so that it may be looked upon as most commonly resulting
from minor surgical injuries and operations. On looking over a
list of the cases which have been under my care in this hospital,
I find that, in not one has tetanus come on as the result of the
major operations, or more severe accidents, but such injuries as
punctures, and compound fracture of the fingers or foot, lacerated
wound over the wrist, or a burn on the trunk, are amongst the in-
juries giving rise to it. So far as operations are concerned, al-
though it may certainly occur after the major operations, it has
generally followed such operations as those for varicocele, fistula
in ano, ligature of piles. &c, all of which are quite as liable, if not
more so, to be followed by tetanus, as the severest operations in
surgery.

With regard to the general causes of tetanus, it is no doubt
predisposed to greatly by the season of the year, and by epidemic
constitution. At those periods and seasons when there are
great alterations of temperature when hot days are succeeded by
cold nights tetanus becomes frequent. In hospital practice there
may be no case for months, then several may occur in rapid sue-

479 Lecture on Tetanus. [July,

cession. The week before this boy died, I saw, not a quarter of
a mile from this hospital, another case which also ended fatally.
The circumstances in which the patient is placed, exercise great
influence ; it may occur ia the old as in the young, in the weakly
as well as in the robust. So far as my experience goes, it is more
frequent among young adults and elderly people than at the mid-
dle period of life; more frequent amongst the weakly than the
robust. Indeed, when a person apparently in robust health is
attacked, it will generally be found that, previously to the super-
vention of tetanus, he has been subjected to some depressing in-
fluence has been out of health in some way, and has lost tone
and vigour.

One of the most important causes of tetanus, especially in mili-
tary surgery, and, probably, a notunfrequentone in civil practice,
is exposure to alterations of temperature and currents of cold air.
Hennen states that this was the most frequent cause of tetanus
amongst the wounded in the Peninsular War. Larrey observed
the same in Napoleon's campaigns. After the battle of Bautzen,
a large number of wounded were left upon the field, exposed to
the cold night air. Next day a considerable proportion were
found to be affected with tetanus. After the battle of Dresden,
the same thing was observed ; while after Moskowa, where the
night was warm, although the number of wounded was immense,
the proportion of tetanic cases was very small. In our Indian
campaignes, at Chillianwallah, and at Ferozepore, the wounded,
after severe exertion under a burning sun, were left exposed
during an exceedingly cold night, and according to Dr. McLeod,
in a very interesting work called Notes of the Surgery of the Cri-
mean War, which I can strongly recommend for your perusal,
the result was a large number of cases of tetanus. M. Baudens,
again, the chief surgeon to the French army in Algeria, noticed,
that out of a small number of wounded placed in a corridor
through which played a draught of cold air, a large proportion
were seized with tetanus in a single night. All this points to the
importance of our not allowing wounded or operated patients to
be exposed to draughts of cold air.

The number of cases of tetanus in proportion to the number of
wounded varies in civil and military practice, and in different
climates, &c. JVir. Rutherford Alcock, who accompanied General
Evan's expedition into Spain about twenty-five years ago, gives
the proportion of tetanus to wounded as 1 to 79. Sir J. M'Grigor
in the Peninsular war, found it to be 1 to 200 ; and in the Schles-
wig-Holstein campaign it was, according to Stromeyer, 1 to 350.
In the Crimea, so far as we can judge by official returns, the
proportion of tetanic cases was very small. These discrepan-
cies are no doubt due to the different conditions under which the
soldiers were placed. Thus, in the Crimea, being engaged prin-

1859.] Lecture on Tetanus, 480

cipally in siege operations, the wounded were not left exposed
during the night, but were removed at once, and put under cover ;
and in the Schleswig-Holstein war, each army being close to its
base of operations, could take adequate care of its wounded, who
therefore were not exposed to those conditions which military
surgeons recognize as the most potent causes of tetanus.

As I have already stated, the proportionate number of deaths
from tetanus varies widely in different climates. At Bombay,
according to Mr. Poland (who in a very able paper, has exhaust-
ed the statistics of tetanus,) it is 2.5 per cent, of all deaths; in
London, according to the Registrar-General's returns, 00.25 per
cent. This preponderance in Bombay is no doubt owing to the
heat of the climate; but it must be observed that the proportion
is not nearly so great amongst the Europeans there as are amongst
the natives.

The situation of wounds : has this any influence in determining
the occurrence of tetanus? It is a prevalent opinion, both
amongst non-professional and professional people, that wounds of
the hand, particularly those of the thumb, and, above all, those of
the web between the thumb and index finger, are more prone
to be followed by tetanus than wounds elsewhere. Whether this
be true or not, admits, I think, of great question. That the hands
are much more liable to injury, and are much more frequently
wounded, than other parts of the body is evident, and the absolute
number of cases following such injuries would therefore be ex-
pected to be greater ; but whether the relative number is greater
is questionable. On looking over my notes of eighteen cases of
tetanus which have come under my observation, and of which I
have kept a record, 1 find that in five of the eighteen the hand
was the seat of injury that is, a little more than one- fourth ; but
this, 1 should say, is about the proportion which injuries of the
hand, including those of the most trivial character, bear to inju-
ries of all other parts of the body.

2. Nature The exact nature of tetanus is an unsolved question.
Nothing appears more mysterious than an affection such as this,
which often seizes an otherwise apparently healthy person suffer-
ing from some slight injury, with the more violent convulsive
spasms terminating in death in three or four days, or in even less
time than that. We have to inquire into the condition of the
nervous system, on which such a disease as this is dependent.
On examining the brain and spinal cord, we find nothing special
to the affection no lesion which would enable the most experien-
ced pathologist to say that the person had died of tetanus. It is
true that we often find some congestion, or softening, as in this
case, just above the cauda equina, or a large amount of serosity
in the ventricles or subarachnoid space, which may be turbid or
bloody ; but all such appearances are common to other diseases

481 Lecture on Tetanus. [July?

besides tetanus, and none of them will enable us to assert the ex-
istence of tetanus during life. Look at the brain and spinal cord
before us. They are to all appearance perfectly healthy, with the
exception of some slight congestion, and a small softened patch
in the cord, just above the caude equina. They present no
special appearance, no sign by which the acutest pathologist could,
by any examination, anatomical or microscopical, say that they
came from a tetanic patient. Finding no structural lesion post
mortem, medical men have been in the habit of calling this, in
common with other diseases of which the exact cause is alike
unknown, a " functional disease." But the term " functional
disease" is only used as a cloak to ignorance; there is no such
thing as a functional disease, and the person who uses the expres-
sion merely means that he does not know the organic lesion on
which the disorder depends. Every function is the result
of the action of an organ ; every derangement of a func-
tion is the result of the derangement of the corresponding organ;
and no function can be deranged without previous or co-existing
derangement of the organ whose action constitutes the function.
As pathology advances, the class of " functional disorders" be-
comes less and less. We do not now hear of functional disorders
of the heart, lungs, or joints, because the pathological anatomy of
those parts being well understood, it is possible to refer their dis-
eases to the real cause. As the physiology and pathology of the
nervous system are not yet well ascertained, notwithstanding the
labours of such men as Marshall Hall and Brown Sequard, many
affections of that system are at present inexplicable, and "func-
tional" nervous disorders are very common. No surgeon speaks
of "functional" coma, because the particular cause (compression)
of the coma is well known and easily recognized ; but one still
hears of " functional" amaurosis, and tetanus is commonly spoken
of as afunctional disease. Amaurosis, when I was a student,
was looked upon almost solely as a " functional" disorder ; but
the introduction of the ophthalmoscope has shown that in most
cases where functional disease was formerly said to exist, there
is, in reality, some structural change in the nervous apparatus of
the eyeball appreciable by the naked eye. So it will be with
other affections as pathology advances, and disease hitherto
vaguely and loosely spoken of as functional will be found to de-
pend on organic changes as appreciable by the senses as are the
changes in an amaurotic retina and choroid.

Yet there is in traumatic tetanus, I believe, always a certain
condition of the nervous system to be met with, if carefully looked
for, namely, an unhealthy state of the nervous branch, or twig,
running from the wound. This twig will be found implicated in
some way congested, inflamed, infiltrated; its neurilemma
thickened," softened, and discolored, often for a considerable dis-

1859.] Lecture on Tetanus. 482

tance from the wound. I have never failed to find this when it
has been carefully looked for. In the present instance, a cutane-
ous branch was found lying bare and inflamed in the bottom of
the issue-wound. In many other cases I have seen the same.
Thus, in the case of a girl who had tetanus, consequent on a
small punctured wound on the inner side of the thigh near the
knee, a branch of the internal cutaneous nerve was found in this
condition. I have seen injury to the internal plantar nerve, by
treading on a rusty nail, followed by tetanus, and the nerve after
death found irritated and inflamed. A dorsal cutaneous nerve
was implicated in a case of tetanus following a slight burn on the
back, and the external cutaneous branches of the musculo-spiral
were affected as high as the bend of the elbow, in a patient who
died from tetanus following injury to the thumb. A similar con-
dition of these nerves was observed in a man with lacerated wound
over the wrist. These and other similar cases which have fallen
under my observation, clearly demonstrate, that although we may
fail in discovering any special lesion in the central nervous system,
yet that in most, and so far as my experience goes in all cases
in which the examination is carefully conducted, it will be found
that a nervous twig connected with the wound is irritated and in-
flamed ; and this seems to be the starting point for this so-called
functional disease. An organic lesion, not central, but peripheral,
still exists, as essential to the production of the affection.

3. Treatment. With regard to the treatment, I need say very
little, and that little is in no way satisfactory. The case we are
now considering followed the usual course of such attacks, begin-
ning with stiffness of the muscles supplied by the portio dura,
violent general spasms coming on in the course of twenty four
hours, and death occurring between the fourth and fifth day.
More than half the cases of tetanus die before, or on the fifth day
from the commencement of the spasms. If the patient survive
that time, the symptoms tend to become milder, the disease may-
wear itself out, and recovery follow. I have seen death occur
in less than thirty hours, and as late as the twentieth day ; so that
the fact of the attack being very chronic is no proof of its inno-
cency. Acuteness of attack, however, is a sure sign of great
danger. So, also, the sooner the symptoms come on after the
infliction of an injury, the greater is the danger, and the more
speedy the fatal issue.

In considering the treatment of tetanus, we must divide it
into that of the acute or active, and of the chronic or sub-acute
form. In the treatment of acute tetanus, I believe that no
remedy known exercises the slightest curative influence. To
drug a person affected with active acute tetanus, is, in my opinion,
utterly useless. I have never seen nor heard of a case cured by
the routine treatment, the sooner we abandon such, I think the

483 Licture on Tetanus. [July,

better. Calomel and opium in large doses, the vegetable seda-
tives, belladonna, conium, henbane, opium, or camphor, largely
administered, are all unavailing (when the disease is acute) in
retarding, mitigating, suspending, or arresting its progress. If
we are ever to cure acute tetanus, we must give up this line of
treatment, which we have been taught by experience to be use-
less, and endeavor to discover some new principle to guide us
in the management of this affection. Yet acute tetanus may be
cured, though not, I believe, by medicine; and much may be
done to mitigate suffering. The first thing to be done, is to di-
vide the nerve leading from the wound, where it can be found
and isolated. The wiser plan would be to divide the trunk of
the nerve, high up in the limb, so as to get beyond the sphere
of the local irritation, which appears to be the chief organic
leison discoverable in these cases. Patients have been cured
by this means. Mr. Murray (the surgeon who tied the ab-
dominal aorta) relates the case of a midshipman, who received
a wound in the foot from a rusty nail ; tetanus came on ; Mr.
Murray divided the posterior tibial nerve, and the patient re-
covered. Such cases give hope of being able to save others,
and this operation should therefore be done at once, where prac-
ticable. It is not, however, by any means invariably success-
ful. Last session, I divided, without success, however, the
branches of the external cutaneous for tetanus, following a
wound of the back of the hand.

In the general management of the patient, we must remem-
ber that we have an exhausting disease to deal with; the pa-
tient sweats profusely during the intervals of the spasms, and
will soon sink if not supported. All external causes of excite-
ment should be removed from about the patient; he should be
kept perfectly quiet, his bed surrounded with screens or muslin
curtains. In addition to these means, the occasional inhalation
of chloroform will alleviate, though it will not cure, acute
tetanus.

In sub-acute and chronic tetanus, the case is different. If the
patient survive the fifth day, and the affection assume a chron-
ic or sub-acute character, we may entertain some hope of his
recovery. He should be kept quiet his strength supported.
Terebinthinate enemata. calomel with opium, belladonna or coni-
um, are the remedies to be employed. Many patients have got
well under, and seemed to be cured by this plan of treatment.
Cannabis indica, ether, and chloroform, have also been recom-
mended, but are not alone to be trusted to. At all events,
calomel and opium, and, if you like, belladonna also, may be
given with advantange. You may also feel disposed to try the
effect of the sedative alkaloids, t am not aware of any cure
having resulted from their use, but atropine, applied liberally,

1859.] Treatment of Hooping- Cough. 484

has been beneficial, by mitigating the pain which the patient
suffers. Such alkaloids, or the corresponding vegetable ex-
tracts, may therefore be applied with benefit.

To sum up : it appears that the best prospect of a cure is to
be found in the division of the nerve leading from the seat of
injury, whenever this is practicable; in the employment of
proper hygienic and dietetic means; in the removal of all
sources of external excitement and irritation, local and con-
stitutional ; and in the administration of moderate doses of calo-
met and opium, with turpentine enemata. Such measures as
these, I say, appear to be more rational, and to hold out a better
chance for the patient, than the empirical administration of spe-
cific sedatives, which experience has repeatedly proved to be una-
vailing in curing the disease, and often even in mitigating its
sufferings. [Lancet.

On the Treatment of Hooping -Cough hy Diluted Nitric Acid. By
John Atcherley, M. E. C. S., Eng.

I wish to direct the attention of the profession to the diluted ni-
tric acid, in the treatment of hooping-cough. It has already
been employed in hooping-cough to some extent, and was first
recommended some years ago, by Dr. Arnold, of Montreal.

Having had abundant opportunities during the last two years,
of testing its efficacy, I may be permitted to speak with some
degree of confidence as to its value. I have confined myself
exclusively to its use in every case I have had to treat through-
out that period, and I can affirm that as the ordinary duration
of hooping-cough, has been computed to average ten weeks, in
defiance of every method of treatment that had hitherto been
adopted, the diluted nitric acid effects its removal in less than
three weeks, except incases where its course has been interrupt-
ed by some serious complications.

Any medicine capable of abridging the duration of a disease,
whose fatality is in proportion to its continuance, must be of
incalculable value ; and I am convinced that when it becomes
more generally used, it will meet with the concurrence of the
profession, and will hold a high place, and be the cardinal reme-
dy, if not supersede all other medicines in hooping cough.

In prescribing the diluted nitric acid, I usually begin with
five-minim doses every three hours, say for a child six months
old, and gradually increase the dose, in proportion to the age,
to fifteen minims every second hour, should the paroxysms be-
come aggravated, or of more frequent recurrence. When the
intervals become lengthened, which generally happens after
the second day, the medicine may be given less frequently ; but

485 Veratrum Viride and Chlorine in Yellow Fever. [July,

it is of importance that the acid should be continued ten days
after all symptoms of the disease have subsided. From the neg-
lect of this precaution, I have seen the cough return with all its
former violence, when the medicine has been abruptly discon-
tinued ; therefore, it should be given in moderate doses three
times a day, after all traces of the affection have passed away.

The form I generally use, is the one originally suggested, viz.,
dilated nitric acid, compound tincture of cardamoms, syrup and
water. This is always taken without the slightest reluctance,
as it is agreeable to the taste a great consideration in prescrib-
ing a medicine for children, which requires to be continued for
some length of time.

In conjunction with the above treatment, I have invariably
employed a stimulating embrocation to the back and chest,
night and morning, consisting of one ounce of camphor lini-
ment, and two drachms of spirits of turpentine.

Of course, it is necessary as in all diseases of the respiratory
organs, that proper attention should be paid to the state of the
bowels, regulation of temperature, clothing and diet. I have
also seen great benefit derived from the inhalation of the fumes
of burning nitre-paper ; two pieces of about four inches square
are burnt in the bedroom on retiring to rest, and one piece
burnt occasionally in the room occupied by the child in the day
time, appears to shorten the paroxysm, and to deprive it in a
great measure of its spasmodic character, rendering it more like
the cough of ordinary catarrh. Chloroform is the best anti-
spasmodic that can be used during the fit, but parents have a
great dread of its effects, unless administered by the medical at-
tendant; but from the apparent simplicity in the fumes of burn-
ing nitre-paper, they are readily induced to give it a trial.

[Medical Times and Gazette.

Our valued friend and confrere, Dr. E. D. Fenner, of the New
Orleans School of Medicine, left for Europe on the 14th of May.
On board the steamer which bore him hence, it will be seen
that his mind still dwelt on home and its medical interests, and
he has furnished the following letter to Dr. Brickell, which will
be appreciated by all who know him :

Veratrum Viride and Chlorine in Yellow Fever.

My Dear Colleague: As some practitioner may desire to try
the new treatment for yellow fever which I brought to the no-
tice of the profession in the October and November numbers of
our Journal last year, I have concluded, before quitting the

1859.] Veratrum Viride and Chlorine in Yellow Fever. 486

country, to leave you some plain directions for carrying out
the same.

I repeat what has been said before, that I think we have in
the veratrum viride and chlorine mixture, medicines which are
fairly entitled to be considered remedies for yellow fever. They
will at least fulfill the following indications, viz: completely con-
trol febrile excitement, and keep up the secretions 0/ the liver, kidneys
and skin. Now these are not all the indications that are pre-
sented in yellow fever, but they certainly are the principal ones,
and those to which our remedies are chiefly diiected. If the
febrile excitement be very moderate, theY. V. will hardly be
called for.

My directions, in brief, are as follows :

At the commencement of the attack, order a hot mustard
foot-bath, and evacuate the bowels with a mild cathartic, such
as castor oil, citrate of magnesia or Seidlitz powders. If the
stomach be irritable, with bilious vomiting and a coated tongue,
give a gentle emetic of ipecac or salt and mustard.

After this, if the fever be high, give five drops of the Y. Y.
in a little water every four hours, till the pulse be brought
down to seventy, when the Y. Y. will be stgpped, or the inter-
val between the doses prolonged so as to keep the pulse at
seventy. At the same time begin with the chlorine mixture,
and give two tablespoonsful every four hours thus Y. Y.
at 2, chlorine at 6 ; Y. Y. at 8, chlorine at 10, etc. If the fever
be moderate from the first, the Y. Y. may be dispensed with,
and the chlorine alone relied on and given more frequently, say
every second hour. These doses are for adults. Children,
even sucking infants bear the chlorine well, but the Y. Y.
should be very cautiously given to them.

The repetition of foot-baths, sinapisms, spongings, enemata,
etc., must be left to the judgment of the practitioner. I have
no doubt that quinine in some way would be a valuable adjunct
to these remedies, but I will not direct it at present.

The following is the chlorine mixture :
$. Acid. Hydrochloric,

Aqua Distillata aa. I ii. Mix and add
Potass. Chlorat, 3 ii.

Let this be labelled and kept on hand. For use, prescribe as
follows :

$. Chlorine Mixture 3 ii.
Aqua Distillat. oj. M

S. Give two tablespoonsful every two or four hours {pro
re nata.)

For drink, I like orange leaf tea, lemonade, barley water.
Covering generally one blanket. Do not raise up in bed after
the first day, until fairly convalescent.

487 Editorial. [July,

With these two remedies as my main dependence, in twenty-
five cases of the bad epidemic last year, I lost only two one
a pregnant lady, who was delivered at the critical stage of the fe-
ver the other a very delicate lady with no recuperative energy.

Dr. W. E. Kennedy told me he treated fifteen cases with
these remedies and lost but one.

Dr. C. Beard treated eight cases and lost none. ,

Dr. S. Choppin treated eight cases and lost one.

Other physicians told me they had tried these remedies with
happy effects. I hope others will try them if yellow fever should
again appear in any of our cities or villages.

EDITORIAL AND MISCELLANEOUS.

Doctor Lunsford P. Yandell. By the following just
tribute from the Louisville Jurnal, we learn that this distin-
guished gentleman, whose name has been so long associated
with medical teaching, and the Medical history of the West, has
resigned his chair in the University of Louisville, Kentucky, to
locate in Memphis Tennessee.

Familiar with his name and reputation from our early youth,
as the co-laborer and the -equal of such men as Dudley, Drake
and Caldwell, we but recently enjoyed the pleasure of a per-
sonal acquaintance with Dr. Yandell. Our recent visit to
Louisville, afforded us this gratification. His genial face, urbane
manners and open-hearted, home-making hospitality, besides a
thousand delicate attentions better felt and appreciated than de-
fined, have left an impression upon our heart, which time, nor
distance, nor change of place, can never dispel. We have been
made to feel that we have an ever welcome place at his board
and in his home, whether it be in Louisville or Memphis. Coz~
lum non animum mutant, had never a more enduring applica-
tion.

" That which the fountain sends forth returns again to the fountain." Evan-
geline.

May his warm heart find responsive throbs all around him in
his new home, and may his kind spirit ever breathe the same
genial atmosphere which exhales from his own generous soul.

"It was recently announced that this distinguished gentleman
had resigned his Professorship in the Medicical Institute of this

1859.] MitoriaL

city. We could not read the annunciation, without a feeling of
regret, for we had known Dr. Y. as a leading mind in the In-
stitute, from its very beginning.

Dr. Yandell was one of the five or six Professors of the Tran-
sylvania Medical College, who left that Institution together,
and, under highly favorable auspices, founded the Louisville
Medical Institute, which, it is well known, they established upon
a broad and deep and strong foundation. For many years, its
prosperity was literally unparalleled. Competition sprung up
in every direction, but all competition was distanced. And it
is certainly due to Dr. Yandell, to say, that a large, very large
share of the prosperity of the Institution was the result of his
strong, energetic, and well directed efforts. His lectures were
always able and popular, and, although his colleagues no doubt
lectured as well as he, it is no disparagement to them to say,
that he did more than any of them, in building up and sustain-
ing the Institute. He had ever a strong, and to a very great
extent, a controlling will. When any public defence of the
school, or of persons connected with it was felt to be needed, he
was uniformly and never in vain looked to, as the champion
who was to fight the battle. And he never fought such a battle
unsuccessfully. His clearness and keenness as a writer and
thinker, his zeal in behalf of whatever he undertakes, and his
unconquerable and almost irresistible spirit, would make him a
most formidable antagonist in any encounter.

Dr. Yandell goes to Memphis, and we feel that in his depar-
ture, not only the Medical Institute, but our community sus-
tains a serious loss. He is a highly successful medical practi-
tioner, and, what is more, a true and devoted friend, a sincere
christian in heart and practice, and as brave and gallant a spirit
as ever lived. Though now past the meridian of life, he has
more fire in him than aregiment of ordinary men. Most heartily
do we commend him to all our friends, wherever he may go."

American Medical Association Twelfth Annual Meeting.

Louisville, Ky., May 3rd, 1859.

Not having, as yet, seen the Report of the Secretary, we condense a
few of the more important particulars of the above meeting from the
very full and correct records taken by the special reporters for the
Louisville Journal.

The Association met at eleven o'clock A. M. in Mozart Hall, the
President, Dr. Harvey Lindsley, of the District of Columbia, in the
chair, supported by Drs. W. L. Sutton, of Kentucky, Thomas O. Ed-
ward, of Iowa, and Josiah Crosby, of Massachusetts, as Vice-Presidents,
with Drs. Alexander J. Semmes, of th* District of Columbia, and S. M .

489 Editorial [July,

Bemiss, of Kentucky, acting as Secretaries. Dr. Caspar Wistar, of
Penn., Treasurer, was also in attendance.

The President announced the Rev. Mr. Robinson, of Louisville, who
opened the proceedings with prayer.

The Association was then welcomed in a brief but most courteous
and eloquent address by Professor Robert J. Breckenridge, chairman
of the committee of arrangements.

Professor Joshua B. Flint, President of the State Medical Society of
Kentucky, accompanied by Drs. Sutton, Chipley, Spillman and Snead,
all ex-Presidents of that Society, came forward and addressed the Pre-
sident of the American Medical Association, welcoming the delegates to
their State, and "assuring the Association of the cordial interest of the
Profession of the State in the objects and purposes of its institution, and
of the readiness of this Society to co-operate in all its endeavors to pro-
mote the honor and usefulness of our common calling."

The Secretary, Dr. S. M. Bemiss, then called the roll, when it was
found that, besides invited guests, over three hundred delegates were in
attendance. The hours of business, as announced by Dr. R. J. Breck-
enridge, chairman of committee of arrangements, were from 9 A. M. to
12 M., and from 3 P. M. to such hour as the Convention should adjourn
upon resolution. The President, Dr. Harvey Lindsley, of Washington,
then appointed the following gentlemen a committee to receive and
report upon voluntary Essays : Dr. Lunsford P. Yandell, of Kentucky ;
Dr. Bryan, of Pennsylvania, and Dr. Comegys, of Ohio.

Doctor Harvey Lindsley then read his interesting address, which
was listened to with marked attention, and which, besides being an
eloquent tribute to the dignity of the Medical Profession and the import-
ance of its improvements, was a paper full of sage and dignified counsel,
conversant about the best interests of the important Body, the govern-
ment of which he was about to resign into the hands of others, and lay-
ing out plans for its management and future advancement.

Besides other propositions made in this able address, one of the
suggestions struck us as particularly useful viz : that a committee be
appointed to prepare " A system of Rules of Order," which shall be
so arranged that they will be adjusted to the wants of this Association, and
serves for the working of the body in all its future deliberations. Such
a system will facilitate business, prevent much unprofitable discussion
on merely parliamentary questions, and close the mouths of many whose
chief function and delight has been to question the propriety of the
chair's decisions on some mere quibble of rigid technicality. We were
much pleased with the address, and hope at some future time* to give it a
more extended notice in these pages.

1859.] Editorial 490

After he had concluded, Dr. L. A. Smith, of New Jersey, moved that
the thanks of the association be tendered to the president for his able
and eloquent address, and it was ordered to be placed in the hands of the
appropriate committee for publication, among the proceedings of the
meeting.

Dr. Caspar Wister, chairman of the committee on publication, read
the annual report, and on motion of Dr. Sayers, of New York, the fol-
lowing resolutions appended to it were unanimously adopted:

Resolved, That hereafter every paper intended for publication in the
transactions not only be placed in the hands of the Committee of Publi-
cation by the 1st June, but it must also be so prepared as to require no
material alteration or addition at the hands of the author.

Resolved, That authors of papers be required to return their proofs
within two weeks after there reception, otherwise they will be passed
over and omitted from the volume.

Adjourned until 3 o'clock P. M.

AFTEKXOOX SESSION.

Dr. W. L. Sutton, one of the Vice Presidents, took the chair in the
absence of the President.

Dr. D. Meredith Reese, of New York, chairman of the Committee on
Nominations, reported the following offices for the ensuing year.

President Henry Miller of Kentucky.

Vice Presidents H. F. Askew, Delaware ; Chas. S. Trippler, U. S.
Army ; L. A. Smith, New Jersey ; Calvin West, Indiana.

Treasurer Caspar Wister, Pennsylvania.

Secretary S. M. Bemis, Kentucky.

Dr. Sayre moved the adoption of the report, which was unanimously
agreed to.

Dr. Brainard, of Illinois, moved the appointment of a committee to
conduct the newly appointed officers to their respective chairs. The
acting President selected Drs. Brainard, of 111., Mattingly, of Ky., Sut-
ton, oflnd., McDowell, of Mo., and R. J. Breckenridge, ofKy., and
they accordingly performed the duties assigned them.

The newly elected President, on taking the chair, addressed the Con-
vention in substance as follows :

Gentlemen of the American Medical Association : I am wholly at a
loss to command language to express the deep sense of obligation put
upon me by calling me to the Presidency of your Association. It is an
honor any man may be well proud of, and although I admit, in all sin-
cerity, that you might without difficulty have selected an individual
more worthy the position, I may be allowed to say you could not hava
conferred it upon one who would prize it more highly or cherish it longer
with the most grateful recollection. I do esteem it the greatest honor

491 Editorial. [July,

ever conferred upon me by the profession that I love and to which I
have devoted along life ; nay more it is the greatest honor that could
be conferred upon any man by the medical or any other profession in
this or any other country ; for any decoration of honor or any mark of
approbation conferred by a crowned head I should regret as a bauble in
comparison. Who are you, gentlemen, when rightly considered ? You
are the rghtful representatives of the great American Medical Profession
an army forty ihousand strong, and a body of men, no matter what
captious criticism may say in disparaging comparison with the European
branch of the profession, in my humble judgment, far superior to the
same number of medical men to be found in any quarter of the globe.
Although as a body you may not be so learned, so critically and nicely
framed in all the minutiae of the profession, yet for strength, integrity
and precision in all the great principles guiding to a successful combat
with disease, this body is equal if not superior to that of any kingdom of
continental Europe.

To be called to the Presidency of such a body of men, is in my sober
judgement the greatest compliment that could be conferred on mortal
man, provided that man is a devotee of medicine, who has given his whole
mind, soul, heart, and strength individually to the profession, and has
that high regard for it which will not suffer any less noble pursuit to in-
terfere with the daily though laborious duties of the profession. Coming
so recently from a sick bed and still enfeebled in health, I beg to be ex-
cused from further remarks and desire you to accept this brief and im-
perfect acknowledgement of the distinguished honor conferred upon me,
instead of what, under other circumstances, I might be disposed to say.

Dr. J. B. Lindsly, of Tennessee, offered the following :

Resolved, That a committee of three be appointed by the chair to in-
quire into and report upon the propriety of dividing the Association into
sections for the purpose of performing such parts of its scientific labors
as may relate to particular branches of medicine and surgery.

Dr. Brodie moved its reference to the Nominating Committee.

Dr. Brainard explained at some length the object of the resolution of
inquiry, and enforced its adoption as the means of giving more effect
and usefulness to the proceedings of the Association, the reports of which
had heretofore gone out unmatured, in consequence of the want of con-
centrated action.

A motion by Dr. Sayre to lay the motion on the table was negatived,
and the motion of Dr. Lindsley was then adopted.

The Standing Committee on Prize Essay was called on for their re-
port, but without a response. This was also the case with the Commit-
tee on Medical Literature, which had no report to present.

The Special Committee on Government Meteorological Reports made
a report, written by Dr. R. H. Coolidge, ofthe U. S. Army, but read
by Dr. Paul F. Eve, of Tennessee, which was referred to the Commit-
tee on Publications.

1859.] Editorial 491

The Committee, appointed in May, 1857, on Criminal Abortion, sub-
mitted a report, written by Dr. Storer, of Boston, which was read by
Dr. Blatchford, of New York, and referred to the Committee on publi-
cation. The following resolutions appended to this report were unani-
mously adopted :

Resolved, That while physicians have long been united in condemn-
ing the act of producing abortion, at every period of gestation, except as
necessary for preserving the life of either mother or child, it has become
the duty of this Association, in view of the prevalence and increasing fre-
quency of the crime, publicly to enter an earnest and solemn protest
against such unwarrantable destruction of human life.

Resolved, That in pursuance of the grand and noble calling we profess
the saving of human lives and of the sacred responsibilities there-
by devolving upon us the Association present this subject to the atten-
tion of the several Legislative Assemblies of the Union with the prayer
that the laws by which the crime of procuring abortion is attempted to
be controlled may be revised, and that such other action may be taken
in the premises as they in their wisdom may deem necessary.

Resolved, That the Association request the zealous cooperation of
the various State Medical Societies in pressing the subject upon the
Legislatures of their respective States, and that the President and Secre-
taries of the Association are hereby authorised to carry out by memo-
rial these resolutions.

The Convention then adjourned till to-morrow morning at 9 o'clock.

Wednesday, May 4, 1859.

The President, Dr. Miller, called the Association to order at 9 o'clock.

Dr. D. Meredith Reese, chairman of the Committee on Nominations
called attention to the fact that the committee could not act definitely
until the place for next year's meeting should be designated. He stated
also that the Medical State Society of Connecticut had requested that
an amendment to the constitution proposed two years since should be
taken from the table, relative to the time of meeting.

It was moved by Dr. Blatchford and seconded by Dr. Sayre, that
the amendment to the third article of the constitution be taken up, which
proposes to add after the words "first Tuesday of May," the words
M or first Tuesday of June," and after the words " shall be determined"
add the words "with the time of meeting."

The amendment was adopted by a constitutional vote.

Dr. D. M. Reese also stated that the Connecticut State Society had
extended a pressing invitation to the Association to hold its next meeting
at New Haven, which invitation was referred to the Committee on
Nominations.

Dr. Flint from the Committee on Prize Essays, begged leave to re-
k. s. VOL. XV. NO. vii. 35

492 Editorial [July,

port that they received four dissertations in time for a careful and
thorough examination, and two others, quite voluminous, only two days
before the meeting of the Association. The latter we have felt con-
strained to exclude altogether from the competition of the present year,
on account of the absolute impossibility of reading them with a critica
purpose and effect. The others have been carefully examined by all
the surviving members of the committee one estimable associate, Dr.
Evans, having been called from all his earthly labors before the active
duties of the committee began.

More than one of the four essays we examined exhibited much labor,
and a commendable scholarship in their preparation are voluminous,
and in some respects very meritorious papers, but, in the unanimous
judgment of the committee neither of them possesses the degree and
species of merit which should entitle its author to the association prize.
The committee beg leave furthermore to report that, in their opinion
and as the suggestion of their own recent experience, the association
should determine in more precise and formal manner than has yet been
done the terms and conditions of competition and of success in the con-
test for prizes, for the government alike of contestants and the committee
of adjudication, and that a committee be now appointed to consider and
report upon that subject.

Dr. J. B. Lindsley, Chairman of the Committee appointed to inquire
into the propriety of dividing the Association into sections, for the bet-
ter performance of its work in considering the various branches of
medicine and surgery, recommended the adoption of such a plan as
being indispensably necessary to making this body a working scientific
association. They do not deem it necessary to enter into any argu-
ment in favor of this plan, it being the one already universally adopted
by similar bodies. They would simply recommend, for the present, a
division into the following sections, as being most suitable to facilitate
the transaction of business viz :

1. Anatomy and Physiology.

2. Chemistry and Materia Medica.

3. Practical Medicine and Obstetrics.

4. Surgery.

The committee do not propose that this subdivision of labor shall in
any manner interfere with the regular business of the Association as
now conducted ; but only that after having assembled each day in gen-
eral session, each section shall meet separately for the purpose of hear-
ing and discussing papers on such subjects as properly belong to them,
and they therefore recommend that the Committee of Arrangements for
the coming year be requested to provide suitable accommodations for

1859.] Editorial 493

the service of these sections, and that each of said sections shall be
authorized to make such arrangements as may be required for the prop-
er transaction of its business.

On motion of Dr. H. F. Campbell, a fifth section of "Meteorology
Medical Topography, and Epidemic Diseases, and of Medical Jurispru-
dence and Hygiene," was added to those already adopted by the asso-
ciation.

Dr. J. W. Singleton, of Ky , moved the supension of the rules for the
introduction of the following :

Resolved, That in the death of Dr. A. Evans of Kentucky, the Asso-
ciation has lost one of its most manly and efficient members, and society
a friend and benefactor.

The resolution was unanimously adopted.

A voluminous report from Dr. Thomas Logan, of California, on Medi-
cal Topography and Epidemics, was received and referred to the Com-
mittee on Publications.

The chairman of the Committee on Voluntary Essays, Dr. L. P.
Yandell, of Kentucky, stated that he had received a paper on a case of
extra-uterine fetation from Dr. Enos Hoyt, of Transvilvania, Mass.,
and another on a case of accidental poisoning by strychnine from Dr.
Douglas Bly, of Rochester, N. Y. He also presented a very volumi-
ous paper entitled, " Observations on some of the changes of the Solids
of Fluids in Malarial Fevers, by Joseph Jones, M. D., Professor of Medi-
cal Chemistry in the Medical College of Georgia, at Augusta," By
request, Prof. Jones gave a verbal abstract of his paper and an exposition
of his theory, and on motion of D. W. Yandell the communication was
referred to the Committee on Publications.

This verbal abstract presented by our colleague, Dr. Jones, of his
Essay on "Some of the Changes of the Solids and Fluids in Malarial
Fever," was listened to with marked attention, and indicates that the
paper itself, is one of the most valuable contributions ever presented to
the association. This paper had been offered by a friend of its author to
the chairman of the Prize Committee, but on account of its late present-
ation, was not examined, and did not come in competition for the prize.

Dr. Lunsford P. Yandell, chairman of Committee on Voluntary Con-
tributions, moved that Dr. Jones's paper be referred to the Committee of
Publication, while Dr. Caspar Wister, of Philadelphia, moved that it be
referred to the Committee, "with power" to report it one of the Prize
Es6ays.

On motion of Dr. PaulF. Eve, of Nashville, the Essay of Dr. Josepb
Jone.s, of Georgia, was finally referred to the Committee on Prize Essays.

After some most appropriate and feeling remarks, in which the speak-

494 Editorial. [July,

er expressed his high respect and veneration for the aged Surgeon of the
West,

Dr. Eve moved to record the name of Dr. Benj. W. Dudley as a per-
manent member of the association, which was adopted by a unanimous
vote, the delegates ail rising to their feet in token of respect.

Dr. J. B. Flint offered the following resolution :

Whereas, Our brethren of Great Britain are engaged in erecting a
monument to the memory of John Hunter, whose invaluable services
in behalf of Physiology and Surgery are recognized and honored, as well
on this side of the Atlantic as in Europe, and whereas, this Association,
as the representatives of American Medicine, would rejoice in some suit-
able manner to participate in so grateful a testimonial of gratitude and
respect ; therefore

Resolved, That a committee of three be appointed to consider in what
manner this participation can best be effected, so as to be acceptable to
our British brethren, and consistent with our own means and opportuni-
ties of action, with instructions to report at the next annual meeting.

The resolution was adopted, and Drs. Flint, Bowditch and Shattuck,
appointed as the Committee.

Dr. Harvey Lindsley offered the following :

Whereas, Parliamentary rules of order are numerous, complicated,
sometimes obscure, and often inapplicable to such a body as the Ameri-
can Medical Association, and whereas, from the nature of the pursuits
of medical men, they cannot be familiar with these rules: therefore

Resolved, That a select committee of three members be appointed to
prepare a system of rules for the government of this Association, as few
in number, as concise and as perspicuous as possible, to be reported to
the next annual meeting.

This resolution was adopted, and Drs. Lindsley, Comegys, and
Blatchford, appointed as a committee.

The nominating committee made the following report ;

The next annual meeting to take place at New Haven, on the first
Tuesday of June, 1860. Dr. Eli Ives is elected junior Secretary.

Committee of Arrangements Drs. Chas. Hooker, Stephen G. Hub-
bard, and Benjamin Sullivan, Jr., with power to add to their numbers.

Committee on Prize Essays Drs. Worthington Hooker, Conn. ; G.

C. Shattuck, Mass. ; Usher Parsons, R. I. ; P. A. Jewett, Conn. ; and
Jonathan Knight, Conn.

Committee on Publication Drs. F. G. Smith, Philadelphia, Pa. ; Wis-
tar, do. ; Bemiss, Louisville, Ky. ; Ives, New Haven, Conn. ; Hollings-
worth and Hartshorne, Philadelphia, Penn. ; and Askew, Wilmington,
Del.

Committee on Medical Literature Drs Henry F.Campbell, Ga. ;

D. F. Wright, Tenn. ; O. Wendell Holmes, Mass. ; S. G. Armor, Ohio.;
and W. H. Byford, 111.

1859.] . Editorial 495

Committee on Medical Education Drs. D. M. Reese, N. Y.; VV. K.
Boling, Tenn. ; Chas. Fishback, Ind. ; John. Bell, Penn. ; Z. Pitcher,
Mich.

The following Special Committees were appointed :

On Morbus, Coiarius, and Surgical Pa'thology of Articular Inflamma-
tion Dr. Lewis A. Sayres, of New York.

On the Surgical Treatment of Strictures of the Urethra Dr. James
Bryan, of Philadelphia.

On Drainage and Sewerage of Large Cities, their Influence on Public
Health Drs. A. J. Simmes, D. C, Chairman ; Cornelius Boyle, and G.
M. Dove.

On the Periodicity of Diseases Prevailing in the Mississippi Valley
Dr. J. W. Singleton, of Smithland, Ky.

On Puerperal Tetanus, its Statistics, Pathology, and Treatment Dr.
D. L. McGugin, of Keokuk, Iowa.

On Hospital Epidemics Dr. R. K. Smith, of Philadelphia.

On Puerperal Fever Dr. J. N. Green, of Stelisville, Ind.

On Anaemia and Chlorosis Dr. H. P Ay res, of Fort Wayne, Ind.

On Veratrum Yiride Dr. James B. McCraw. of Richmond, Ya.

On Alcohol, Its Therapeutical Effects Dr. J. R. VV. Dunbar, of
Baltimore, Md.

On Meteorology Dr. J. W. Westmoreland, Atlanta, Ga.

On Milk Sickness Dr.vRob't Thompson, Columbus, Ohio.

On Manifestations of Diseases of Nervous Centres Dr. C. B. Chap-
man, Wisconsin.

On the Medical Topography of Iowa Dr. T. O. Edwards, Iowa.

On Microscopic Observations on Cancer Cells Dr. Geo. D. Norris,
New Market, Ala.

On the Philosophy of Practical Medicine Dr. Jas. Graham, Cin-
cinnati, Ohio.

On Some of the Peculiarities of the North Pacific and their Relations
to Climate Dr. Wm. H. Doughty, Ga.

The following special committees were continued or altered:

On Microscope John C. Dalton, jr., N. Y. ; David Hutchinson, Ind. ;
A. R. Stout, Cal. ; Calvin Ellis, Mass. ; Christopher Johnson, Md.

On Diseases and Mortality of Boarding Schools Dr. C. Mattingly,
Ky. ; and Dixi Crosby, N. H.

On the Various Surgical Operations for the Relief of Defective Vision
Drs. M. A. Pallen, Mo. ; T. J. Cogley, Ind. ; and W. Hunt, Penn.

On the Blood Corpuscle Dr. A. Saver, Michigan.

On American Medical Necrology. Dr. C. C Cox, Maryland.

On the Hygienic Relations of Air, Food, and Water, the natural and

496 Editorial. [July,

artificial causes of their impurity, and the best methods by which they
can be' made most effectually to contribute to the public health Dr. C.
C. Cox, Maryland.

On the effect of the Virus of the Rattlesnake, &c, when introduced
into the system of Mammalia--Dr. A. S. Payne, Virginia.

On the Climate of the Pacific Coast and its Modifying Influences upon
Inflammatory Action and diseases generally Dr. O. Harvey, Califor-
nia.

On the Constitutional Origin of Local Diseases and the Local Origin
of Constitutional Diseases Dr. W. H. McKee, North Carolina, and
C. F. Haywood, New York.

On motion of Dr. Brodie, Dr. A. J. Semmes was requested to serve
as Secretary pro tern, during the remainder of the session.

Dr. Gibbes, from the committee to examine into a plan of uniform re-
gistration of Births, Marriages, and Deaths, offered the following report :

They have given the same a careful consideration, and they unani-
mously recommend that the Report be adopted and referred to the Com-
mittee on Publication.

They also recommend that the same committee be continued, with in-
structions to add to the Report in time for publication in the ensuing
volume of Transactions a form of registration law which may be likely
to answer the requirements of the several States.

Dr. Sayer, of N. Y., offered the following :

Whereas, The me,dical profession at large have an interest in the
character aud qualifications of those who are to be admitted as their
associates in the profession ; therefore,

Resolved^ That each Stale Medical Society be requested to appoint
annually two delegates for each College in that State, whose duty it shall
be to attend the examination of all candidates for graduation; and that
the Colleges be requested to permit such delegates to participate in the
examination and vote on the qualifications of all such candidates.

This was referred to a Committee of Conference.

Dr. Comegys moved the appointment of a committee of five to con-
fer with the Committee of Medical Teachers and report at the next
annual meeting, provided that no medical teacher be selected on the part
of this association.

Professor Crosby, of Darmouth College, contended that the elevation
of the standard of medical education depend more upon practitioners than
Colleges ; if bad materials were sent up from physicians' offices for Pro-
fessors to model into physicians, it could not be expected that good results
would follow. He wanted a committee of conference, not based on any
sectional feelings, and he believed the whole matter could be arranged
satisfactorily.

1859.] Editorial 497

Dr. D. W. Yandell wished to reply to one remaik of Prof. Crosby, as
tothe bad materials sent by private teachers to the Colleges. He had
himself rejected students who were too big fools to be made physicians,
and these same persons, in a few months, had gone to some of the Colle-
ges and came back with their diplomas in their pockets. After a very-
eloquent, appropriate, and conciliatory speech from Dr. Davis, the reso.
lution of Dr. Comegys was unanimously adapted.

After receiving the names of about sixty delegates, which had been
recorded at the Secretary's desk during the day, the meeting adjourned
to meet on the following day.

As we were not present at the short closing session on the morning
of the 5th, we cannot at present give any account of its proceedings;
we understand, however, that no important business was done,, and that
the attendance was small. After this session, the Association adjourn-
ed to meet in New Haven, Connecticut, on the first Tuesday in June,
1860, at such place as the committee of arrangements shall designate.

The Late Meeting. Cui Bono.

Thus, hastily, and doubtless somewhat imperfectly, we have trans-
ferred to our pages such minutes of the twelfth annual meeting of our
National Medical Congress as we could gather from our own notes and
the more accurate reports published by the enterprising and courteous
secular press of Louisville.

Among the many important measures entered on the minutes of this
meeting at Louisville, no one, in our opinion, can compare with the
proposition originating with, and in committee finally perfected by
Professor J. B. Lindsley, of Nashville, Tennessee, viz : u To divide the
Association into sections." This we consider one of the most decided
advances towards a perfect organization which has been proposed in
the association for many years. It is indeed a reorganization of the
body, so far as its scientific objects are concerned, making it now no
longer, a mere committee for the publication of papers but a true de-
bating and deliberative body, where medical reports and topics can be
discussed, where an interchange of medical opinion may take place,
and where an authoritative decision in all matters brought before the
various sections, can be given.

Up to the year 1851, the method of appointing the committees to make
reports, was radically defective and impracticable. Committees were
appointed to make their several reports upon the various departments of
medicine. These reports finally degraded themselves into mere Bib-
liographical notices of the various wprka published in the several de-
partments, while no special field was cultivated and no specific subject

498 Editorial. [July,

was ever discussed. No research was made, no contributions furnish-
ed the association, except such as had already been published through
the journals, or in the form of books ; and then a thoughtless condemna-
tion or a no more palatable, because undiscriminating approval, was
often the only notice the association took of the labors of American
physicians.

Under such a working plan, the Association was becoming the mark
for foreign criticism, and even ridicule. The volume which we compla-
cently called " American Contributions to Medical Science," began face-
tiously to be denominated, " The voluminous boasting of American Phy-
sicians." Thinking men every where, and such members of the Associa-
tion, as had the highest interest of American medicine near their hearts,
deplored the deficiencies of a system so embarrassing ; but none suggest-
ed either remedy or amelioration. The existence of the various Standing
Committees, (of Departments of Medicine,) seemed so entirely a part of
the fundamental organization of the body, that to attack and depose
them, appeared like taking the very keystone of the arch away, when
the entire structure, which every one admitted was magnificent, must
tumble to pieces. " What was to become of American Medical Litera-
ture of American Surgery of American Obstetrics, Therapeutics, and
American Medical science generally, if the American Medical Associa-
tion, the grand high national tribunal of the American Medical Profes-
sion, does not take cognisance of it, and record it, and foster it, and pa-
rade it before the world as American and nothing but American ?"

Meanwhile, volume after volume was annually accumulating on the
shelves of the members of the Association, and in the libraries of learned
societies all over the world. These volumes, containing the reports of
the Standing Committees, were far from being valueless, and the Associa-
ciation was, even then, in its infancy, exerting a powerful and wholesome
influence over the progress of the Medical Profession in this country.
A tolerably fair, though too compendious a resume of the labors of
American writers, which are eminently journalistic, was annually dis-
tributed to different parts the world, which commanded the attention,
if not always the respect, of foreign readers. But still the American
Medical Asociation as a scientific body, did not appear, in its transac-
tions, to contribute anything important in the advancement of medical
science. It was, up to this time, rather the defender and fosterer of
American Medical Science, than the direct promoter of true advance-
ment in medicine. As such, it was looked up to by the best of the pro-
fession, with respect and reverence, and its sage counsels were observed
as rigidly as the exigencies of the schools and of the profession gener-
ally, would permit.

1859.] Editorial 499

As early as the year 1849, certain members of the association, fully
appreciating the embarrassments attending the old working plan, were
anxious to suggest committees of a more special character, whose range
of duty should be less widely extended, and who, therefore, might be
expected, by their researches, to make some real advance in their par-
ticular departments. Hence, at the meeting in Boston, as we find re-
corded on the minutes of the second meeting, Dr. L. A. Dugas, of Geor-
gia, proposed a larger number of committees, giving a more special
labor to each. At the same meeting, Dr. Isaac Hays of Philadelphia,
proposed to alter the constitution, in so far as related to the Standing
Committees, " on Medical Sciences," " on Practical Medicine," M on
Surgery," " on Obstetrics," "on Medical Education," and " on Medical
Literature."

Xeither of these proposed changes in the constitution were acted
upon, until May 1851. At the meeting in Charleston, "Dr. Hays of
Pennsylvania, called the resolution submitted by himself, during the ses-
sion of 1849," and Dr. G. B. Wood was appointed chairman of a com-
mittee to report upon the subject, as it was by his resolution that Special
Committees were to be appointed, in place of the Standing Committees,
abolished at Dr. Hays's suggestion.

Twenty-seven Special Committees were reported by Dr. Wood, and
Essayists were appointed to various specific subjects of great scientific in-
terest. The very next volume of our transactions, shows marks of vast
improvement. The Association now at once assumed its true position
among the learned societies of the world, and began to contribute its
quota to the general fund of medical knowledge. Those who may have
toiled in particular fields of science, had now the opportunity to garner
up the harvest of their labors, in the common treasury of the Associa-
tion, thus making our transactions, each year, the storehouse of the re-
search, and investigation of all American Physicians, whose industry
and ability might prompt them to labor in the cause of science.

Although the above method of supplying subject matter for the Com-
mittees of the Association may be regarded as highly satisfactory, as
well as beneficial in its results ; still a radical and glaring defect exist-
ed in our working plan. This pertained to the disposition made of
the essays, after they had been prepared by the various Special Com-
mittees, and presented to the Association. One unfamiliar with the
course ordinarily pursued by the Association, in regard to the en
would be astonished to learn that many of the papers, published in the
volume of transactions each year, have never been read before the
Association, except by title or brief synopsis , and that the discussion
of a medical topic before that body, is a thing unheard of. The inter-

500 Editorial. [July,

change of scientific opinion, has not been heretofore one of the exercises
or benefits of our meetings, and in this respect, the members who attend-
ed them, and those who remained at home, were on an equal footing
both must wait the publication of the Transactions, to ascertain what has
been the result of the year's labors. Then only, could they learn wheth-
er the papers presented for publication, and virtual endorsement of the
Association were creditable, or calculated to degrade that body before
the scientific world. Under the plan heretofore in operation, these evils
were unavoidable. It cannot be expected that, at a meeting of from
three hundred to five hundred physicians, any considerable number of
them will be interested in all the subjects discussed in the essays to be
presented, however important the subject may be, and however deeply
interesting its discussion may become, to a certain class of members;
for instance, questions of Meteorology in its relations to Hygiene,
would seldom be attractive to but few, yet that few would be willing
often, to spend hours or even days, in the examination and discussion
of essays conversant about them. So with the departments of Physi-
ology, Chemistry and the various practical branches of our science.

Our " Qui Bono V almost forgotten until now, we hope will be yet
satisfactorily answered.

A new era has now been inaugurated in the annals of the Association.
The meeting just closed at Louisville, in this particular, is one of the
most important that we have had for years. The report of the chair-
man of the Committee, Dr. J. B. Lindsley, recommending the division
of the Association into sections, according to the various departments of
medicine, fully explains itself, and must meet the approbation of the
entire profession, as it, at the time, met the unanimous adoption of the
Association. Under this plan, the American Medical Association is
iiow made a working scientific body, and while there is suggested an
admirable subdivision of labor, the plan in no way interferes with the
regular business of the Association, as now conducted. Papers will
now be read before each section, discussed thoroughly, and, if neces-
sary, returned to their authors for revision, or even rejected, if found un-
worthy of publication and thus the Association will be saved the risk
of publishing reports which have never undergone the slightest exami-
nation, as has sometimes been done.

The advantages of this measure might be more extensively argued,
but time nor space will not allow. In conclusion, we repeat that we
highly approve of the report, and that the thanks of the Association
are due to the originator of the resolution, proposing such a valuable
improvement in its working system. Even were this the only thing
done, we had not met in vain.

1859.] Editorial 501

Medical College of Georgia The Annual Announcement.
Frequent applications for the catalogue and circular have induced the
Trustees of the Medical College of Georgia, to secure from our Publisher
the introduction of the College Annual Aithouhaiuait, under the cover
of our present issue.

Nearly twenty-eight years of the most uninterrupted and gratifying
success, while it has perfected them in the art of teaching, has not in
the least, diminished the ardor of the corps of Professors in this Institu-
tion. With the demands of advancing Science, they have continually
extended their appliances and increased their facilities for rendering the
most efficient and useful course of Instruction.

The recent arrangement for a special course on The Diseases of Children,
we fully agree with the Board, is of the utmost importance, and will go
far to clear many of the obscurities in the pathway of the young practi-
tioner in a department of medicine, the difficulties of which are every-
where acknowledged. Children are the tenderest and frailest of all hu-
man objects, and while their diseases demand the most perfect skill in
their treatment, the diagnosis upon which we must base all therapeutic
measures, is rendered obscure by the inability of the patients to express
intelligibly their sufferings to the Physician. Infantile Symptomato-
logy, Pathology, and Therapeutics therefore, become subjects of the
deepest interest to the practitioner, and his neglect to pay special at-
tention to those departments during his collegiate course, is often at-
tended with the most unfortunate results in after life.

The large additions both to the Museum and Library since the last
session, and the constantly increasing facilities for both College and
Clinical instruction, offer in the approaching session afar more attractive
course, in our opinion, than the Trustees of the Institution have been able
to present for many years. "We refer our readers to the announcement
at the end of the present number of this Journal, adding that, whatsoever
may be done for other Colleges, the Trustees of the Medical College of
Georgia have reason confidently to claim and to expect the continued
fostering support of the Medical Profession at the South.

Medical College Statistics for 1858-9. We are able to present
the result of the various College Commencements, as has been collected
from the circulars and journals, containing their several reports. High
in the list of the forty-one colleges in the United States, our readers
will find the Medical College of Georgia, both for its number of Matri-
culants and its number of Graduates. We earnestly hope that the
school may continue both to deserve and to enjoy the high apprecia-
tion and support of its many friends.

502 Editorial [July,

The following list is from the New Orleans Medical News and Hospi-
tal Gazette :

Matriculants. Graduates.

Jefferson Medical College Philadelphia. . .570 256

University of Pennsylvania " . . .410 140

University of Nashville Nashville 436 103

University of New York New York 350 128

University of Louisiana New Orleans . . 333 97

Medical College of South Carolina. . .Charleston 195

College of Physicians and Surgeon. . .New York. ... 180 58

m Medical College of Georgia Augusta 165 58

New Orleans School of Medicine New Orleans. . 164 36

Pennsylvania Medical College Philadelphia. . 130 33

University of Michigan Detroit 143

Harvard University Cambridge ...139 30

St. Louis Medical College St. Louis 135 40

Philadelphia College of Medicine Philadelphia. .70 19

New York Medical College New York 107 25

Medical College of Ohio Cincinnati 139 32

Kentucky School of Medicine Louisville 103 28

Missouri Medical College St. Louis 23

Rush Medical College Chicago 31

University of Vermont 80 20

University of Buffalo Buffalo 67 13

Shelby Medical College Nashville 53 11

Albany Medical College Albany 48

Medical School of Maine 50

*r Savannah Medical College Savannah 34 ...... 8

Dartmouth Medical College Dartmouth .... 9

Cleveland Medical College Ohio

Starling Medical College

* Oglethorpe Medical College Savannah

Memphis Medical College Memphis

Medical College of Virginia Richmond. ... 70 20

University of Virginia

University of Maryland Baltimore. ...

Yale Medical College New Haven . .

Castleton Medical College

Berkshire Medical College

University of Iowa

University of Louisville Louisville. ... 35

Woodstock Medical College

Geneva Medical College Geneva

* Atlanta Medical College Atianta

Typographical Errors. Although we have but little to acknowl-
edge in the way of mistakes, in the execution of our Journal, we yet
would be glad that all our readers could appreciate the difficulty which
often attends the securing of a perfectly correct impression. We find the

1859.] utorial. 503

following in an exchange newspaper; it is curious, but by no means im-
probable :

A Glasgow publishing house attempted to publish a work that should
be a perfect specimen of typographical accur;. r having been

read carefully by six experienced proof readers, it was posted up in the
hall of the University, and a reward of fifty pounds offered to any one
who should detect an error. Each page remained two weeks in this
place ; and yet, when the work was issued, several errors were discov-
ered, one of which was in the first line on the first p _

The Southern Field and Fireside. This is the title of an excellent
Literary Paper, published in this city, which has reached its fifth number.
As Physicians, like the rest of mankind, must ever need the softening
and recreating influences of Polite Literature, we make no apology for
directing the attention of our readers to the above weekly Journal.

The Southern Field and Fireside presents the happy union, as its
name indicates, of agriculture and polite literature. Each of these de-
partments is conducted with marked ability by the respective Editors.

The Literary department, is presided over by W. W. Mann. Esq., a
most elegant and pleasing writer, who has for many years enjoyed a
widely extended reputation as the Paris Correspondent of the Southern
Literary Messenger, and the National Intelligencer. His extensive
travel, fine taste, thorough acquaintance with the field of literature,
both domestic and foreign, and especially his earnest care for the moral
influence of his paper, secures to his readers a most refreshing and
wholesome weekly repast on the table over which he presides.

Dr. Daniel Lee, the Agricultural Editor, is the distinguished Pro-
fessor of Agriculture in the L'niversity of Georgia. His eminent abili-
ties in this department, have been long known and highly appreciated,
and cannot fail to increase, both the value and popularity of the Field
and Fireside, by adding the utile of agricultural science to the dulce of
literary refreshment, teeming weekly in its columns.

The Field and Fireside presents eight folio pages, quarto size, each
issue containing forty-two columns of reading matter. It is published
in Augusta, by James Gardner, Jr., Esq., at $2.00 per annum. We
refer our readers to the prospectus to be found under the cover of the
Mav number of this Journal.

Strychnia in the Adulteration of Alcoholic Liquors. Dr. Henri Erni,
in an article in the Peninsular and Independent Medical Journal, denies
that strychnia is ever used for the adulteration of alcoholic liquors:
because it would be detected by its intensely bitter taste, which is evi-
dent when dissolved in seven hundred thousand parts of water ; 2nd, be-
cause of its high cost ; 3rd, because it is a most dangerous poison, and

50-i Miscellaneous. [July,

one which, unlike most organic poisons, can be readily detected by
chemical tests. With regard to malt liquors, Dr. Erni states that this
poison cannot be introduced into them together with hops, since the
tannic acid, which these always contain, precipitates strychnia complete-
ly, in the form of an insoluble compound. As a substitute for hops, it
would be much less likely to be employed than aloes and many other
bitter drugs, on account of its high price. [iV. Orleans Med. News and
Hospital Gazette.

Tracheotomy. Dr. Brainard, of the Chicago Medical Journal, gives
the following as his method of preventing hemorrhage in this operation,
and keeping the opening in the trachea pervious without resorting to a
tube: "Having incised the skin and fascia, by successive and careful
incisions, I press the sterno-hyoid and sterno-thyroid muscles to each
side with the fingers, and thus expose the thyroid body. This effected,
I pass under the isthmus a director curved or an aneurismal needle.
This is followed by a common suture needle, which may be passed
with the blunt end foremost, armed with two very strong ligatures. A
ligature is then tied very firmly on each side, and the isthmus of the
thyroid body divided between them. A little dissection with a blunt
instrument denudes the trachea to the required extent, and an opening
can be made without a drop of blood being drawn into it. The liga-
tures which have been thus secured, save the purpose of fixing the
trachea, if desirable, and they may be tied behind the neck so as to
raise it forward and keep the wound open.

"The necessity of using the tube I avoid by the following means:
Having denuded the trachea, insert a small suture needle, armed with
a ligature beneath two of its rings. Withdraw the needle, and drawing
gently up on the thread, make a semi-circular incision on one side so as to
form a valve, readily opened by drawing upon the thread. The opening
thus formed can be kept patent or be all owed to close at will." Ibid.

Wutzer's Operation for the. Radical Cure of Inguinal Hernia. Dr.
W. W. Goodwin reports, in the Louisville Medical Gazette, his success
in this operation, and says: It is estimated that one-tenth or one-
twelth of the human family, at some period of life, are subjects of the
disease, in some form, and that eighty per cent of the cases are inguinal ;
from which the great importance of any efficient operation, which is at
the same time free from danger, is apparent. The success of the opera-
tion, thus far, has been very satisfactory ; the few failures that have
occurred were principally in cases of long standing, when the rings and
canal were greatly enlarged, or from imprudence on the part of
patients. In some instances the operation had to be repeated before
the cure became permanent. In those cases where the rings and canal
are not much enlarged, I am confident that the radical cure may be
relied on with the utmost certainty. The operation is almost painless,
and almost entirely free from danger. From the best information I can
get, it has been performed between two and three thousand times without
one fatal result, or any serious suffering or apparent danger in any case.
More cannot be said of the most trivial operation in surgery.

1859.] Miscellaneous. 505

Dr. G. recommends a light truss and broad pad to be applied when
the patient first assumes the erect posture. The introduction of irritants
on the cylinder, as cantharides ointment, as recommended by Rothermel,
he thinks entirely unnecessary, and does not believe that it favors the
adhesion between the serous surfaces of the inguinal canal and invagina-
ted scrotum, nor that the adhesion of the integumentary surfaces of the
plug adds anything to the success of the operation, but regards the
occurrence as a positive evil in the event of the failure of the operation,
as it would interfere with its repetition. [Ibid.

Ipecacuanha in Post Partum Hemorrhage. Dr. J. B. Read reports,
in the Savannah Journal of Medicine, a marked case of arrest of uterine
hemorrhage after delivery. After the persevering use of ergot, cold
effusions on the surface of the abdomen, ice within the uterus, and other
remedies, the hemorrage still continued. Despairing of the patient's
recovery, half a drachm of powder of ipecacuanha was administered, in
accordance with a suggestion of Mr. Higginbottom (London Lancet,
July, 1845.) "In five minutes vomiting was induced, and with the
very first effort the uterus contracted suddenly and firmly, expelling the
hand which had been introduced from its cavity. Her pulse became
stronger, color returned to her lips and face, and she exclaimed, "I feel
all right!" Her vomiting continued, at intervals, for perhaps ten
minutes.

The loss of blood in this case must have been very great, as the
patient remained pallid and bloodless for a long time.

Dr. Read believes that the result was produced by the simple act of
emesis, rather than from any specific action of the article administered.
He alludes to the sympathy that exists between the uterus and stomach,
to the facts that uterine pains during labor are often accompanied by
vomiting, and that vomiting during the latter months of pregnancy,
when violent and long continued, produces uterine contraction, and thus
may occasion premature delivery.

14 The physiology of the act of emesis, the great excitement of the
nervous system produced by it, and the powerful state of contraction
into which the abdominal muscles are thrown during the expulsion of
the contents of the stomach, will doubtless readily explain the action of
the ipecacuanha in this case, whilst from its rapidity of action, and the
innocuous qualities of the medicine itself, independent of any special anti-
hemorrhagic power it may possess, will recommend it to practitioners in
preference to other emetic agents." [Ibid.

Bottles to Prevent Accidental Poisoning. A bottle has been recently
patented in England, to obviate the frequent recurrence of accidental
poisoning, which has of late years excited so much painful attention in
that country.

The object sought to be obtained was a bottle which should present
so marked and sensible a difference in appearance, touch and use, to
those employed for ordinary purposes, that the possibility of mistake
would be avoided. The Lancet gives the following description of the
bottle : In shape the bottles are hexagonal, with deep flutings or

506 Miscellaneous.

grooves running lengthways along the bottles. To sight and touch
they instantaneously present most striking points of difference from any
other kind of bottle. ' Vessels of this description, made in blue glass, are
intended to be used for external application's only. For poisonous or
powerful medicines, prepared or not from prescriptions, the dose of
which is a tea-spoonful and under, bottles similarly shaped and fluted, in
white glass, are proposed to be employed. The bottles are provided
with an entirely new contrivance, the effect of which is to make it impos-
sible to pour out the contents otherwise than very slowly and gradually,
almost drop by drop. This is accomplished by the simple and inexpen-
sive plan of contracting the neck of the bottle at the lower part of the
shoulders, and the mouth being of the usual size, the process of filling is
but slightly affected by the contraction. The very deliberate and cautions
action thus produced, will, it is believed, deter any one from taking
over doses of medicine ; while it is difficult to imagine a case in which
any one could pour out and take the whole contents of one of these
bottles in mistake for something else.

To illustrate the manner in which the patent bottle acts in comparison
with ordinary ones, it may be mentioned that not more than a teaspoonfnl
would come out of the one, in the same time that an ordinary phial
would take to discharge its contents. A person about to take a wrong
medicine, say laudanum, contained in a patent bottle, and proceeding to
pour it, would be struck by finding that instead of the whole draught
having run into the wineglass at once, as usual, merely a teaspoonful
would have left the bottle. This would naturally lead to an examination
of (he label, and consequent discovery of the dangerous error.

Although to employ a two ounce bottle would tire the hand and arm
of the holder, yet when only the proper dose is sought to be withdrawn,
the patience is not taxed in the slightest degree. [Boston M. & S. Jl.

Dr. George B. Wood. We are sorry to have occasion to announce
that this distinguished physician has resigned the posts he has for so
many years filled with such signal ability, of Professor of the Theory
and Practice of Medicine, in the University of Pennsylvania, and of
Physician to the Pennsylvania Hospital. The former resignation takes
effect at the close of the next course of lectures ; the latter, immediately.

There are few men in this country who have served their profession
as faithfully, honorably, and disinterestedly as Dr. Wood has, and it is
not too much to say that the news of his retirement from the active
duties of his profession, will be received by his brethren with universal
regret.

At a meeting of the Board of Managers of the Pennsylvania Hospital,
held on Monday last, Dr. F. G. Smith was elected one of the physicians
to the institution, in place of Dr. Wood, resigned. Dr. Smith is a
gentleman of high scientific attainment and good practical abilities.
The appointment is a judicious one, and well deserved.

[Medical and Surgical Reporter,

Nothing Impossible. You can do anything if you will only have
patience ; water may be carried in a sieve, if you can only wait till it
freezes. [Ledger.

SOUTHERN

MEDICAL AID SURGICAL JOURNAL.

(NEW SERIES.)

fol. XVI.] AUGUSTA, GEORGIA, AUGUST, 15)9. [No. 8.

ORIGINAL AND , ECLECTIC.

ARTICLE XVII.

An Essay on the Adaptation of Climate to the Consumptive, for a
permanent residence; embracing an Examination of the climate
of certain localities of frequent resort; and also, an Investigation
of the degree of adapted ness of the Pacific Climates of the United
States. Presented to the Medical Society of the State of Geor-
gia, at its annual meeting, held at Atlanta, April 13th, 1859.
By William Hexry Doughty, M. D., of Augusta, Ga.
(Ordered to be printed.)

(Continued from July No. page 471.)

Having thus elaborately presented the meteorological history
of this part of our western possessions, we pass from their consid-
eration in detail, to an examination of their applicability, or
rather their adaptedness to the consumptive. And in the first
place, we will take up the interior. The peculiarities of climate
which distinguish this section, might a priori have been readi-
ly appreciated without a resort to their elaborate exposure by
means of its meteorological record, for its inland situation of
high altitude, and its own peculiar structural arrangement and
conformation, together with its sustentative relationship to
neighboring regions, equally peculiar and impressive in their
topography, are so familiarly known, and their influence upon
climate so accurately and sensibly appreciated, as to point at
K. 6. vol. xv. ko. vn. 36

508 Doughty. An Essay on the Adaptation of [August,

once to a state of un adapted n ess to the requirements of the tu-
bercular. We remark therefore, that we have associated its
notation along with that of California, solely for the purpose of
comparison, and not with the view or hope of establishing
there a sanitarium for the consumptive; hoping thereby to pre-
sent the climatic features of this Pacific State in such a con-
nexion, as to insure its correct appreciation. We might have
selected other regions, perhaps more eligible, as agents for com-
parison, but chose to adopt this as showing the entire Pacific cli
mate as a unit, and also that we might inductively recognize the
reactions of the climate of the coast, upon that of the interior,
and vice versa. We shall therefore dismiss the farther considera-
tion of this portion of the subject, with the following summary of
its climatological characteristics. Its altitude secures to it a
light and dry atmosphere, but also brings with it great extremes
of temperature ; in the winter reducing its temperature some-
times below zero, and in summer, having an analogous extreme
of heat. It is not improbable, that the daily thermometrical
record, may border on similar extremes, for as before mention-
ed, while at night the severity of the cold may be such as to
form ice, yet, at noon, the degree of heat may be such as to
liquify some of the softer solids. The monthly mean tempera-
tures range from 26. 18, to near 70-3 ; the mean annual tem-
perature is 46.92 ; the possible annual range of the thermometer
is 118 ; the mean annual quantity of rain is 16.64 inches ; winds
when observed, were principally from the south and west;
about two-thirds of the year is recorded as fair weather ; and
finally, the occurrence of snow is noted frequently during the
cold season.

The climate of California has few parallels, if any, in meteo-
rology. We have just remarked, of those territories interior
and contiguous to it, that it is possible to form a correct idea of
their climatic conditions, by the study and appreciation of their
general topographical conditions, in their obedience to certain
general laws ; but it would, to say the least, be exceedingly
difficult to form any thing like a correct idea of the true climat-
ic features of the State of California, by any such process of
generalization. For, if we refer to its mountain features, and
study their influence upon the divisions of its climate, we obtain

1859.] Climate to the Consumptive^ &c. 509

but an imperfect idea, because that influence undergoes special
modification, by the action of special physical agents. On the
other hand, if we refer to its coast or sea-shore situation, and
endeavor to deduce therefrom its positive climatic conditions,
we fail, because the exceptional prevalence of extraordinary
currents of the ocean, stamp it with an exceptional coast cli-
mate. And again, if we examine it in the light of the proba-
ble reactions of the adjacent plateau, we obtain only a partial
view, since its own essential peculiarities effectually counter-
balance any distinctive impressions from that quarter. The
peculiarities which it presents, are the combined result of the
action of certain currents of the ocean, upon the particular con-
formation of the land, and vice versa ; and are not therefore
deducible from its general continental arrangements, or any single
topographical element, however marked it may be. Hence, in
order to understand thoroughly or to form a correct idea of its fea-
tures of climate, we must ascertain the mode, and the results of the
action of these special agents, particularly those results which
ensue from the alternate prevalence of the warm and cold masses
of water of the Pacific. This feature in the physical geography
of the north Pacific, produces a very different action and influ-
ence upon the climate of its eastern coast, from that which is
exerted by the waters of the Atlantic upon the coast of
Europe. For, be it remembered, the waters of the Gulf
Stream are always of a certain temperature, which is higher
than the ordinary sea- water, being modified but slightly by the
ordinary agents, even to its final distribution. Now, having
always a particular temperature condition, it can only amelio-
rate the climate of such places along its course and subject to
its influence, as would otherwise be marked with excesses of
cold, and rendered perhaps uninhabitable. While to such as
already possessed a high temperature, it would only serve to
increase their thermometrical condition by the addition of new
increments of heat. Here however, instead of the prevalence of
currents of the sea, at or about a given temperature all the year
round, we find an alternate, but no less specific circulation of
cold masses of water in the summer, and of certain warm ones
in the winter. These, we feel authorized to say from writers
upon the physical geography of the sea, are not one and the

510 DOUGHTY. An Essay on the Adaptation of [August,

same current, assuming a higher or lower degree of temperature
at particular seasons, but are distinct currents, having this spe-
cial mode of circulation. Why the warm currents prevail in
the cold season, and the cold ones in the warm, or the particular
source of the two currents, or the cause of the alternation, is not
yet determined, we believe.* Nevertheless, the fact is incontro-
vertible, that the absolute sea- temperatures in the winter season
are warmer than those of the land ; and the temperatures of
the same in the summer, are colder, than those of the land, and
the winter currents. Concerning the attempted analogy of
effect, between these currents and the Gulf Stream, it is at once
apparent, that no analogy can exist, since the effect upon cli-
mate along the Pacific, is altogether determined by the special
prevailing current, whether warm or cold.

Again ; at certain seasons the influence of these currents
upon the climate of this State, is materially increased by
its own topographical features. For instance, the conjoined
valleys of the interior, forming one of great extent, with their
definite and abrupt separation from the coast, by the coast
mountains, and from the far interior by the Sierra Nevada, are
so completely insulated, that they experience a condition of
climate peculiarly their own. During the summer, therefore,
when the rays of a vertical sun are poured into them, they attain
a degree of heat and rarefaction of atmosphere, which greatly
intensifies the natural inflowing of the sea-atmosphere. The
observation of the disparities between the interior valleys and
the immediate coast, has led to a division of its climate into that
of the coast and the interior. Adopting this division, we have
next to enquire into their adaptedness, as places of residence for
the consumptive. Concerning the interior, we remark that no
condition of atmosphere pertains thereto, which could constitute
it a place of resort for the consumptive. For during the winter,
it is exceedingly damp, and has a foggy, murky atmosphere;
during the summer, an excessively heated and dry atmosphere.
In consequence of its depth, extent, and particular relationship
to bordering mountains, a somewhat confined, and perhaps de-
teriorated atmosphere also characterizes it, because the free

* Perhaps at the conclusion of this essay, we may furnish our own reflections
upon these various points.

1859.] Climate to the Consumptive, Sec. 511

access of circulating currents of air from other and purer regions
is prohibited.

Coast. If, as was formerly supposed, uniformity of tem-
perature be the controlling consideration in the search for a
climate adapted to the consumptive, we think no one can gain-
say the fact, that the thermometrical conditions revealed during
the consideration of the climate of the coast of California, estab-
lish beyond cavil, the existence of a uniformly high temper-
ature. Extreme degrees of cold are prevented from being reach-
ed in the winter season, by the circulation of warm waters off
the coast, which, by elevating the temperature of their own at-
mosphere, act as regulators or modifiers of the land tempera-
tures particularly under the prevalence of the south-west
and west winds, which are shown to prevail along this coast at
this time:* the degree of that modification, being in propor-
tion to the intensity of action of the several physical agents.
At the extreme southern boundary of this coast, where these
agents exert a limited influence, we observe greater variability,
than higher up, where they are more active. On the other hand,
summer excesses are prevented by the circulation of cold masses of
water off the coast, which, by reducing the temperature of their
own atmosphere, and the subsequent wafting of the latter to-
wards the heated interior, lowers the temperature of the coast,
to a moderate stand, and preserves it at a uniform degree, until
in their turn, they are supplanted by the winter currents. So
marked is the effect, in the regulation of the temperature, that
even the spring and autumn, characterized throughout the great
Atlantic plain by changeableness and variability, are rendered
gradual and uniform in the rates of advance and decline of their
individual months, show a high mean temperature, and exhibit
in the monthly ranges of the thermometer, far less fluctuation,
than is found in many situations more highly thought of. But,
as has before been stated, we are not to consider the influence
of any particular condition of the atmosphere or climate ab-
stractedly, but their several conditions connectedly and in asso-
ciation with erch other. For notwithstanding its thermometri-
cal conditions are so favorable, being embraced within narrow

* The north-west wind would also contribute more or less to this effect It
will be remembered, that this wind is often observed at San Francisco.

512 Doughty. An Essay on the Adaptation of [August,

limits, yet if associated with too great relative humidity, the
effect produced upon tbe human system, may be totally differ-
ent from that which would at first appear. We must, therefore,
enquire into the probable degree of its humidity, and after that,
notice the effects of its association with this particular tempera-
ture condition.

We cannot avoid the recognition of the common fact, that the
coast is generally more humid than the interior, more particu-
larly where the general atmospherical circulation is towards the
land. At first blush therefore, we should expect to find the
coast under consideration very moist, but as we have despair-
ed of finding a suitable climate in the interior of countries,
where less dampness exists, we are compelled to select such
coast climates as are comparatively less damp, than the general
rule would signify. Under this view, we hope, from the modi-
fication which the general climatic laws undergo here, by the
intervention of so many physical agents, to show that no viola-
tion of our theoretical climatology of consumption, would be
committed, by suggesting some places along this coast. Cer-
tainly if the various islands of the ocean, and the State of
Florida, whose ample resources for the generation of moisture
are co-equal with their geographical extent, can receive eclat
and praise at the hands of the profession, we may claim some
degree of regard for this part of the Pacific coast, whose facili-
ties are far less, and whose mean temperatures are more uniform
throughout all seasons. If can derive moisture only from two
sources, namely, the fall of rain, and its transfer from the ocean ;
the degree of which in the former case, is dependent upon the
amount of precipitation, and the retentive power of the soil.
The latter, however, constitutes the principal source, for the
general structure does not admit of a retention, but favors, we
b3lieve, an easy disappearance, and besides, the amount of pre-
cipitation is comparatively small. The actual amount, or rather
degree of moisture transferred from the ocean, it is impossible
to state, since it can only be approximatively determined even
by actual measurement with the hygrometer. Measurements of
this character have not been given in the meteorological reports
heretofore made, the various officers engaged in taking the ob-
servations, not having been furnished with suitable instruments

1859.] Climate to the Consumptive, dec. 513

until recently. As a consequence of this fact, the best efforts at
forming or establishing a practical climatology, for the consump-
tive, as well as for all others demanding attention to this point,
must be more or less problematical, if not defective. It is at
present, however, a pleasing gratification for us to know, that
at least so far as the climate of our own country is concerned,
this feature in its meteorology, will no longer be neglected or
withheld, since both the medical staff of the army, and the
Smithsonian Institute, that great patron of science, have adopt-
ed such measures as will surely result in its full accomplish-
ment. That the atmosphere along the Pacific coast is moist, will
not be denied, but that it is injuriously so, may very reasonably
be questioned, for there are some circumstances which militate
against such a supposition. Just here, the testimony of Mr.
Blodget may be usefully employed; while pointing out some
of the differences btween this entire coast and the west of Eu-
rope, he uses the following language.* " This coast atmosphere,
though of low temperature, does #ot appear to be as humid as
that of England and France, notwithstanding the large quantity
of sensible moisture, fog or mist, on the sea-winds at San Fran-
cisco. Below or south of the Columbia River, it is mainly dry
and bracing at all seasons, or the general climatological effect is
such, in contrast to that of Sitka, where the saturation is excessive
and the quantity of rain like that of Burgen, in Norway. The
low temperature southward, is a single and distinct condition,
as it appears; and if it were removed, the whole coast would
much more nearly correspond with that of Europe, where, as
along the west of Spain and of Portugal, the prtvailing features
for this season are dryness and serenity" "The coast south of
Yancouver, is iron-bound, in technical phrase, with a few inden-
tations or deviations from a right line to add to its amount of
exposed surface. For these reasons the sea influences are of less
importance, or penetrate less than they otherwise would, and these
points of identity with other districts, remain but little known."
Again ; as perhaps might be expected, a more sensibly hu-
mid atmosphere is found in the sum ner season, such at least,
seems to be the conviction of writers upon the subject. " Tlie
most remarkable phenomena of weather there, are the summer

* See Blodget's Climatology of the United States, page 195.

514 Doughty. An Essay on the Adaptation of [August,

coast wind and its attendant mist. This seems to be due solely
to the proximity of districts of great heat and sudden rarefac-
tion on the land, to the cold mass of waters off this coast, and
to its refrigerated surface atmosphere." " The attendant mist is
peculiar, and it is evidently a condensation produced by contact
of the cold air alone, and not by natural condensation in the volume
coming from the sea. The air out at sea is usually clear, and the
mist only forms a narrow rolling line along the place of contact
of the volumes differing so widely in temperature. Any cold
jet of air intruded into a mass having a high temperature, will
produce a similar condensation."

Finally, at this point, Mr. Blodget quotes from Dr. Gibbons,
a part of which quotation, we here transcribe, as illustra-
tive of the real amount of humidity during the day. " The sun
shines forth," says he, " with genial warmth, the mercury
rising g3nerally from 50 at sunrise, to 60 or 65 at noon, but
when the sun has reached the zenith the wind rapidly increases,
corning down in gusts fromtthe hills which separate the city
from the ocean, and often bringing with it clouds of mist. But
the ^dampness, is never sufficient to prevent the elevation of clouds
of sand and ddst which past through our streets in the most live-
ly manner."

But again ; even admitting for the sake of argument, a state
of great humidity, the degree of influence exerted by it upon the
well and the sick, must be greatly modified, because of the pecu-
liar temperature with which it is associated, and also the degree
of circulation of the atmosphere. At most places, such a tem-
perature is observed as adds to and materially aids in the inju-
rious effects of humidity of atmosphere upon the system, either
by enfeebling the nervous energies, or by over-stimulation of
them ; but here, it is so mild, moderate and uniform, that it
rather retards and opposes a hurtful influence from the damp-
ness. It is neither a hot nor a cold climate, but occupies a me-
dium position between them, so that it serves to excite to the
requisite extent, all the vital functions of the body, thereby ex-
alting the same to such a state, as would enable it to resist suc-
cessfully, perhaps, the otherwise bad effect of associated mois-
ture. The degree of circulation of the atmosphere, also tends

* The italics are our own.

1859.] Climate to Olc Consumptive, &c. 515

to limit the effect of a condition of great humidity, for it pre-
vents the complete saturation of the strata of air in the immediate
vicinity of the body. Along this coast, the force of the winds is
sometimes considerable, and is at all times sufficient to prevent
even an approximation to that state to which we have just al-
luded. Taking the most unfavorable view of the various asso-
ciated states, we remark, that their effect must be markedly
different and far less injurious, than those places which we have
examined as the favorite resorts, with their excesses of heat and
cold respectively, and their- superadded humidity.

The moderately stimulated vital secretions would be neither
too abundant nor too scanty ; neither too rapidly dissipated nor
too greatly retarded ; the exhalation of carbonic acid unimped-
ed ; the respiratory acts without disturbance, while the activity
of the muscular and nervous structures would be maintained at
a desirable point. Finally, the practical influence of the Pacific
climate upon the animal system, is well delineated by the au-
thor, from whom we have so often quoted. " The elastic at-
mosphere and bracing effect of the Pacific climates, constitute a
striking difference from those of the Eastern States. Whether
due to the absence of humidity alone is not clear, but to whatever
cause it is a notable practical feature. The interior valleys where
the heat is excessive, are similar to the cold coast also, and there
is no climate which is not the reverse of enervating, in its whole ex-
tent. It has generally been held that this distinction has its
origin in the quantity of atmospheric moisture attending the
heat, and this is probably true for the most part, and particu-
larly so of the eastern United States. If, as before stated, the
moisture of the sea-air on the Pacific is relative rather than posi-
tive, or is developed by the contact of great extremes of tem-
perature, the whole may be taken as more dry than it would at
first appear to be, and its uniformly bracing character will not
be difficult to account for. As it is, all residents concur in pro-
nouncing it more favorable to physical and mental activity, than
any (hey have known, from whatever quarter they come."* "There
has yet been no competent observer on the spot, who has taken
up this point and has analysed the singularly invigorating ele-
ments that prevail along so great a range of habitable coast.
* Blodget's Climatology of the United States, pages 200 and 201.

516 Doughty. An Essay on the Adaptation of [August)

Nothing is clearer than that they are present in unusual measure)
and perhaps they are due to Hie low summer temperature, concur*
ring ivith a minimum of moisture, and with the peculiar state of
this minimum quantity."*

Since we commenced investigating the climate of the Pacific
slope, we have seen the following statements in reference to it, in
the American Journal of the Medical Sciences, made by Dr. Hen-
ry Gibbons, in his annual address before the San Francisco Medical
Society. " A few years ago," he remarks, " it was supposed that
the climate of California was almost proof against pulmonary
disease. In 1850, if an individual happened to cough in church,
all eyes were turned on him with curiosity and amazement.
The native population, it was said, were entirely exempt from
disorders of the lungs. But time has dispelled the delusion.
Pulmonary consumption and the kindred affections have be-
come the great enemy of human life, as in the Atlantic States.
Our entire climate everywhere is less injurious, it is true, to pec-
toral disorders than the corresponding latitudes in the Atlantic.
But, the cold and searching winds of the summer on the sea-
board, while they often build up the strength by their bracing
and tonic powers, are in general unfavorable to patients suffer-
ing from the class of maladies under consideration ; and the
extreme heat of the interior is equally noxious, from its debili-
tating influence. The relation of our climate to this class of
diseases may be summed up in a few words. Persons afflicted
with bronchial or pulmonary disorders, in the incipient stage,
are almost invariably benefitted, and oft-times cured by tra-
versing a tropical climate, and taking up their abode in
California. On the other hand, such diseases are developed -
ab initio in this country, about in the same degree as in the
Atlantic States. As the female population increases, the
bills of mortality exhibit a corresponding increase in the num-
ber of victims." " Some years ago, it was a general practice to
send pulmonary cases to the Sandwich Islands. But experience
has shown its futility. We stand in need of some other sanita-

* We have not hesitated freely to extract from this author, because the supe-
rior advantages which he must have enjoyed in the examination of the meteoro-
logical records of the various departments at Washington city, entitle his opin-
ions to the greatest respect and authority.

1859.] Climate to the 0 ic

rium. In many cases, change of climate is the only remedy ;
and a genial climate, not liable to sudden or material fluctua-
tions, and exempt from strong winds, are requisite conditions.
In the summer season, the region bordering on the Bay, at its
northern and southern extremities, may serve the purpose, hold-
ing as it does, a medium place between the damp and chilly
ocean climate of San Francisco, and the arid and scorching heat
of the interior. In the winter we must turn our attention to
the south. Los Angelos and San Diego, in the southern section
of the State, are still too far north. The table-land of Mexico
will probably supply the disideratum. But even in Mexico,
proximity to the ocean must be avoided. Twelve months ago,
in a brief stay at Manzanella, which is on the western coast, in
latitude 19, I observed among the native population, an ex-
traordinary prevalence of pulmonary diseases, caused, in all
probability, by their sleeping on the damp ground, exposed,
more or less, to the cool night wind. Sixty or seventy miles
inland, in the vicinity of Cotima, is a different climate, said to
be much more salubrious. With all the knowledge I now pos-
sess upon the subject, this spot appears preferable to any other,
and accordingly I have lately recommended it to my patients,
instead of the Sandwich Islands. This subject, however, de-
serves much more consideration, than it has yet received."

It is not a little singular, that, at the very moment almost, at
which we are endeavoring to bring to the more favorable no-
tice of the profession, the climate of this State as a sanitarium
for those afflicted with pulmonary consumption, and that too by
an elaborate exposure of its entire meteorology, as handed to
us by direct instrumental observation, we observe the same en-
quiry engaging the. minds of the profession there also, and their
convictions leading them to search still farther southward and
westward. We cannot, however, say that we feel in the least
intimidated, or deem our positions any the less tenable, for
" facts are stubborn things," and figures cannot mislead. And as
those facts were obtained by observations at the place of dispute,
by persons fully competent to the task, and have since under-
gone generalization by others equally competent, by whom they
have been sent forth to be embraced as such, we feel justified in
questioning the authenticity and accuracy of all other observa-

518 Doughty. An Essay on the Adaptation of [August,

tions, that may tend to invalidate them. Whilst therefore, we
may be allowed to express our astonishment at the positions
assumed by Dr. Gibbons in the face of the meteorological record
of the coast, yet we would not be understood as asserting
that they are entirely erroneous, for future and a more
extended consideration of the subject, may demonstrate some
objection not yet brought to light. But, notwithstanding the
object of the writer is to fix the impression, that the climate of
this State is not beneficial to this class of patients, yet we think
that much may be gleaned from the above extracts, which
tends to strengthen the suggestion thrown out by us that of
its possession of such meteorological conditions, as are not una-
dapted to the consumptive. For it seems that the supposition
had obtained, that "the climate of California was almost proof
against pulmonary disease." Indeed such was its strength,
that it amounted to a positive belief or conviction, since the sim-
ple act of coughing by an individual during public worship, at
once placed him in a conspicuous position, and excited " curi-
osity and amazement" in the minds of those, with whom he
worshipped. Furthermore, even tradition itself, with its mysti-
fied records, served to fix deeper this impression, for the native
inhabitants were said to have been " entirely exempt from dis-
orders of the lungs." This supposition, doubtless based upon the
tradition of the past, and the observations of the earliest emi-
grants to this country, assumes far more than we dare do, for
it will be observed, that the idea advanced by us is, not the
capacity of the region to prevent the development of pulmonary
disease in general, nor of pulmonary consumption in particular,
but its failure to present those elements of climate, which have
been elsewhere seen, to favor the supervention of the latter,
and which have j ustly been recognised as effective agents, in the
ripening of the cachectic diathesis, by those who have investi-
gated the relations of climate to this disease. So far from re-
garding this climate as proof against pulmonary lesions in gen-
eral, we would expect to find bronchitic, catarrhal, and pneu-
monic affections quite prevalent, for the reason, that the coolness
of its nights, with the common exposure of the inhabitants to
them, especially in the wet season, would rather predispose to
affections of the mucous membranes, from which that of the res-

1859.] Climate to the Consumptive, d-c. 519

piratory apparatus and of the air passages generally, would not
escape. Even in the summer, especially to those who have re-
moved thither from the Atlantic States, where the divisions of
seasons are sensibly different, with their accustomed disre-
gard of exposure to chilling influences at night, these affections
might be looked for.

Again; following the remarks of our author, we observe in
the sentence immediately following those to which we have
alluded, what appears to be an ambiguity, for after speaking of
disorders of the lungs in general, he here particularizes " pul-
monary consumption and kindred affections," as the great ene-
my of human life, in this State. Does he mean by "kindred
affections." all the other lesions of the respiratory apparatus, or
the general list of cachectic, scrofulous diseases? Certainly all
of the numerous diseases of the pulmonary tissue or organs, are
not kindred to tubercular consumption. Nay more, the exis-
tence of these various other lesions does not entail the necessary
existence, also of consumption, although where the predisposi-
tion to it, is strongly marked, other things being equal, they
may, and do sometimes hasten its development.

But this writer, in summing up the relation of this climate to
pulmonary diseases, fully justifies a reasonable expectation of
benefit to be experienced by a change of air to this region, to
those who are in a condition to remove thither. He says, that
" persons afflicted with bronchial and pulmonary disorders, in
the incipient stages are almost invariably benefitted, and oft-
times cured by traversing a tropical climate, and taking up their
abode in California." Still he would have you understand, that
"such diseases are developed ab inito in this country, about in the
same degree as in the Atlantic States." Does not this remark
favor the suggestion, which we have made, after a careful exami-
nation of the record of its meteorology, that benefit may not un-
reasonably be expected ? For such as he declares to be " almost
invariably benefitted," comprise the only class, who could pos-
sibly undertake the journey, or could hope to be benefitted by
change of climate at all. So far as the effort to counter- balance
this, by a reference to the ratio of its primary development
among the inhabitants, is concerned, wre remark, that there are
some circumstances, which, when taken into account, lessen ma-

520 Doughty. An Essay on the Adaptation of [August,

terially the degree of importance to be attached to the observa-
tion, and in fact to all similar and kindred observations, not
only up to the present time, but for some years to come. For the
very conditions under which this State has become thickly set-
tled in a short time ; the causes of the rapid emigration, among
which we would specify the inordinate stimulus to commercial
enterprise ; the general habits of the emigrants; the character of
the lives which they lead ; the hardships endured by them,
and the necessary exposure undergone in the pursuit of their
objects; their condition of mind, that of frenzied madness for
gold ; their utter disregard of the rules of hygiene ; the wildness
of their speculations ; their constant anxiety and endeavor to
find other and more enriching fields, as was evidenced in the
heedless emigration to Fraser Kiver ; their continued state of
excitement, as was painfully manifested during the late usurpa-
tion and reign of the Vigilance Committees^ their immorality
and dissipation ; and finally the mortification of a defeat of pur-
poses, and the crushing disappointment of large anticipations,
have only administered to the production of such diseases, as
manifest themselves by derangement of the organic, nutritive
processes of the body. It is not astonishing, that a greater pro-
portion of phthisical cases are observed now than formerly,
because, during this period of confusion and excitement, the
system, with the seeds of the disease in many cases already
sown, thus stimulated and taxed to its greatest energies, ap-
peared to contend successfully against these numerous agents ;
but now, that the public mind is becoming more quieted, and
the consequent depression from this former artificial state of
stimulation is taking place, the system becomes an easy prey to
those influences, which have been working gradually but persever-
ingly for its destruction, and readily succumbs to those perverted
vital processes, the result of former indulgencies. Hence it is, that
the delusion spoken of has been dispelled. Hereafter, however,
as the mental and moral condition of the inhabitants becomes
more quieted and improved, and the sins of the past shall have
been atoned for, it will perhaps be found that the climate does
not so readily engender those vices of nutrition, as might be in-
ferred from the remarks of Dr. Gibbons. Moreover, our readers
cannot fail to perceive, that the numerous predisposing and ex-

1859.] Climate to die Consumjjtive, d ;~>21

citing causes, which we have mentioned above, are of them-
selves sufficient to develop if not to beget the predisposition to
pulmonary consumption, independently of any special unadapt-
edness of the climate.

Passing next to a review of the second paragraph of our au-
thor, we are again startled at the revelations of the character of
the climate. ''In many cases,'' says he, " change of climate is
the only remedy ; and a genial climate, not liable to sudden or
material fluctuation, and exempt from strong winds, are requi-
site conditions/' The intimation clearly made here, is to the
effect, that this climate is a prey to such unwholesome condi-
tions. Now we had thought, and certainly we are justified in
the belief, that the coast of this State, at least, was almost entire-
ly free from "sudden or material fluctuations," in the sense in
which those terms are used, as applicable to the eastern United
States, and possessed to an eminent degree a genial climate.
The Army Meteorological Register, contains observations taken
along this coast, and if our understanding of them be correct,
they forbid the apprehension of " sudden and material fluctua-
tions" of temperature. Even previous remarks of Dr. Gibbons,
are somewhat calculated to sustain this criticism, for he says,
that, " so little difference is there in temperature between win-
ter and summer in this wide range of coast, that flannel gar-
ments are constantly worn, and no one thinks of changing the
dress from winter to summer."

"We ought to remark, however, that the Register does not
contain the daily fluctuations of the thermometer, inasmuch as
the general monthly record is sufficiently minute to enable us
to appreciate perhaps correctly, the amount and degree of fluc-
tuation incident to this coast. In our arrangement, we have
endeavored to bring to light, almost every feature at all calcu-
lated to show the vicissitudes of this climate, having preferred
rather to use the negatively proved fact of its mildness and uni-
formity, than to follow the usual course of writers, by comment-
ing upon the positive signs : for under the circumstances,
strong negative evidence amounts to positive proof.

Again ; this gentleman, while he thinks that a place of resi-
dence may be found here for the summer season, totally disre-
gards the idea of a winter residence ; for places " in the south-

522 BotTGHTY. An Essay on the Adaptation of [August,

em section of the State, are still too far north." To this, let
the limited range of the thermometer; the regulated tempera-
ture of the succeeding months ; the general range of the mean
temperatures; the mean of the monthly maxima and mini-
ma; the high monthly mean temperatures; inshort, the
great moderation of temperature observed in every respect,
reply. Surely as represented by these various conditions,
the climate is incomparable to most other regions, much
farther southward. These features of uniformity, high measure of
temperature, and freedom from extreme fluctuations, are un-
mistakeably shown, as true of that part of the coast about San
Francisco and Monterey. Finally, this writer, after attempt-
ing to show that this region will not do as a place of resort for
the consumptive, concludes after a limited search farther south-
ward, that probably the table land of Mexico will be found to
''supply the desideratum." For ourselves, we cannot see in
the climate of this region, any circumstances, which would lead
us to look here for a sanitarium, for notwithstanding it has been
styled " a temperate region in the torrid zone," yet its general
climatic features are too stern for persons of weak habits.
Viewing the entire republic of Mexico, we are free to assert that
we are unable to divine a suitable place for the phthisical, in
either of its three divisions, the tierra caliente, tierra templada,
and tierra frigida. For the first, with its sultry and poisonous
atmosphere, the second, with its excessive humidity, and the
third, with its sternness and frigidity, are alike unadapted.

Again, we may call to our assistance the writings of Mr.
Blodget, which clearly express the ideas, which we have sought
to impress throughout this paper.

He says,* that, " the arid climates of the interior, and the cool
Pacific coast, have been occupied so recently, and so little ob-
served, that it is difficult to trace the climatological geography
of disease there, but enough is known to decide that malarious
diseases are comparatively rare, and that their antagonist forms
as observed in the eastern United States, or the pulmonary
class, are almost unknown from California southward."f

" Humidity is an essential element of each, and in its absence,

* Climatology of the United States, page 460.

f The Italics are our own. *

1859.] Climate to the Consumptive, &c. 523

"both disappear from all districts when the temperature is high
enough to develope malaria." " Over the whole interior and
Pacific region, these affections, (respiratory diseases,*) will be
little known, and in southern California, the climate is far supe-
rior in this respect, to any part of Italy. Equable in temperature,
and, at the same time extremely elastic and dry, it cannot generate
respiratory diseases"

" Of admissions to the city hospital, San Francisco, for nearly
two years, August 7th, lb5L, to July 1st, 1853, there were 84
in a total of 1.870 belonging to the respiratory class. Of these,
but II were of consumption, 45 per thousand of all, and 5.8
per thousand of consumption. It is believed that the cases of
all diseases of this class originating in California, will not reach
4 per cent, in the number of deaths, and will thus stand at less
than one-third of the number in the eastern States." Again;
"geographically the diseases of the respiratory organs of which
consumption is the chief, have their maximum in New Eng-
land, in the latitude of Boston, and diminish in all directions
from this point." But '* the absolute minimum for the continent
in temperate latitudes, is in southern California."

The winds that blow along the coast of California, are those
which are commonly recognised as most conducive to health,
and especially to such invalids as are subjects of pulmonary
consumption, f " Moist and cold air favors the coming on of
tuberculous disease ; and hence living on a sea-coast, with an
easterly marine exposure, is very injurious. Less inconveni-
ence is felt with a western and southern exposure, which is
deemed to be rather sanative, and to offer to the patient the best
prospect for restoration to health."

Again ; \ " south winds are highly ozoniferous and probably
on this account, produce catarrhs and bronchitis. They soothe
and allay a dry and irritable condition of the mucous surfaces of
the air tubes and cells, and greatly alleviate the sufferings, and
indefinitely prolong the existence of the phthisical patient." It

* The Parenthetic sentence is our own, as also all of the numerous succeeding
italics.

f Bell <fc Stokes's Practice, page 252.

\ See American Journal Medical Sciences, vol. lxxviii, page 146. Review
of Pickford on u Hygiene or Health, as depending upon the conditions of the
atmosphere, etc."

N.S. VOL. XV. NO. VIII. 37

524 Doughty. An Essay on the Adaptation of [August,

is possible however, that the strength of the winds, which blow
along this coast, may be, to some extent, objectionable at cer-
tain seasons, but we cannot say, that they are so at all times.
Exercise in the pure air, may be freely engaged in, for, as a
general rule, the number of fair days exceeds the cloudy and
rainy days. Even at San Francisco, where the number of fair
and cloudy days are nearly equal, this principle of hygiene is
not violated, for the proportion of cloudy is about two and a
half times that of the rainy, so that free exercise is not pre-
vented.

Finally, what classes of disease are most prevalent here?
" Epidemics are of rare occurrence in this State," Dysentery
and diarrhoea formerly " were prevalent, and extremely fatal."
But at present, under the improving social condition and habits
of the inhabitants, they are fast disappearing. Limited epi-
demics of cholera were experienced in various localities, in 1850
-51, although "Sacramento was nearly depopulated by it."
Influenza, croup, scarlatina, and diseases of the urinary organs
are also met with, the first of which sometimes manifests itself
as an epidemic. " Insanity, as might be expected, is fearfully
prevalent in California." " Fevers, to which the dubious term
malarious, is conveniently applied are scattered every where,
in city and country, and are often endemic in certain districts."

In conclusion, notwithstanding most of the essential condi-
tions of a climate for the consumptive, have been complied
with by this State, namely, a relatively high and uniform tem-
perature, limited ranges of the thermometer, freedom from great
non -periodic extremes, a moderate dew-point, and abundant
facilities for the exercise of the physical man, and also diver-
sions for the mind, yet much more observation is necessary, be-
fore it can be adopted as the desired place for such. We stand
greatly in need of correct mortuary statistics, not such as are
found in the census reports, for they are entirely too loose and
indefinite to be reliable. In order to demonstrate the true rela-
tionship of the climate to this disease, they must be such as are
deduced from the actual number of deaths among the native
and resident population, and not from the reports of mortality
at army posts, or among the migratory and transient part of
the inhabitants. These latter constitute a frightful source of

1859.] Climate to the Consumptive, &c. 525

disease of all kinds, and form the basis for an incorrect appre-
hension of its climatological geography. They must be exclud-
ed especially from any calculation, purporting to exemplify the
proportion of phthisical cases. Another source of error is found
also among that class of the inhabitants, whether transient or
permanent, who, by their disregard of hygiene and exposure to
all sorts of debilitating influences, both moral and physical,
seem rather of themselves, to force its production in apparent
defiance of the climate. That class then, which should and
must form the only true basis for an exposition of the relations
of climate, to the production of phthisis, becomes reduced to a
small portion of the inhabitants. These are alone to be found
among those, who give the necessary attention to those imperi-
ous prophylactic and hygienic measures, which are universally
recognised as necessary to the health of the vigorous, and whose
moderation and freedom from excesses of every character, both
physical and mental, throw the burden of its production upon
the climate. Until these distinctions are observed in the mor-
tuary statistics of this disease, it is plain that they are defective,
since they only prove that the climate cannot avert the effect of
causes, which are totally independent of it. Such statistics, as
have been published, showing the number of deaths from con-
sumption in California, are in the highest degree objectionable,
because they embrace all of the defiant and incongruous elements
which we have just mentioned. Persons from all classes of so-
ciety, and from all countries, make up its motley population,
and constitute the chief part of those who form the objectionable
parts of society.

ARTICLE XVIII.
An Essay on the Nature and Treatment of Cholera Infantum, read
before the Medical Society of the State of Georgia, at its last
annual meeting, held in Atlanta, April 13th, 1859, by H. AY.
DeSaussure Ford, M. D., Prosector to the Professor of Sur-
gery, in the Medical College of Georgia. (Ordered to be
printed.)

The subject of this Essay, Cholera Infantum, as originally
induced, or rather, commenced during dentition, was chosen,
not as more full of interest, or more novel, than many others,

526 Ford, on Cholera Infantum. [August,

but as one whose pathology, to the vulgus, is somewhat vngue
and obscure, notwithstanding the labored, and extended views
of a host of investigators. If the interpretation of its pathology
shall differ immaterially from the generally accepted one, still
the desire shall be strong, to suggest a different treatment, which
treatment, from observation of its efficacy, shall recommend to
Practitioners, the adoption of a pathology lately disclosed, and
also be urged as an argument to disparage, not only the usual
tmunent, but the generally accepted pathology also.

Infancy is the most critical, most susceptive, period of exis-
tence ; all the organs are in a state of unceasing development
and growth, each dependent on one another, different parts
sympathizing, extensively. If such mutual communion and
interchange exists, then how certainly must the suffering of one
particular organ, or even local disease, extend itself, insinua-
tingly, through the whole economy. If this developing, growing
organism is attacked by morbific causes, the effects escaping the
vigilance of attendants, how disastrous, when we think, that
" disease not merely disturbs the present, but its influence
reaches to the future ; it not only interrupts the present function
of the organ affected, but puts a stop, for a time, to the comple-
tion of the general machinery of the body, or disarranges the
due proportion of one part of that machinery to another."

The particular period, most critical with these little ones, is
dentition, which comprehends the great, and important changes,
which take place in their organisms. The mere mention of the
disease horrifies mothers, who imagine it very painful, rapid, and
always fatal, when not necessarily is it either; the infant may
be subjected to most profuse discharges a striking characteris-
tic of the disease at its onset lingering for many days, without
succumbing; but certainly, from this draining off of the fluids,
each day the tone of the system is impaired, each moment cry-
ing out for prompt and energetic treatment. The ignorant
think infancy is a period peculiarly prone to frequency of dis-
charges from the bowels, without any immediate impairment of
health, and hence physicians are often ushered upon cases, es-
pecially among the poor, which discover to him extreme debili-
ty and deplorable emaciation. While they have to contend
against these indiscretions in the parents delay, they are yet ex-

1859.] Fokd, on Cholera Infantum. 52*S

pected to check these excessive flows from the alimentary canal,
as well as, oftimes, uncontrollable micturition, and are often per-
suaded, by the anxious solicitude of these parents, to administer
opiates immediately.

During the past summer, I treated eight children, who had
Cholera Infantum, all of them teething, and notwithstanding
the swollen gums were scarrified successfully down to the offend-
ing tooth, the symptoms continued, five of them arriving at a
state of almost exhaustion. Here, then, are eight cases which I
followed up, the treatment having been at first, on the old plan,
because they were intended to afford a subject for thought, and
experiment. Induced to counsel with a friend of more expe-
rience, early in the season, on this subject, he suggested a treat-
ment which was adopted, it seeming to answer the demands of
an adopted pathology. In passing, it may be stated, the treat-
ment was successful except in one case, that case, seen the first
time, showed indications that the little one, was " in articulo
mortis."

Discussing the etiology of the disease, Dr. Eberle quoting the
the following from Dr. Condie : " a majority of the children
fall victims to Cholera Infantum, in the neighborhood of marshes,
or in low, wet, or otherwise unhealthy situations," says: "this,
I apprehend, will not be confirmed by the observation of those
who practice in the neighborhood of paludial districts." As if
searching for a contrast, that gentleman commences his next
sentence thus : " Unquestionably, Cholera is much more com-
mon, both in infants, and adults, in such localities, than in high
and salubrious parts of the country, and there can be no doubt
that miasmata have a considerable tendency to favor the oc-
currence of cholera, whether in adults, or in infancy." While
the object of this essay, is intended to dwell, more especially
upon the diarrhoea, and other excretions in Cholera Infantum,
it may be interesting to state, directly in this connection, that
five of the aforesaid cases, were surrounded by intermittents,
their own homes situated upon, or near, the banks of a canal,
such localities noted for being asylums for paroxismal fevers.
There was certainly in each case, an unequivocal paroxismal
feature, leading me to believe, though originally induced by
the irritation of a tooth, yet the disease was signally aggravated

528 Ford, on Cholera Infantum. [August,

by this very malarious influence. Mr. Eberle continues to
argue; "if, however, Koi no-miasmata be the principal agent
concerned in the production of this malady, why is the disease
so exclusively confined to a particular period of infancy in our
cities? and why does it commence so early as the latter part of
June, and usually acquire the most extensive sway in July?"
Now few have advanced the opinion, that the disease is princi-
pally induced by miasmata, yet acknowledging the period of
dentition, the one most prone to its ravages, nor has it been
established that the disease attacks so universally, in the early
summer months, as Eberle would suggest; for, most of our
cases occurred in the latter part of July, continuing into Au-
gust, our hottest and most sultry months; months true, whose
atmosphere is charged heavily with this mysterious miasm.

While confessing that miasm does exert an influence over
the disease, I would be doing my established opinions injus-
tice, to think, with some, it was the sole cause of the affection,
especially since the period of existence, has been so certainly
marked as above, and before all others, the one for its develop-
ment. It is by no means unusual, to see this febrile excitement
continue, after we are confident the irritation, at the gums, has
subsided, which, doubtless, is the first cause of the symptomatic
fever, as well as the excretion from the bowels, and this excite-
ment continuing, too, in a paroxysmal form, as before suggested.

At one time, the disease was thought peculiar to this country;
but it is developed in all climes, from the most salubrious to the
most foul, and pestilential ; notwithstanding, however, this ap-
parent impartiality, it is most prominent and fatal, where
there is high atmospheric heat, with vitiated condition of the
atmosphere, as instanced by its prevalence in our large cities.
"At that period of life, to wit: primary dentition, to which the
disease is almost exclusively confined," says Gholson, " the
physiological development of the digestive organs, in order to pre-
pare for the change of the food in the organism, which the now
rapidly developing process of dentition admonishes to be near
at hand, is so rapid as to amount almost, to a pathological condi-
tion." " This rapid nutrition and growth, seem to be directed,
especially, to the glandular or follicular apparatus ; the morbid-
ly excitable condition of these follicles, and, indeed, the diges-

1859.] Ford, on Cholera Infantum. 529

tive mucous membrane, generally, is so strikingly at this period,
that, taking an a priori view alone, we should naturally expect
choleraic affections to be frequent at this period, and that those
causes which are capable of producing them, at other periods of
life, would, a fortiori, produce them now.''

The disease commences with diarrhoea, eventually resulting
in violent purging and vomiting the irritability of the stomach
sometimes, with the looseness of the bowels, oftener, at a later
period. Thin, watery evacuations, curdled often in their con-
sistence; usually greenish in color; sometimes yellow, or of a
mixed color, and in the latter stages, evident traces of blood.
Unsatisfying thirst, which aggravates the disease; much heat
of surface, except in cases of exceeding prostration ; pulse some-
what accelerated, but natural respiration ; pain and tenderness
of the abdomen, on pressure ; great loss of muscular power, with
sunken eyes, and progressive emaciation ; little or no marked
fever, except when it attacks the brain, or some other organ, or
complicated with paroxysmal fever. There is very great diversity
at different periods, in the color, consistency, and nature of the
dejections ; thin, watery, and profuse at first, then greenish, then
more or less bloody as the disease advances a fatal termination ;
very frequently profuse micturition. Close watching will satis-
fy the attendant, that there is a very decided periodicity in
these vomitings and purgings. " The onset of the disease, may
be sudden and overwhelming. A child will go to bed appa-
rently well. Its mother will be awakened in the night by its
cries and vomiting; and when a light is made, will find it
drenched in those profuse watery discharges, which have been
poured out from its stomach and bowels. These discharges
continue irrepressible, and when morning dawns, she can scarce
recognize, in the pale and haggard aspect, the shrunken and
collapsed features of the dying infant, the rosy-cheeked, bright-
eyed babe, she had, ere now, hushed to sleep with so much
seeming promise of health."

"In the Southern and Western sections of this country, says
Gholson, there is still another type of this disease that type
which results from its being complicated with the prevailing
fever of the country in which it occurs." Five of the cases, be-
fore mentioned, I think, were such as suffered with such compli-

630 Ford, on Cholera Infantum. [August,

cation, viz: Intermittent Fever, which was prevailing in their
midst.

" The Hepatic pathology was, atone time, applied to this, as
indeed to almost every other disease in the southern country.
The absence, however, of any constant lesions in the liver,
prove very conclusively, that those functional disturbances in
this organ, which we frequently observe in this disease, are gen-
erally sympathetic of the gastro-intestinal disease, and play a
secondary and subordinate part in its morbid phenomena. The
only essential pathological element * * * is clearly, and con-
fessedly, the follicular affection, and the only question, at the
present day, connected with its pathology, is as to the nature
of this follicular disease," which, I think, is a mere disease in the
nutrition and secretion of these follicles, for " the irritation may
be transmitted from the gums, through the ganglionic system of
nerves, to the various vascular organs, as the lungs and liver,
and secretory surfaces, and the gastric and intestinal mucous
membrane giving rise to congestions in the one case, and ex-
cessive-secretion, diarrhoea and Cholera Infantum in the other."
In the Southern Medical and Surgical Journal for 1850, in an
article by Professor Campbell of Augusta, we find the following :
" We have now glanced sufficiently, we think, at the Anatomy
and Physiology of the Sympathetic System of Nerves, to make
application of such points as are pertinent in the solution of our
pathological problem. In its anatomy we have seen its connec-
tions with all three of the branches of the fifth nerve by ganglia,
the connection of these various ganglia with each other, as well
as with the cerebro-spinal axis, and lastly, the distribution of
branches from these ganglia, which are connected by the arte-
ries into every part of every one of the splanchnic viscera; in
its Physiology we find it in entire charge of the important func-
tions of nutrition and secretion, and, that wherever these pro-
cesses are effected, it is by the agency of this nerve, alone upon
the blood vessels." Accepting this view of the intimate and
close connection between the fifth pair, sympathetic and cerebro-
spinal axis, we can readily understand the rationale of Eberle's
treatment he says: "within the last four years, I have not
treated an instance of this complaint viz : Cholera Infantum ;
in which I did not at once apply blisters behind the ears, and,

1859.] Ford, on Cholera Infantum. 531

in most instances, with unequivocal advantage." Professor
Campbell continues : " we are all aware that nearly the whole of
the intestinal canal, or rather, that portion between the stomach
and lower part of the colon, receives no direct innervation
from the cerebro -spinal axis, but is entirely dependent upon
the sympathetic nerve for its supply of nervous influence, of
whatever kind it may enjoy, whether motory, sensory, or secre-
tory, and, consequently, an impairment in the function of this
nerve, must, necessarily, correspondently alter its condition.
The alteration in these functions, would, of course, depend in a
great degree, upon the amount of impairment in the source of ir-
ritation. Thus, as we have seen, if the supply be entirely cut
off, the functions of the arteries seem, in a great measure, to
cease passive congestions occur, and the parts inflame and
ulcerate. Now we can also very naturally conceive of a con-
dition of these nerves somewhat analagous to the above, yet
intermediate between the entire interruption, caused by section
and perfect health a condition of embarrassed or perhaps, ex-
alted innervation. This intermediate condition is exactly the
state which, from the developments of the foregoing investiga-
tion, we feel that we are authorized to affirm, is that which
recurs as the result of severe dentition, and that upon it is de-
pendent the whole train of intestinal morbid phenomena obser-
vable during this process. The irritation at first produces sim-
ply an exaltation of the innervation of those secretory surfaces,
and, consequently, secretion is more active than normal, produc-
ing simple diarrhoea."

I have been led to interpret this disease as one of Atony, the
mucous follicles becoming, so to speak, exhausted by the constant
excited secretory action, and unable in such weakness and de-
bility, to establish their normal functions, they call for Thera-
peutic aid. If we then consider it as one of Atony, as well as
febrile excitement, even with inflammation for their is such in
these mucous surfaces during the latter stages and maintain
with Gholson, that the Hepatic pathology, though not positively
absent, yet occupies a subordinate influence, our treatment will
be directed accordingly. Without any consultation with Medi-
cal works on this point,' except to deplore the promiscuous and
frequent use of mercury, I hesitate not to recommend a treat-
k. s. vol. xv. yo. vin. 38

532 Ford, on Cholera Infantum. [August,

merit. In this connection, I may say: if this liver which does
not seem to perform its function from the thin, watery, colour-
less dejections, and this same organ does not present any ana-
tomical lesions, and it is not the original cause of the disease,
what the necessity, or warrant, for dosing the sufferers with the
mercurial preparations ; certainly it cannot be to cloak igno-
rance, and certainly its advocates cannot, in this age, think the
liver and its secretion of bile, the governor of this intricate,
wonderful engine, man! Besides suppose black stools do ap-
pear, is there any warrant that such blackness does not depend
upon an admixture of blood, which has been excited by this
excess of bile washing over these tender mucous tubes?

It was stated in a former connection, that I practiced an ap-
proved treatment, viz: Paregoric or Laudanum, and Hydra-
gyrurn cum Creta, night and morning, and that the patients
were discharged after a day or to, apparently convalescent, this
convalesence, however, proved spurious. Being recalled, I dis-
covered the children equally, if not more so, enfeebled by a se-
cond, sudden, aggression of the disease. I recommend as a good
plan, as far as my individual success is concerned, as well as
scientific reasoning, the following treatment: Sulp. Quinine and
Sulp. Iron, half grain of the former, and quarter of a grain of
the latter, three times daily. Besides a mixture of this kind, I
give sometimes, three doses of the Quinine, commencing early
in the morning, giving one dose every two hours. The rea-
sons for giving the Quinine are obvious, viz: as being the pan-
acea in all coses of febrile excitement, and as relieving conges-
tions, and inflammations, for, says Dr. Kobert Campbell of Au-
gusta, in his published Lectures on Dysentery, " Quinine acts
upon the vascular tissue, to give it tone and contractility .,r

The Sulp. Iron is used as a tonic as well as styptic. Lime-
water, Camphor water, and Bicarbonate Soda, were used freely,
when there was excessive -vomiting ; also mush poultices with
mustard over the epigastric region.

I may add here, that on January 22d, of this year, I was
called to see an infant eighteen months old, who had every
symptom of Cholera Infantum. When I saw her, 12 M., she
had had persistent vomiting and five dejections, since 8 A. M.,
represented as profuse, thin, and watery. The child had not all of

1859.3 Cancer. 533

her teeth, yet the gums were not tense or swollen. I examined
for this, but discovering no apparent irritation at this point, did
not, of course, cut the gums any how. Prescribed 10 gtts.
Paragoric with a little Soda, after every evacuation, until par-
tially under the influence of the opiate. The morning of the
23d., 10 A. M., she was still vomiting had rested very badly,
and had three or four discharges during the night. Unwilling
to push the opiates any further, I resorted to my hobby horse,
a mixture of Quinine and Iron, ordering three doses that day.
Notwithstanding the infant was weak and very sick, my belief
was so strong in the efficacy of the medicine, that she was not
seen again until noon of the 24th, which visit rewarded my
credulity. In a day or two, the child was discharged, with in-
structions that remainder of contents of iv. phial should be
taken. I omitted to state that brandy, in the form of toddy, is a
great adjuvant in the treatment of this disease.

Before closing this, it would be proper, probably, to apolo-
gise for not treating my subject more originally, and more at
length. I deemed it proper to put in as close compass my views
as possible, and these views from my peculiar, and fortunate
surroundings, must, necessarily, be derived, in a great measure,
from the experiences of others, more freely walking the wards
of Hospitals, and hence whatever claims for originality in this
essay I might seem to merit, they are merely practical experi-
ments, upon a scientific principle.

Cancer. Read before the Rutherford County Medical Society,
Nov. 1858. By B. W. Aveht, M. D,. of MuVfreesboro', Tenn.

The following cases of Cancer, which I propose to report to the
Societv, have occurred under my personal observation. They
have been selected from a number of others, as embodying the
most prominent characteristics of this disease, so far as my ob-
servation has extended in its management.

All the cases, except one, have been treated within the last
few years. Notes taken during the progress of each, are relied
upon for correctness.

Case I. James .Mitchell, aged sixty-five, of strictly temperate
habits, originally a large stout man, a farmer by profession, had
noticed for manv years a small tumor upon the back of the right
hand, though not of sufficient importance to produce inconve-
nience. About three years before I saw the case he received

534 Cancer. [August,

a scratch upon the surface of the tumor, from the tooth of a dog.
Inflammation foil wed, the tumor suppurated, and in a short time
assumed a malignant character. The disease continued to in-
crease, until the whole hand became involved. He is now suf-
fering great pain from it, the hand is almost entirely destroyed,
and is the seat of frequent and violent attacks of homorrhage.
His general health is bad, he is much emaciated, and has hectic
fever and night sweats. Amputation was determined on as offer-
ing the only hope of relief.

On the 25th October, 1845, the operation was performed below
the elbow. Nothing occurred during or after the operation to
embarrass the case. His recovery was unusually rapid. He
soon recovered his former health, and was able again to attend
to the business of his farm. I saw the old gentleman four months
after the operation, when he informed me that he had not felt so
well for many years. In less than one year, however, from this
time, I was requested to visit Mr. Mitchell, and found a tumor
about the size of a turkey's egg, just below, and near the sternal
end of the clavicle of the same side. It was quite hard, and had
every appearance of maliglancy. I did not see him afterwards,
but learned from his physician that the tumor soon softened, com-
municated with the lungs, and that he died in a short time with
pulmonary disease.

In this case there was no appearance of disease in the stump.
He died about fifteen months after the removal of the limb.

Case II. On the 8th of April, 1854, I removed the entire right
breast of a negro woman, aged thirty-five years, who was the sub-
ject of scirrhus cancer, involving about two-thirds of the gland.
This patient had enjoyed good health up to the time of the ap-
pearance of the tumor in the breast. She was the mother of
several children, all of whom were healthy. About three years
previous to the operation, the disease first made its appearance.
The gland had become quite painful, and had ulcerated at two
points. Her general health had not suffered to any great extent,
but recently there had been a more rapid decline.

The tumor being very large, the incision for its removal was
necessarily along one. The lips of the wound were brought
together, and confined by sutures and adhesive straps. In twenty
days the cicatrix was complete. Her health improved rapidly ;
so great was the improvement, that only a few weeks elapsed
until she was able to perform the ordinary house labor of a fe-
male servant. I think she was the weaver of the family.

About a year after the operation, this patient presented herself
again for treatment. A tumor, the size of a hen's egg, had formed
in the axilla of the same side. It was of some two or three
months standing, quite painful and hard, except at one point,
which evidently showed the presence of fluid. It was opened

1859.] Cancer. 535

with the lancet, and its contents discharged. This proved to be
a semi-transparent fluid, containing a small quantity of pus. It
was contained in a sac, which separated it from the main body
of the tumor. A month afterwards I examined the tumor again,
when an operation for its entire removal was determined on.
Before the appointed time arrived, however, the tumor had taken
on an acute form of inflammation, which had extended from the
axilla to the spine. The operation was not attempted. She died
two weeks afterwards.

There was no return of disease in the original location. The
cicatrix remained sound. This patient survived the operation
fourteen months.

Case III. In the month of September, 1855, I was requested
to visit a negro boy, in an adjoining county, for the purpose of
removing a tumor from the left scrotum. This patient was ten
years old, in good health, and well grown ior a lad of his age.
His parents were healthy. The tumor was hard, unyielding, and
quite heavy. It had never been painful, and was only, trouble-
some from its weight and size. Its first appearance was detected
about three years before I saw him. The growth of it had been
continuous, though more rapid for the last four or five months.

Assisted by l)r. Donoho of Cainesville, and Dr. Smith, of
Murfreesboro', I removed the entire tumor, together with the left
testis, which was involved in the general mass. The tumor after
its removal, weighed lib. 8oz , and proved on examination to be
malignant. Recovery was very prompt in this case. The boy
seemed to be in the enjoyment of uninterrupted good health for
about nine months. The first intimation of a relapse in this case
was the discovery of a tumor of considerable size in the cavity
of the abdomen, which from its location, was thought to be an
enlargement of the spleen. Subsequently, however, it was found
to be a distinct growth, situated in the epigastric region. Con-
stitutional symptoms of a grave character soon supervened, at-
tended with dropsical effusion, particularly within the abdomen.
To relieve the distension it was thought advisable to perform
paracentesis abdominis, which had been done on one or two oc-
casions by Dr. Donoho who had charge of the case. His decline
was rapid. He died thirteen months after the removal of the
tumor. There was no return of the disease at the point of the
operation. The cicatrix was complete, and remained so up to
the time of death.

A post-mortem examination was obtained, which revealed the
presence of a large diseased mass within the cavity of the abdo-
men, evidently malignant in its character.

Case IV. In November, 1855, Dr Burke, of this county, re-
quested me to examine with him, a negro woman, whom he had
had under treatment for a year or more, for a sore upon her leg.

536 Cancer. [August,

This patient was forty years old, and the mother of several
children. Her health had generally been good until recently.
Most of her sufferings she attributed to the condition of the leg,
which was probably true. An examination of the case showed,
the presence of a fungoid growth, two inches in diameter, situated
on the front of the lower third of the tibia. This disease origina-
ted from a small tumor discovered five years previously, but
which at first was not of sufficient importance to excite much
attention. In a year or two it gave evidence of growth, and
fmally from some imprudence became inflamed, suppurated, and
did not afterwards heal. Within the last few months there had
been quite an increase of disease in the parts. Various escharo-
tics had been used with a view of removing the fungoid formation,
but without success, each slough being followed by a reproduc-
tion of a similar character.

I dissected out the entire growth in this case with the knife,
extending the incision for some distance beyond where there
seemed to be any appearance of disease. The sound skin on each
side of the leg was divided, and partially dissected up, so as to
afford a covering to the original seat of the sore. The dressings
consisted of adhesive straps firmly applied, and the bandage.
The healing process progressed finely, until there was almost an
entire closing of the wounds made in the operation. At one
time she reported herself well. In a month or two though, there
was a relapse in the original "location, manifestly assuming the
same character. All hope of success by the means thus far em-
ployed having failed, amputation was determined on as offering
the only remaining prospect of relief. The limb was taken off
below the knee. A healthy cicatrix of the stump followed. Her
general health signally improved, and in a short time she seemed
to be free from all disease.

Six months after the removal of the limb, another tumor made
its appearance in the groin, which grew with unusual rapidity.
The parts soon suppurated, a fungus nematodes was developed,
constitutional symptoms followed, and the patient soon became
a prey to the disease. She survived the operation twelve months.
The stump continued sound.

Case V. February 1st, 1857. Robert Belt consulted me to-
day on account of an enlargement of the left testis, which he
savs has been approaching its present size for a period of years.
The gland has recently become quite painful, and from its weight
has been a source of great annoyance. The organ is now about
treble the dimentions of the other. It is hard and unyielding,
except at one-or two points, which show the presence of fluid.
The age of the patient is about twenty years. He is small in
stature, and has the appearance of general bad health. This con-
dition though be attributes to an attack of intermittent fever from

1859.] Cancer. 537

which he has had a slow recovery. I can discover no symptoms
showing the lesion of other organs. The removal of the testis is
advised.

Assisted by Drs. Baskette and Smith, a few days after the ex-
amination mentioned above, I extirpated the testis. He had a
speedy recovery. In three weeks he returned home with the
wound healed. His health also improved very perceptibly. A \
examination of the specimen after its removal, satisfied us that it
was malignant in its character.

I did not see the patient after h;s return home, but through the
kindness of Dr. Geo. W. Robinson, who had the subsequent
management of the case, I am enabled to give the following facts :
"At your request I will give a brief statement of the case uf
Robert Belt after your operation. After his return home, his
health appeared better than usual for about three months. In
July I think he consulted me in regard to some pain he felt at
times in his abdomen. Upon examination I found within the
abdomen two or three large unyielding tumors, also another of
considerable size, just above the clavicle of the left side. Rapid
emaciation ensued. His bowels were constantly costive, and
were moved only when urged by medicine. At times his ab-
dominal pains were acute in the highest degree. The cicatrix
remained sound and healthy. His death took place about the
first of December,"

This patient survived the operation ten months.

That the above cases may be brought more definitely before
the Society, I now propose to throw together in statistical *hape,
the age of each patient, as well as the length of time that each sur-
vived the operation

AGE. DIED.

15 months after the operation.
14 "
13 "

12 " " "

h 5 20 " 10 " " "

Reference to the above figures show that these patients (though
few in number.) embrace ages ranging from ten to sixty vears.
The average age is thirty-three years. The average lenth of life
after the operation is thirteen months. The length of time from
the date of each operation clearlv proves that age did not influence
the result. The same fact obtains .as regards the selection of the
local deposition. It will be remembered that these operations
were performed on different parts of the body : 1st, The removal
of an arm; 2d, An entire mamary gland ; 3d, A tumor involving
the testis; 4th, An inferior extremity ; 5th, A testis ; yet no one
of these locations seemed to have exerted any beneficial influence
over another in protracting the life of the subject. There is
another fact in connection with this part of the subject worthy

Case 1.

60 years.

" 2. '

35 "

" 3.

10 "

" 4.

40 "

538 Cancer. [August,

of notice, which is the length of life after the operation compared
with the duration of the disease in each case, previous to that in-
terference. The duration of the disease previous to the operations
seems to have had no controlling influence upon the length of life
afterwards. The patient that had been the subject of the local
affection the greatest number of years, proved to be the longest
liver after the operation. A question of great practical impor-
tance might arise in this connection. Would these patients have
died within an average of thirteen months from the date of the
operations had none been performed ? Or in other words, does
the removal of a cancerous growth tend to establish a relative
limit to life? These cases certainly give an affirmative answer
to such a question. The great majority of cases, as we gather
them from statistical calculations go to strengthen this position.
But these reflections are leading me from other considerations
connected with this subject, which are probably of equal, if not
of greater importance.

The cases reported very clearly prove the following facts :

1. That a wound made for the removal of a cancerous growth
including the entire local disease, will, under ordinary circum-
stances, heal with great promptness, and that the cicatrix may
remain sound. Such was the result in each of these cases.

2. That neither the integrity of the cicatrix nor the sudden re-
turn of health which may follow an operation, affords any immu-
nity whatever from a subsequent relapse.

3. That the secondary manifestations are apt to appear in or-
gans more immediately essential to life, accounting in a great
degree for the remarkable limit to the duration of life after an
operation.

The conclusions ded%cible from these propositions are, first, that
cancer is dependent upon constitutional dyscrasia,# which cannot
be eradicated by any topical appliances, however successful they
m3y be in relieving the local distress; and secondly, that no
beneficial results are to be hoped for by the mere removal of a
cancerous growth, but on the contrary rather is it to be expected
that in the majority of cases the transfer of the cancer irritation
to important organs, will prove more signally disasterous to life.
If this view of the subject be true, as well might we expect to cure
a case of syphilis by cauterizing the chancre, or to eradicate
scrofula by the extirpation of an enlarged lymphatic gland, as to
relieve a case of cancer by the mere removal of a tumor, it being
but the local manifestation of a constitutional vice.

It is proper, however, to remark, that the doctrine of the con-
stitutional nature of cancer is not universally admitted by patholo-
gists. It is affirmed by many entitled to credit, that cancer in its
first inception, is purely a local disease, and only becomes constitu-
tional in its progress and secondary development. In the French

1859.] Cancer. 539

schools of medicine may be found numerous advocates of this
theory. Amongst these Velpeau may be considered as occupying
the most prominent position. A very animated discussion upon
this subject occurred in the Academy of Medicine, Paris, in 1854,
in which MM. Robert and Velpeau were the principal disputants,
the first affirming and the second denying the presence of this
peculiar diathesis as essential to the existence of cancer. The
great discrepancy in the result ofVelpeau's operations, when
compared with other surgeons, induced M. Robert to call in ques-
tion the correctness of his diagnosis. His success certainly has
not been experienced by other surgeons.

Taking the generally received opinion as testimony upon this
subject, there would seem to be but little doubt remaining as to
the necessity of some peculiar diathesis in the production of this
disease. What that diathesis is, and what circumstances are
necessary to excite it to the development of a cancer growth,
are questions which pathologists have not thus far been able to
explain.

The difficulty experienced in correctly diagnosing a case of
cancer, has given rise to many of the conflicting opinions which
have heretofore obtained on this subject, and which at present lie
in the way of reliable investigation. Notwithstanding so much
has been written, and so much of theory promulgated, aiming at
this one object, yet it cannot now be said with truth that there is
a single pathognomonic characteristic, by which the cancerous
diathesis, or even a cancer tumor may be unqualifiedly recogniz-
ed. The aid afforded by the microscope in detecting the presence
of the cancer cell, as it has been denominated, though at one time
considered an unerring acquisition, is now only relied upon to a
limited extent. Recent experiments have clearly proven that
cancer may exist with or without this peculiar cell formation.
It is farther claimed that tumors presenting the ordinary indica-
tions of benign growths, do occasionally contain cells, in which
this peculiar conformation may be recognized. The following
examples are in point : About the first of August last, I removed
a tumor from the thigh of a negro man, which was attached by a
pedicle to the skin and cellular substance immediately beneath it.
An examination of the tumor after its removal with the naked
eye showed that it was only a benign fibrous growth. A small
quantity of fluid, squeezed from it, was tested by the microscope,
when a most interesting and beautiful display of cancer cells was
presented. Another case, in a dying condition, from the secon-
dary formation of a malignant growth, was submitted to the same
test, when not a single cancer cell could be discovered. It might
be argued, however, that in the first of these cases, the dia-
thesis existed, and that the tumor, though benign in its character,
was selected as the most acceptable location for the deposition of

540 Cancer. [August,

the cancer cells ; whilst in the second, the specimen obtained
might not have been a true representation of the growth from
which it was extracted. Such conclusions, were these the only
examples, might with some degree of cogency be entertained,
but strengthened as they are by similar results, entitle them at
least to some degree of confidence.

There is one theory of this disease, which pathologists with
few exceptions adopt. It is now almost universally conceded,
that the development of cancer is the result of some anomaly of the
blood, which anomaly is primary to, and productive of, the peculiar
dyscrasis or cancer diathesis. What the peculiar condition of
the blood is which produces the effect in question, neither the tests
of the microscope, nor chemical analysis, have thus far explained.
The experiments made though, have done some good in the en-
couragement afforded through partial results favoring some of
the characteristics observable in cancer. We are still left, how-
ever, unadvised as to what is the true pathology of the disease.

Before closing these observations, I wish to call the attention
of the members to a few thoughts, which, though somewhat specu-
lative, seem not to be contradicted by many of the leading features
which characterize the cancer dyscrasis.

Taking the assumption as true, that the constitutional vice is
seated in the blood, a legitimate enquiry suggests a farther inves-
tigation of the qualitative nature of the fluid, in its departure from
the healthy crasis. Disease dependent upon anomalies of the
blood, results ordinarily from one of two conditions. The first
is that in which defective action is manifested; the consequence
of anaemic anomaly. The second is the reverse of the first, and
results from a state of the constitution denominated plethora,
hypinosis, or in contradistinction to anaemia, may be termed
hyperemia. Without stopping to enquire into the specific char-
acter of the blood in these adverse conditions of the system, the
general conclusion must be that whenever disease supervenes in
the two, it cannot be identical. In the one it is observable in
defective innervation, in the other in exalted vital action, conse-
quently the diathesis of one must be dissimilar to the other in
direct ratio to the extent of the departure. It was by this plan
of investigation that the present pathology of phthisis pulmonalis
was arrived at. It is now a well established principle that the
formation of tubercle is the consequence of defective vital powers,
in which innervation is at fault. An observance of this principle
has led to important practical results. The treatment once adopt-
ed in consumption is now abandoned, and though it is still an in-
curable disease, its subjects are enabled to live longer than hereto-
fore. And to such as have hereditary taints, almost an entire
immunity from its tendencies may be enjoyed, by attention to a
course of living, the object of which is to build up the constitution,

1859.] Cancer. 541

and to keep the vital forces in full performance of their several
functions.

Could we learn this much of the pathology of cancer, the prac-
tical results would be equally valuable. And why may we not ?

To apply this purity of reasoning to the subject under consid-
eration would lead at once to the enquiry, as to which of these
conditions are primary in the cancer diathesis. Does this disease
have for its primary cause the same qualitative character of the
blood that obtains in tuberculosis? All pathologists, I believe,
acknowledge that it does not. A comparison of the subjects of
the two affections, their modes of life, the onslaught of the disease
in each, as well as the progress and development, all go to prove
the dissimilaritv. This absence of identity does not obtain from
a want of relative frequency of attack in different organs of the
body, but in the character of attack, and the pathological condition
shown in the localization of each.

Take cancer patients as a whole, examine their habits of life,
together with the peculiar constitutional tendencies that have
characterized them previous to the manifestation of the disease,
and much will be found to establish the fact that it is from an ex-
hausted state of the vital functions that the anomalous changes
originate.

The statistical tables of cancer show that the largest number of
cases occur about the period oi life when all the vital powers of
the system have arrived at the acme of physiological function,
and when a change is about to take place in which the producing
and expending processes are involved. Then it is that we might
reasonably expect a manifestation of whatever morbid phenomena
the circumstances of previous years had been instrumental in ac-
cumulating. Take for example the case of a female, who has
lived through the years of reproductive life, whose health has
been good, and whose catamenial functions have never been at
fault, bring her to that period when a change has to take place,
when the monthly flow has to cease, and when all the relations of
functional life have to adapt themselves to new modifications,
and we have pictured a proper subject according to statistical
history, for the development of cancer diathesis. At this period
the mammary glands and the uterus are peculiarly influenced ; a
hypertrophied form of disease appears in the one or the other,
which we denominate cancer. Or in the other sex, take the man,
who has lived at ease, who has kept his blood rich by indulgences
in the luxuries of the table, and the use of alcoholic drinks ; bring
him to ihe period when the equilibrium of functional life has to
be changed, and the same statistical record shows this to be the
time when the cancer tumor more often makes its appearance.
Reverse these pictures, and you will find but few instances of the
supervention of the cancer diathesis or the presence of malignant
growths.

512 On the Otorrhoea of Children. [August,

A few practical observations may with propriety be brought
to strengthen this position. It cannot but be remarked that sud-
den and active improvement of the general health not only occur-
red in the cases reported above, but that this condition almost
invariably follows operations for the removal of cancerous growths.
It is equally remarkable that a relapse of the disease usually takes
place at the time when the general health of the subject seems
to be entirely re-established. Paget makes a robust constitution
and the active performance of the vital forces, obstacles to the
removal of a cancer tumor, and even urges the propriety of
abandoning the operation under circumstances of this character.
Rokitansky has observed cancer tumors sometimes to disappear
when the constitution has suffered from attacks of other diseases,
or where the richness of the blood has been reduced by privations.
It is not improbable that occasionally, both the cancer diathesis
and the cancer deposit, are so modified by circumstances of this
character, as to result in an entire eradication of the disease.

If then these speculations should prove to be true, and an ob-
servance of them be adopted in the treatment of cancer, might
we not expect practical results more flattering than those that
have heretofore attended the efforts of the profession? The treat-
ment of cancer has seldom extended beyond the local deposition,
and will always be ineffective as long as this course is pursued.
Should the researches of pathologists, however, succeed in bring-
ing to light a more rational diagnosis in which the cause and
effect, proximate and remote, of this disease, can be arrived at,
the hope may be a vain one which might look forward to the time
when it will be classed amongst the maladies of life amenable
to treatment. But in the present state of our science, remedial
agents, whether locally or constitutionally administered, seem to
possess but little efficacy in removing the disease, or even protract-
ing to any great extent the life of the subject. \_Nashville Med.
and Surg. Journal.

On the Otorrhea of Young Children. Translated for the Boston
Medical and Surgical Journal, from the Journal fur Kinder-
krankheilen.

Otorkhcea, or a discharge or running from the ear, consists, in
very many cases, of merely a chronic inflammation of the ex-
ternal passage of the ear, which has given rise to an increased
secretion. The inflammation is usually confined to the external
portion of the meatus, but sometimes extends to the surface of
the membrane of the tympanum. The disease is most frequent-
ly observed in children, although it is not rare in adults. In
the former, it is generally accompanied by a tendency to glan-
dular engorgements, with symptoms of general debility ; in

1859.] On the Otorrhcea of Children. 5-43

adults, it is also the sign of a depressed condition of health.
The exciting cause may be a blow upon the ear, the employ-
ment of irritating local applications to the ear, or any acute
inflammation of the lining membrane of the meatus; but the
most frequent causes are scarlet fever, measles, or catarrhs.
Often no cause can be discovered ; the children complain of a
slight iritation in the ear, which they seek to alia}7 by introdu-
cing the finger, or a little stick, and the irritation disappears
when the discharge begins. Sometimes, however, the discharge
is the first symptom of the disease. In the early stages, the hear-
ing is only slightly diminished by the disease, even when the in-
flammation and swelling extend to the external surface of the
membrane of the tympanum ; but when the disease has existed
for any length of time, the membrane itself participates in it,
and dullness of hearing, or deafness ensues. Moreover, it must
be borne in mind, that catarrh of the meatus and external sur-
face of the tympanum, is often but a symptom of irritation with-
in tfie tympanum, and ceases as soon as this irritation is removed.
After the disease has existed some time, there is often consid-
erable irritation of the meatus, amounting, at times, to acute
pain, with occasionally slight haemorrhage. Haemorrhage is
more frequent, however, when there is a polypus in the meatus.

On examination of the meatus, its lining membrane is found
to be thicker than usual, and sometimes so much so as to close
the passage entirely. In many cases the membrane is red, and
destitute of epithelium ; on the other hand, it is frequently
white, and covered with a thick epithelial layer. The secretion
is generally very foetid, of various colors ; sometimes of a milk-
white, at others, of a dark slate color ; and whatever its quanti-
ty, color, or consistence, it never contains flocculi, but when
mixed with water, renders it cloudy.

It need hardly be said that polypus sometimes exists along
with chronic catarrh of the meatus. In such cases there is
bleeding from the ear, and flocculi are found in the secretion.
The latter are also found when there is ulceration of the fibrous
tissue of the membrana tympani, in which case blood is often
mixed with the secretion. If the catarrhal inflammation extends
to the mucous surface of the membrana, the latter becomes,
like the meatus, thickened, and often very much congested.
The membrane then loses its natural color and form ; if we are
able to employ a speculum, the outer surface is seen to be flatter
than usual, and, in consequence of its thickening, neither the
long nor the short process of the stapes is visible.

In the treatment of catarrhal otorrhcea, it is of the first import-
ance to remove the secretion, and keep the meatus clean. This is
best done by frequent syringing with lukewarm water. If there
be so much pain or tenderness that the syringe can not be used, one

544 Case of Popliteal Aneurism. [August,

or two leeches must be applied to the outer edge of the meatus,
followed by warm fomentations or poultices, or the vapor of
warm water may be directed upon the ear. After all tender-
ness is removed, and the meatus cleansed from the secretion,
weak astringent solutions should be injected, and moderate
counter-irritation applied to the mastoid process. These simple
means, in connection with remedies for improving the general
health, especially tonics, suffice, in very many cases, for curing
the discharge. In very obstinate cases, the counter-irritation to
the mistoid process must be maintained, so as to keep up an
artificial discharge, which is best done by means of croton oil ;
and a strong solution of nitrate of silver, (ten to forty grains to
the ounce,) should be thrown into the meatus every third day,
by means of a glass syringe.

There are cases, however, which resist this treatment, the dis-
charge continuing unchanged for two or three months. The
treatment should then be steadily persevered in, as it may at
least prevent ulceration of the membrane of the tympanum, ca-
ries of the bones, and the development of polypi.

Report of a Case of Popliteal Aneurism, successfully treated by con-
tinued Flexion of the Knee- Joint. By Alexander Shaw,
Esq., Surgeon to the Middlesex Hospital, etc.

At a recent meeting of the Eoyal Medical and Chirurgical So-
ciety of London, Mr. Alexander Shaw, Surgeon to Middlesex
Hospital, reported a case of successful treatment of Popliteal
Aneurism, by the above method which seems to have been re-
cently particularly recommended by Mr. Ernest Hart, of the
West London Hospital. Any successful endeavor to avoid the
use of the knife, by so simple and practicable an expedient,
well deserves the attention of the profession. Other cases are
reported the following, is perhaps the most striking :

The patient, aged thirty, first perceived a pulsating tumor in
the left ham a week before his admission into the Middlesex
Hospital. It was of the size of a lemon, occupied the centre
of the popliteal space ; was easily compressed ; the pulsation
was strong, and there were other signs of its being a recent
aneurism. On December 1st., the knee was secured in the
bent position, by a band brought round the foot and thigh, and
fixed near the hip. The immediate effect of the flexion was
that the patient ceased to feel the beating of the tumor, and that
ou inserting the oiled finger into the flexure behind the knee,

1859.] Case of Popliteal Aneunt 545

no pulsation could be discerned. On the fourth day, when the
limb was unbound, the tumor was found to have lost about a
third of its original size; its walls were thicker and denser, the
force of the pulsation was considerably diminished, and the sac
had receded more deeply into the popliteal cavity. Gradual
improvement continued to take place. Between the third and
fourth week from the commencement of the treatment, the sac
had become greatly reduced in size ; its walls appeared nearly
solid, and the pulsation was so faint, that it was expected at
each visit to find it extinct. The treatment was varied, by oc-
casionally undoing the strap, which confined the knee, for sev-
eral hours together ; but owing to the stiffness caused by the
long continuance of the flexion, the position of the joint was
not much altered by the relaxation. I was not till the thirty-
eighth day that the pulsation in the tumor altogether ceased.
The sac was at the time about the size of a walnut. The pa-
tient gradually recovered the power of extending the joint. On
the fiftieth day, he could walk with only a slight halt, and on the
fifty-sixth day he was discharged. During the first ten days,
the patient complained of the pain, as well as the irksomeness,
of keeping his knee constantly bent; and for a slight swelling
of the joint, a lead lotion was applied. Afterwards, he made
light of the inconvenience, and never at any time asked to have
the belt relaxed.

At the close of the case, the author offered a few brief re-
marks on the principle on which the cure was effected, and, in
illustration, added the observation that, by extreme flexion of
the knee-joint of a sound limb, the force of the current of blood
through the popliteal artery can be weakened to such a degree,
as to cause stoppage of pulsation in the tibial arteries.

Mr. Fergusson eulogized the papers read, and said he regard-
ed the proceeding described by Mr. Hart as a valuable addition
to the practice of surgery. He spoke of the value of pressure
generally, in the treatment of aneurism, and also of u manipula-
tion" modes of treatment which he thought would set aside,
in many instances, the necessity for the kinfe. In the plan pur-
sued in the cases before the Society, there might be failures, but
this was no reason why we should discard the method, but
should rather encourage us to persevere to determine the real
value of the proceeding. The plan was not altogether novel,
for it had been tried three or four years since in King's College
Hospital. One of his house-surgeons had ascertained, in a case
of popliteal aneurism, that when the leg was flexed upon the
thigh, the pulsation of the tumor ceased. The aneurism was
of the size of the fist, and was treated by pressure in the groin,
and by flexure of the leg upon the thigh. This was persever-
ed iu for some time, but without benefit. The man, being im-

546 Case of Popliteal Aneurism. [August,

patient of treatment, left the hospital and died of some other
disease. To show the influence of position in certain cases of
aneurism, he related a case of that disease in the popliteal space,
in which the emj-loyment of pressure gave encouraging, but
tardy results. It was found in this case, that on extending the
leg to its full degree, after the employment of pressure, all pul-
sation in the tumor ceased.

Mr. Birkett briefly referred to three cases of aneurism, treat-
ed by pressure which had come under his notice, in Guy's Hos-
pital. In one case, ordinary pressure in the groin was applied ;
then pressure by flexion. Neither did good, but it must be ad-
mitted that they were not fairly tried. The femoral artery was
afterwards tied, and the patient recovered. In the second case,
ordinary pressure was applied at first with success; but sudden-
ly the tumor became much enlarged, the femoral was tied, and
the patient did well. In the third case, the patient, a man, had
an aneurism in the right popliteal space. Pressure was tried,
and in founteen days he appeared well. The tumor contracted,
and felt like a small hard ball. Flexion was then resorted to,
but not persevered in, and ordinary pressure was again employ-
ed. The aneurism, however, gave way, and the femoral had to
be tied. The man subsequently had a small aneurism in the
left popliteal space ; he would not submit to flexion, so the fem-
oral vessel was securred.

Mr. Savory said that these cases were especially interesting
and instructive in their relation to the physiology of the blood-
vessels. It was familiarly known that a transverse wound of
an artery gaped widely, and that when an artery was complete-
ly divided, the ends retracted. Yet these important facts had
seldom received more than a passing notice. They had never
been explained. To what was this retraction due? The mus-
cular tissue was in no way concerned in it, for it occurred at a
long period after death, as well as during life. Neither would
elasticity alone explain it. Another condition was required,
and that was tention. The arteries were elastic tubes, always
tense; so that, when divided, by no management of posture or
position could the retracted ends be. brought into apposition.
The extent of the retraction was a measure, then, not of their
elasticity, but of their tension. This constant state bf tension
was obviously connected with their purpose; by it their paten-
cy, under every variety of movement and position, was secured.
But this rule had its exceptions, and these were to be found at
the knee and elbow joints. At these parts, when an artery was
divided, extreme flexion would bring their ends into apposi-
tion ; but in this position, and for this very reason, the course
of the vessel was interrupted ; the course of the blood through
it was impeded ; the pulse ceased in the limb beyond. Thus

1859.] Puerperal Convulsions. 547

tie conceived was explained the principles upon which the cure
of aneurism by this means was accomplished. It was not due
to pressure in the sense in which that term had been employed.
It was due to the fact that the circulation through the artery at
a short distance on the distal side of the sac was arrested ; so
that, as far as thd principle was concerned, it would probably
succeed, whatever part of the popliteal space the aneurism occu-
pied. Now, in connexion with this interesting fact the arrest
of the current through the artery, by extreme flexion of the
limb Mr. Nunn, in some observations on the arrangement of
the arteries of the limbs, recently published, has alluded to the
remarkably free anastomosis which existed around these joints.
They were clearly for the purpose, as he said, of compensating
for the occasional interruption through the main channel. He
(Mr. Savory,) added, this plan of treatment appeared free from
one grave objection to the ordinary treatment by compression,
namely, of interfering with venous circulation. For although
in extreme flexion, the current through the main vein was in-
terrupted also, yet here there was also an abundant superficial
venous anastomosis around. The veins, like the arteries, were
elastic, and to say the least, were equally tense. [ Lancet.

Puerperal Convulsions. By FRANCIS H. EAMSBOTHAM, M.D.,
Obstetric Physician to the London Hospital, etc.

On Monday, February 7, 1859, at 5 P. M., I was sent for by
Mr. Pryce,'of Walworth, to Mrs. G., Beresford street, aged
twenty-eight, a stout, plethoric woman, pregnant for the first time,
between six and seven months. She had complained, for six
days before the attack, of drowsiness, confusion of ideas, with
slight pain in the head, stertorous breathing, and puffy hands and
face. She had never been the subject of hysteric or epileptic fits.
In the afternoon of Sunday she experienced a severe attack of
vomiting and purging, and at 9, P M , was seized with a violent
convulsion. The fits recurred very frequently the people about
her said every ten minutes through the night and during Mon-
day. She remained perfectly insensible the whole time, her
breathing heavy and stertorous. On my arrival however, there
had been an intermission of nearly an hour free from fits, and she
had just swallowed two or three tea-spoonsful of tea for the first
time since the beginning of the seizure. Nevertheless she was
still quite unconscious, with widely-dilated pupils, acting sluggish-
ly to the stimulus of light. The uterus occasionally became hard,
and there seemed to be a disposition for the commencement of
premature labor. She had been bled twice during the night,

K.S. VOL. XV. KO. VIIL 39

548 Antiquity of Metal Sutures. [August,

losing about thirty ounces of blood at the two operations; and in
the day had been cupped on the back of the neck, and twelve
leeches had been applied to her temples. The hair had been cut
off, ice was applied to the head, and a turpentine enema had been
administered, which had brought away a large quantity of fcetid
stools. I had some difficulty in reaching the os uteri with my
finger, for it was very high, and inclined more than usually back-
ward. It was dilated to the sixpence, just admitting the end of
the finger, and the membranes were felt tense. Before withdraw-
ing my hand I ruptured the membranes, and gave exit to a con-
siderable discharge of liquor amnii ; I then felt a limb, but could
not make out which. Her size was greatly diminished. She had
no more fits while I stayed in the house. I recommended that
as long as she remained unconscious three grains of calomel
should be placed on her tongue every two hours, in the hope of
passing into the stomach ; and that another turpentine enema
should be injected. There were only two more fits after I left ;
labor-pains supervened, and she was delivered at 2, A. M, (Tues-
day ;) the knees presenting. Her consciousness gradually return-
ed soon after delivery ; though headache continued. On Satur-
day, the 12th, Mr. Price wrote to me, that he had seen her that
morning sitting up, after a refreshing sleep of five hours; that
she still complained of her head, and felt relief from the cold ap-
plication. The lochia after delivery were very scanty; she took
ten grains of calomel, and for two days the sphincters performed
their duty imperfectly. It is remarkable that she has no recollec-
tion whatever of anything that occurred for six days before the
attack appeared, although she was following her ordinary occu-
pation all the time; and except for the headache and drowsiness,
seemed as usual. No albumen could be detected in the urine.
She is now convalescent.

Holding the opinion, as I do, that, an attack of puerperal con-
vulsions is merely a modification of cerebral apoplexy, I consider
that this young woman's life was saved by the prompt and deci-
sive bleeding. [Med. Times and Gazette.

Antiquity of Metal Sutures.

Dr. J. H. Aveling calls attention (Med. Times and Gaz., Jan. 22,
1859) to the fact that Fabricius Aquapendente, in 1647, gave all
the reasons which are now being put forward for preferring the
inorganic to the organic ligature. After describing the ligature of
Fallopius, which was of thread, and like the one which we until
lately have been using, and that of Guido, which was made of metal,
and hooked the two lips of a wound together; he says that he pro-
vides himself with many flexible needles of iron or of brass, made
soft, except at the point, over burning coals. These he passes

1859.] Xew Method of Curing Hydrocele. 549

through the lips of the wound, and then turns back the extremi-
ties, the right to the left and the left to the right, fitting them over
the wound either straightly and plainly, or by making a knot and
allowing them to remain until the wound is almost agglutinated.*

The following are the reasons Fabricius gave more than two
hundred years ago for preferring his metal fibula to that of Fallo-
pius, which was of thread :

" Quod si licet aliquando paradoxum vobis afferre, dixero potius
meam fibulam potiorem esse, propter rationes ex comparatione
desumptas a juvantibus, et nocentibus, si quidem fibula Fallopii
ex filo facta, mordet ubique carnem, quia filum asperum est, et
inaequaJe, cum sit tortum, acus vero livigata est, et perpolita. Rur-
sus filum mordendo labia vulneris transverse ea perrodi, quod ex-
perientia passim patefacit, etconfirmat; at acus flexibilis, cum
rotunda sit, et levigata, nihil istiusmodi tacit: exemplo sint annul-
li aurei, aut ferri qui auribus perforatis diutissime gestantur, ute-
umque penduli sint. Rursus si filum valentius stringatur, inter-
dum rumpiter, quo non patitur acus mollis, ferrea, aut oenea. Am.
plius filum est materia, quae facile tenditur, et laxatur, ferrum vero
flexibile neutiquam laxatur, Amplius laxitas ex filo dupliciter
succedit, turn ex laxa fili natura, turn ex perrosis labiis, unde etsi
a filo labia vulneris ad mutuum contactum adducuntur, non tamen'
adduc conservantur, quia propter fili naturam dupliciter laxantem
disjunguntur, et hiant; sed neutram laxitatem ex acu flexibili ro-
tunda, et perpolita expectare oportet. Ultimo filum non difficult-
er putrescit a sanie, et ichoribus, at acus ferrea, aut cenea, im-
munis est ab hujusmodi labe. Quod si tandem addatis, ees, et
ferrum habere vim refrigerandi, et adstringendi, vulneris gluti-
nationi consentaneum erit : et hoc est argumentum veritatem par-
doxi omnino comprobans, et confirmans.'t

These advantages may be summed up thus : 1. Iron does not eat
into the flesh. 2. It does not ulcerate out. 3. It does not stretch
and break. 4. It is not rotten by the discharge.

What more remains to be said than is here stated ? Is it not
curious that we are only just now beginning to appreciate the
fact which Fabricius gave to the world so many years since ?

[American Jour, of Med. Sciences.

Xew Method of Curing Hydrocele.

This method, suggested by Dr. Simpson, at a meeting of the
Medico-Chirurgical Society of Edinburgh, is founded on the fact
that iron and other metallic wires, when placed in contact with
living tissues, did not, as a general law, excite inflammation to

* I think this plan of using needles might be returned to with advantage in
some cases of wounds about the face,
f De Chirurgicis Operationibus, p. 146.

550 New Mode of Administering Iodine. [August,

a higher stage than that of adhesion, or the effusion of coagula-
ble lymph. Dr. Rothmund, of Munich, performed the radical
cure of hernia by exciting adhesive inflammation in the return-
ed hernial sac, passing, for this purpose, and leaving for eight
days, a metallic needle traversing the peritoneum; and had not,
it was averred, lost a single patient out of 1000 operated on. If
metals in serous sacks create a higher stage of inflammation than
the adhesive, such a fortunate result as this would not have been
attained. Dr. S. had thought for some time that metallic wires
passed through the sac of a hydrocele would act in two ways :
first, they would drain off the fluid; and, secondly, they would
subsequently, by their presence, form the surest means of ex-
citing the subsequent amount of adhesive inflammation that was
required for the cure of the disease. Dr. Young had, in one of
his patients, afforded him an opportunity of putting this idea to
the test. Dr. S. showed the Society the slender wire or metal-
lic seton which had been used in this case. It was passed
through the sac by first traversing the sac from below upwards
with a long-handled surgical needle, such as is used in transfix-
ing and tying haemorrhoids, threading the eye of the needle,
after it was projected through the scrotum above, with three or
four slender iron threads, pulling the needles then backwards
through the sac and out, and thus leaving the metallic seton in
its place. The liquid drained off in an hour or two; adhesive
inflammation set in, and progressed for two days, when it began
to subside. The wires were removed on the third day ; and the
cure had remained apparently quite complete, with the vaginal
sac firm and consolidated. Dr. Young had promised to publish
the whole case at length. This method of treating hydrocele
was, Dr. S. held, much simpler in its performance than tapping
and injecting; not by any means so painful to the patients; less
likely to produce a suppurative or dangerous amount of inflam-
mation ; and, perhaps, experience would show also, betimes,
that it was surer and more certain in its results. \Edinhurg
Med. Journal.

New Mode of Administering Iodine.

Efforts have lately been made in France to administer iodine
in a more efficacious manner than had hitherto been done. M.
Leriche of Lions has published valuable articles inLTJnion Me-
dicale, wherein he endeavors to show that iodine, combined with
vegetable substances, advantageously replaces cod liver oil. He
proposes a syrup made of the juice of water cress and iodine,
and also an iodine wine. The syrup has the advantage of not
fermenting, and contains exactly one grain of iodine per ounce.

1859.] New Theory of Chlorosis. 551

The wine is composed thus: Bordeaux wine, eight ounces ; con-
centrated infusion of red roses, about thirteen drachms; tincture
of iodine, one drachm and a half. Each ounce contains one
grain of iodine. From one to six tablespooivfuls may be given
daily, according to the indications and the age of patients. In
the space ol three years II. Leriche treated thirty-eight scrofu-
lous patients with the wine; twenty-one were perfectly cured,
after a treatment steadily pursued tor some time ; eight did not
improve at all ; and nine improved but slightly, either because
the treatment was carried on imperfectly, or because it was left
off too soon.

M. Boinet, on the other hand, well known by long continued
investigations respecting the use of iodine, read on the 28th of
September last, before the Academy of Medicine of Paris, a
paper, in which he proposes to use iodine as an article of food.
The author administers iodine as found in nature, viz : combined
with those plants which contain the greatest quantity of the
alkaloid. The latter being thus given in minute doses, in a
continuous and almost imperceptible manner, yields most ad-
vantageous results. M. Boinet uses fuci, marine plants, cruci-
fera?, salts containing iodine, and some mineral waters holding
iodine in solution. His axcipients are ordinary bread, ginger
bread, cakes, buiscuits, chocolate, wine, beer, syrup, etc., some
being especially calculated for children. Trials were begun by
M. Boinet as far back as 1849, upon subjects suffering very se-
verely from the various well known scrofalous symptoms, and
most of them were cured, after continuing the iodized food for
several months. The author has not found that iodine admin-
istdred for a long time produced a loss of flesh and atrophy of
certain organs. Far from having these effects,, the iodine in his
hands has invigorated patients, and favored the development of
organs. Messrs. Chatin and Trousseau are to report upon the
paper. {American Jour, of Med. Sciences.

New Theory and Treatment of Chlorosis. By Dr. Vox Maack.

The glycogenic function of ihe liver is hardly made known, and
already pathologists hasten to assign to it a part in the pathogeny
of diseases. Although we receive the ideas of the author with
the greatest reserve, we republish his theory in order to illustrate
this scientific tendency, common to all ages.

" The diminution of the red corpuscles in the blood of chlorotic
patients," says the author, " is an established fact. These cor-
puscles owe their color to the iron which they contain ; it is,
therefore, evident that the quantity of this metal in the blood is
diminished in cases of this kind. This diminution is not the re-
sult of resorption, for the urine contains only a small quantity of
solid matter, but it is the consequence of bad elaboration.

552 New Hygrometric TJieory of Cholera. [August,

"We know also that the very small quantity of iron which the
organism in the healthy state draws from the ingested aliments
is quite sufficient for all its wants, and that the bile is the only
secretion which contains it in notable quantity.

" This being known, how do we explain the formation or de-
velopment of chlorosis in a young woman who enjoyed good
health proviously ? She takes the same aliments after the appear-
ance of the disease as before ; it is, therefore, impossible to attrib-
ute this affection to a privation of the ferruginous element, for,
afterwards, as before, the same quantity of it is absorbed, and has
sufficed for many years to maintain health.

" The real cause is more likely this, that it is impossible for
the organism to transform the iron into hematin and to fix it.
From what does this impossibility arise ? M. Lehmann has
proved that hematin, like salicin; phloorrhizein, etc. is a sacchar-
ine compound. Hematin needs, therefore, sugar for its formation.
Thus, as soon as the saccharine secretion of the liver is diminish-
ed or arrested, the formation of the coloring substance of the
blood will cease, and consequently that of the red corpuscles.

"The true origin of chlorosis would consequently, be the want
or the diminution of the quantity of sugar elaborated by the liver."

The author draws the following conclusions from his premi-
ses:

1. The treatment of chlorosis must consist in the use of sugar.
2. The object of the treatment must be to re-establish the sac-
charine secretion of the liver. 3. The medication which consists
in the abundant use of iron has not introduced into the organism
an element which was wanted there, as is believed, but has cured
by acting upon the healthy secretion of the liver.

The best remedy, according to Dr. Von Maack, consists in
the use of grape-sugar and of honey. This treatment of chlorosis,
it seems, has been practiced for a long time by the people in the
northern part of Schleswig, and of certain regions of Hanover.
An adjuvant to it is cold water used freely as a drink ; already
Petter has recommended it as excellent in diabetes. [Archives
fur Wissentschafiliche ffeilkunde, and Norih.Am. Med. Chir. Rev.

New Hygrometric Theory of Cholera.

The meteorological relations of the cholera epidemic were for
the first time carefully studied in this country during the last
visitation. It cannot be said that the results were very conclu-
sive in any one direction, or that any theory of disease in relation
to climatal disease has been eliminated from the investigations
then made; but the council of the British meteorological society,
in their last report, while recording their sense of the incom-
pleteness of these and other collected observations for any medi-

1859.] New Hygrometric Theory of Cholera. 553

cal theories, undertake to continue their labors, and express a
strong hope of useful deductions.

M. de Ruolz, well known for important discoveries in the art
of electro-gilding, has been content to argue from a narrow basis,
and has lately communicated to the Cercle de la Presse Scienti-
fique of Paris an interesting series of facts regarding the propor-
tion of moisture contained in the atmosphere during the preva-
lence of cholera. By analyzing the various statistical data col-
lected during the French epidemics of 1832, 1849 and 1^54, M.
de Ruolz has deduced the following facts : In 1832 the epidemic
in Paris reached its height in April, when the hygrometer was
lowest : it declined to the utmost in September, when the hy-
grometer was highest. In 1849 the hygrometrical observations
at the observatory of Paris had been unaccountably neglected ;
but 185-4 afforded" results quite in accordance with those of 1832.
Hence, M. de Ruolz infers that there undoubtedly exists a posi-
tive coincidence between the intensity of the epidemic and the
hygrometrical state of the atmosphere, the former being in the
inverse ratio of the humidity of air. Other circumstances he
considers to point to the same conclusion : thus, Lyons, a city
remarkable for its damp atmosphere, owing to the two rivers
which embrace it, has never been visited by cholera. Amongst
washerwomen, who live in a damp medium, he says the cholera
has always been very low, and he makes the same assertion
writh reference to "persons living in damp places, on the banks
of rivers, &c." Finally, M. de Ruolz tells us that during the
last choleraic invasion in London, the copious watering of the
streets was found very beneficial. The views thus enunciated
in the Cercle Scientitlque did not remain wholly unopposed.
Thus, it was remarked that sailors were very subject to cholera ;
that cholera made great havoc in Holland, where the air is no-
toriously moist; and that in certain localities the cholera has
been known to lay waste one bank of a river and to spare the
other. M. de Ruolz, however, pressed for further investigation,
and suggested that, by way of experiment, in any future epidemic
the streets should be well watered, and the fire engines should
play on the roofs of the houses in the infected quarter. It were
idle to smile at his singular expedient, if indeed it were proba-
ble that any useful result could flow from it. And there is no
valid reason why Mr. Braidwood should not brigade his force
against an epidemic, or why cholera should not be attacked with
the fire engine as well as with the lime pail and the brush of the
whitewasher a favorite panacea with metropolitan vestries or
by the artificial creation of ozone and the introduction of certain
ozonified breezes, as more subtle chemists have recentlv sug-
gested. But we have the strongest doubts whether~M.de
Ruolz's theory will " hold water." The experience of Lambeth,

054 Lecture on Varicocele. [August,

of Wandsworth, and of other humid districts close to the river
side, has certainly not offered confirmatory facts; and though
unacquainted with the actual statistics of deaths from cholera
amongst London washerwomen, we are in possession of a num-
ber of isolated observations which do not dispose us to regard
soapsuds as a prophylactic against epidemics, in the sense which
M. de Kuolz suggests. London Lancet.

Varicocele Clinical Lecture of M. Nelaton. Communicated
for the Boston Medical and Surgical Journal. By Hall
Curtis.

Messrs. Editors. Some of your readers may be pleased to know
the views of this surgeon, who, having been attached for many
years to the Military School of St. Cyr, was enabled to examine
several cases of varicocele, and was induced to believe that
this affection, though by no means rare, is neither well under-
stood nor suitably treated that errors are found in all the surgi-
cal works mentioning the subject that the general causes to
which its formation is attributed are wrongly stated, and really
have no bearing in the matter.

Among the causes which our classical writers have much in-
sisted on are found the three following : hernia, with its conse-
quent treatment, the truss; abdominal tumors; constipation.

If one examines the period of life when the varicocele is most
frequently seen, namely, from the 16th to the 20th year, instantly
he has a negation of the causes mentioned above, and considered
the most predisposing agents in the malady.

Firstly, hernia is very rare at that age. M. Malgaigne, in 300
cases occurring between the ages of 10 and 40 years, finds only
26 cases between the 10th and 20th year.

Secondly, abdominal tumors are excessively rare in young sub-
jects, especially at that period when you encounter the varicocele.

Thirdly, constipation. Young subjects are but rarely found
who labor under this affection to a degree which, by its obstinacy,
could be sufficient to produce a compression on the spermatic vein,
and form the varicocele.

Again, hernia is much more frequent at the right than the left
side whereas varicocele is found almost constantly at the left.

From the autopsies which M. Nelaton has made, he proves
that when a varicocele exists, the spermatic vein is tortuous,
knotted and dilated throughout its course in the abdominal cavity ;
the hernial sac or the truss pressing upon the vein would cause
the dilatation of the vessel below the inguinal ring only, and not
within the cavity of the abdomen.

Anatomy has furnished a supposed solution of this abnormal

1859.] Lecture on Varicocele 555

condition, and to the question why is the varicocele most fre-
quently found in the left spermatic vein, has given a plausible ex-
planation by referring to the anatomical disposition of the vein,
and the manner in which it joins the large trunk into which it
pours its contents.

The right spermatic vein, near its junction with the ascending
vena cava, pursues a direction nearly similar to that of the larger
vessel, and by a gradual approach joins it at an acute angle, the
two currents readily uniting and flowing onward without obstruc-
tion.

The left, on the contrary, it is stated, joins the emulgent renal
vein at a right angle, thus in a direction perpendicular to the cur-
rent of blood coming from the kidney a current considerably
larger and moving with greater force. From this it appears that
the spermatic vein is unable to empty its contents into the renal,
in consequence of which is formed the varicocele.

This, however, is not true; the left spermatic vein does not
enter the renal vein in a direction perpendicular to the latter, but
bending outward from its course turns again inward, describinga
double curve on itself, and falls into the renal vein, forming an
acute angle, as the right spermatic in its junction with the vena
cava.

Another reason assigned for the frequency of varicocele in the
left spermatic vein is its greater proportional length. This may
be disproved by the fact that a varicosed condition of the sperma-
tic is not more common in tall men than in those of medium
stature, though naturally we should find the veins longer in the
former class.

The evil consequences of varicocele have been much overrated.
Many authors state an atrophy cf the testicle follows the varicos-
ed condition of the vein. This is not by any means proved.
To judge properly of the question, one should have ascertained
that the subject was endowed with equal health and strength in
each testicle before the appearance of the varix and that after
its advent the testicle had diminished.

That you find the testicle smaller when a varicocele exists,
is at times true. But this is owing neither to a diminution in
the testicle, nor an arrest in its development ; the fact that the
gland is small here, does not depend on the pre-existence of the
varicocele, but they coexist accidentally. Nor because the testi-
cle is small, can you judge that its power of secretion is less than
its fellow gland ; not unfrequently will you find a considerable
difference in the weight of these glands, though their mutual
functions are equally performed.

M. Nelaton thinks varicocele an affection whose cause is un-
known usually found in youth and rare in old age that it
disappears as man matures, and that the smaller ones are the most
painful.

556 Cure of Facial Neuralgia. [August,

His treatment is determined by the facts, that they generally
exist without pain, do not cause much inconvenience, that they
do not cause an atrophy of the testicle nor any loss of its power,
and that they disappear with maturity. He therefore insists on a
palliative treatment in ordinary cases, the use of a suspensory
bandage ; when considerable inconvenience arises, you may
swathe the scrotum, thus supporting and compressing moderate-
ly the vessel, similarly to the elastic stocking for varicose veins
of the leg and only operating as the last measure in those cases
where the pain is insupportable.

Easy and Certain Cure of Facial Neuralgia. By Dr. BURDACH,
of Luckau.

Dr. Burdach recommends corrosive sublimate as a specific,
never-failing remedy, in cases of facial neuralgia. He has used
it for more than thirty years, and always obtained a prompt and
permanent cure, no matter how severe a form the disease bad
assumed. The formula he employs is tbe same which be re-
commended in Hufeland's Journal for 1826 and 1830, in the
treatment of rheumatic gout; it is the following:
ty. Liquor. Hydrarg. Bichlorid. corrosiv. (Pharmac. Borus.) 3jss;
Yini Semin. Colchici, Bss. M.
S. Thirty to sixty drops every two bours.

Cases requiring the latter dose were extremely rare. (The
Liq. Hydrarg. Bichlorid. corros. of the Prussian Pharmacopoeia
contains corrosive sublimate and hydrochlorate of ammonia, one
grain of each to the ounce of water.) Each dose of the medicine
should be followed by a draught of the decoction of the Species
ad Decoctum lignorum ; (the species ad decoct, lignor. consists
of Guaiacumwood, two parts; Lappa, and Saponaria, one part
of each ; Liquorice-root and Sassafras, half a part of each. One
ounce of this mixture is used to a pint of water.) There is about
one-thirtieth to one-fifteenth of a grain of sublimate given in
each dose, a quantity which is generally well borne by the
patients. In order to assist the cure, Dr. Burdach sometimes
ordered the local application ofveratria ointment, but in the
generality of cases it could be dispensed with, as the sublimate
acted promptly enough without it. In very sensitive patients,
acetic acid, chloroform, or tincture of opium, might be added to
the given formula; such an addition, however, is not to be re-
commended.

To obtain the prompt action of the remedy it is absolutely
necessary to give it in fluid form, and at the intervals prescrib-
ed above, for in the form of pills it seems to exercise but little
control over the disease. [Aledizinisc/ie Cent. Zeitung1 and North
Amer. Med. Chir. Review.

1859.] Cataract. 557

Cataract.

The Question was asked at the Congress of Brussels, (Bulletl-
no delta Scienza Jfediche), "Has experience established that cer-
tain forms of cataract are curable without an operation? If in
the affirmative, what are the means which may be substituted
for the surgical?"

If by the word cataract, is mean i spontaneous opacity, (or hap-
pening under the influence of some cause, the action of which is
up to the present unknown,) which comes on more or less rapid-
ly, in the substance of the crystaline lens, it may be answered
without hesitation : No, there does not exist in the annals of
science, a single authentic fact to show that a cataract has ever
diminished or been arrested in its development under the influ-
ence of any medical treatment whatever.

If it is denominated cataract, the opacity of the crystalline,
which is a consequence of a traumatic lesion, there exists de-
monstrative facts, that antiphlogistic treatment instituted with
energy, has arrested the development of this opacity, prevented
the extention of it, or caused it to diminish when already very
extensive.

If finally the word cataract is extended to the opacity of the
capsule, which in the immense majority of cases, not to say in
all, are deposited only consecutive to an inflammation of the iris,
or of the membrane of the aqueous humor, experience has de-
monstrated that the opacity may frequently be removed by
treatment adapted to the latter affection.

AY hat is the utility of closing the eye-lids in diseases of the
eyes? What are the affections which require this closure, and
what is the best mode of effecting it?

The objects of closing the eye-lids are to secure immobility of
the palpi brae, to secure the globe of the eye from the action of
air, and the foreign bodies suspended in it, to contain it, or res-
train its movements to favor the action of remedies, by prolong-
ing them in contact with the oculo-palpebral apparatus, and
finally, to allow the maintainance, at will, of a uniform temper-
ature.

To these various ends, it may be useful in ulcers and perfo-
ration of the cornea; in the protrusion of this membrane, and
hernia of the iris, in recent staphylomas, in ophthalmoptosis,
and after certain operations on the eye, such as puncture and
the operations for staphyloma, cataract, artificial pupil, etc.

Finally, much advantage may be derived from it in ectropion;
in wounds with loss of substance of the external superfice of the
palpebral.

The best process for performing it, is that which corresponds
most closely with the following conditions: To fix the eye as

558 Hypophosphite of Quinine. [August,

far as possible in a state of repose, and diminish in the same de-
gree the friction between the globe and lids ; to contain it mod-
erately, uniformly, and in a manner not to produce any pain;
not to concentrate too much heat in the eye ; to be able to renew
it at pleasure, and without trouble or embarrasment, to allow
exit to liquids employed in treatment, and to normal and patho-
logical secretions. [Pacific Med. Journal,

Hypophosphite of Quinine. A New Remedy proposed by J. Law-
rence Smith, M. D., Professor of Chemistry, University of
Louisville.

The recent recommendation by Dr. Churchill, of the use of the
hypophosphites in the treatment of phthisis, is now undergoing
a general test by the medical profession ; and so far as reported
upon, there appear to be different opinions in regard to their
efficacy. Some speaking of them with much praise, while oth-
ers see but little benefit from their use. In one thing all
agree that no injurious effect arises from their administration.

From my own observation and inquiry, patients using the
hypophosphites, either in their solid form or their Syrup or gly-
cerol^ have experienced marked relief from many of the annoy-
ing symptoms attendant upon phthsis.

The special object of this note, is to bring to the attention of
the medical profession, a new combination of hypophosphorous
acid, which I have lately had made at the Louisville Chemical
Works, namely, the hypophosphite of quinine.

It was first made by adding an excess of recently precipitated
quinine, to a hot solution of hypophosphorous acid, and on
cooling, the salt crystallizes out in beautiful silky tufts, which,
when dry and broken up, resembles asbestus in appearance.
The method adopted and proposed for making it on a large
scale, is by double decomposition ; using the sulphate of quin-
ine and the hypophosphite of baryta, the operation must be
conducted so that there shall be no excess of either salt in the
solution; the solutionis filtered from the sulphate of baryta,
concentrated and allowed to crystalize, which it does in the
manner already mentioned.

The salt thus obtained, is in delicate fibrous crystals, soft to
the touch ; they are of a beautiful silky lustre, very soluble in
hot water ; one ounce of cold water at 60 Fahr., dissolves 8
grains of the salt. When heated, it loses its water at about 230.
and at about 300 it turns brown and melts.

Proposed Uses. If the preparations of hypophosphorous acid
are useful in phthsis and analogous diseases, then its combina-
tion with quinine must be beneficial in those phases of these

1859.] Compression in Uterine Hemorrhage. 559

diseases wbere quinine is at all recommended. I would there-
fore suggest its use in the hectic fever of phthsis; also as a
tonic in the same disease; also in the various forms of cachexy
where quinine is used.

Nor ought its use to stop here, for owing to its solubility in
water, it can be readily administered in that menstruum, (say 5
grains to tne ounce of water,) thus becoming useful for children,
and also in compounding, where the presence of an acid is objec-
tionable, as is now necessary in dissolving the sulphate. In
the form of a pill, it would be more soluble in the stomach than
the sulphate.

With these few hints, I leave the article to the medical pro-
fession to be fairly tried, feeling confident that its solubility
alone will be sufficient to make it an important addition to our
materia medica. [Louisville Med. Xews.

On Compression of the Aorta in Uterine Hemorrhage. By Dr.
Spiegelbe bg.

M. Seutest, of Brussels, in a communication made to the Berlin
Obstetrical Society, proposed what he termed a new method of
arresting uterine hemorrhage, viz., the compression of the aorta,
a procedure which he described as both easy of execution and
certain of success. Of course, in a society of obstetricians, the
pretension to novelty was soon disposed of, and the communi-
cation only calls for notice as having induced Dr. Spiegelberg
to make some remarks condemnatory of the practice. That
compression of the aorta will arrest uterine bleeding, he has
convinced himself by many experiments; but the explanation
of this is not due to the fact that all blood is thus prevented en-
tering the uterus. The instant we divide the arteries convey-
ing blood to the uterus, its muscular fibres contract, and the
organ becomes diminished in size. Every one knows that such
contraction will arrest hemorrhage. Dr. Spiegelberg has seve-
ral times observed these remarkable results in both pregnant
and non-pregnant animals ; and has found the same consequence
follow compression or ligature of the aorta, when it has passed
the diaphragm. If, therefore, compression of the aorta, thus ex-
cites powerful contraction of the uterus, it should evidently be
an appropriate means for arresting hemorrhage, but the author's
experiments show that for such compression to be of use, it
must be permanent, the uterus distending again, as soon as the
calibre of the artery becomes unobstructed. But on a living
woman, compression could not be kept up continuously long
enough to secure permanent contraction. Moreover, the aorta
cannot be so completely compressed through the abdominal

560 Origin of Flexions of the Utems. [August,

parietes, even immediately after delivery, as it can in animals
when the cavity is laid open. So that, however surely we may
seem to exert compression, some blood will always gain admis-
sion. Again, the closure of the aorta cannot be effected in
women as in animals, just below the diaphragm, but only after
the large vessels of the intestines, and the renal and spermatic
arteries have been given off; from which vessels the organ may
obtain an abundant supply of blood. Lastly, the compression
employed will also close the vena cava inferior; and the speaker's
experiments and observations have convinced him that in such
a case contraction of the uterus will not take place the organ
remaining then gorged with blood and relaxed. Indeed, it
would a priori be expected that if the return of blood from the
organ be obstructed, the vessels would become distended, and
the open state of their orifices after birth would allow of the
escape of their contents. This explains the casein which It.
Lee and Schneemann have observed the hemorrhage increased
after compression of the aorta. Dr. Spiegelberg, therefore re-
gards the practice as destitute of a physiological basis, and of no
practical utility; and he agrees with Dr. Schneemann, in consid-
ering the cases which have been seemingly benefited by it, to be
really examples of excitement of contraction induced by the
friction of the uterus made during the attempts at compression
of the aorta. [Monatsschrift fur Gebartskunde, and Medical
Times and Gazette.

On the Origin of Flexions of the Uterus. By Prof. VlRCHOW".

Virchow sums up his very elaborate treatise on the mode in
which flexions of the uterus originate, in the following proposi-
tions: In the history of flexions we may distinguish three dif-
ferent periods : one of mere predisposition, one of simple flexion,
and one of flexion complicated with different inflammatory pro-
cesses.

The predisposition is frequently created by partial peritonitis ;
it manifests itself by attacks of the nature of colic, and is at least
somewhat lessened by early attention.

Long-continued retention of the urine and of the faeces favors
the formation of flexion, particularly at the time of menstruation,
the puerperal state, etc., and is, therefore, to be carefully avoided.
Enlargements of the uterus, particularly if connected with relax-
ation of the organ, can increase the flexion very rapidly, while
the removal of these conditions, for instance in chronic endo-
metritis, may diminish the flexion to a considerable degree. It
is, therefore, of great consequence to keep careful watch over
the menstrual and puerperal periods, and to allay catarrhal in-

1859.] Hydrochlorate of Ammonia in Neuralgia. 561

flammation of the uterus by antiphlogistic treatment and other
means.

It is very questionable whether antiflexion can be complete-
ly removed; in retroflexion a cure may be attempted. If the
flexion is complicated with consecutive affections, particularly
with endometritis or perimetritis, a persistent and careful local
treatment is requisite. Endometritis may be removed by it ;
perimetritis, on the contrary, produces adhesions of the uterus,
which confirm the flexion more and more the longer they exist,
and render it almost impossible to correct the position of the
organ. [Allgemeine Wiener Medizinische Zeitung, and North
Amer. Med. Chir. Review.

Hydrochlorate of Ammonia in Neuralgia.

Mr. H. C. Brenchley, Surgeon to the Brighton Dispensary,
relates {Lancet, Oct. 16, 1858,) the following case to illustrate
the efficacy of hydrochlorate of ammonia in neuralgia.

A young man, aged 23, unmarried, healthy, and without any
other apparent complaint, had long suffered from very severe
attacks of neuralgia of the face, coming on at intervals of about
one month, and lasting from two or three days to a week. It
sometimes came on on one side of the face, and at other times
on the other side. During one of these attacks I saw him, and
ordered him quinine and arsenic, which put an end to the attack
for the time. After the lapse of a month or six weeks, he had
a second attack, which was cured in the same way. A third
attack, however, came on after a shorter interval. This time the
quinine and arsenic failed to relieve him. On the third day,
when I saw him, he was in great agony, propped up in bed, and
unable to do anything from the severity of the pain. The left
side of his face was swollen, flushed, and hot, the temperature
considerably higher than on the right side; the heat also of the
inside of the mouth was so great that I expected I should find
matter forming from decayed teeth ; but, on examination, I failed
to do so.

I nowtried the much-vaunted remedy the valerianate of am-
monia, but without any effect. The usual remedies having fail-
ed, I gave him the hydrochlorate of ammonia, in doses of half a
drachm every hour, in camphor mixture. I saw him three
hours after he had commenced this treatment, and found he had
been much relieved after taking the second dose; and, having
taken the third dose, he was almost free from pain, and begged
to be allowed to continue the remedy. The heat and flushing
of the face had subsided, and the temperature of the mouth con-
siderably reduced, feeling quite cool after the burning heat of its
former state. He went on for three or four days with the reme-

562 Diphtheritic Angina and Laryngitis in Children. [August,

dy, in closes of fifteen grains, three times a dajr, although there
was no return of pain. Three months have now elapsed, and
he has had no relapse.

The mod us operandi of this medicine is not very clear; but
whatever other specific virtues it possesses for the cure of .neu-
ralgia, in this particular case it evidently acted as an indirect
sedative by lessening the arterial action; for the first and most
striking effect of the medicine was the rapid lowering of the
temperature of the mouth and face. From further observation,
I have found that this remedy is most useful in those cases of
neuralgia which are attended with heat and swelling.

[American Jour, of Med. Sciences.

Observations on the Treatment of Diphtheritic Angina and Laryn-
gitis in Children. By Dr. Hauner.

Both diseases occur only in feeble children, debilitated by
previous diseases, mostly, however, in such who have suffered
either recently or some time previously from an exanthematous
disease. Diphtheritis is contagious, and can be transmitted from
sick to previously healthy children ; it may become fatal by
general infection, pyaemia, or loss of strength, as well asby pro-
pagation itself to the laryDx, bronchi, and lungs. That treat-
ment will alone be successful which endeavors to stop the pro-
gress of the diphtheritic process to important organs, anticipa-
ting it, as it were, by local means, and which tries to strengthen
the constitution by internal remedies. The antiphlogistic treat-
ment is decidedly obnoxious. Of all local remedies the author
considers nitrate of silver the most efficient; he applies the
caustic in substance to the diphtheritic layers in the mouth, on
the uvula, throat, etc., and takes care to carry the application
somewhat beyond the diseased surface. Instead of the stick, a
strono- solution of nitrate of silver (9j- 3ss to 3j of distilled
water) may be used. In regard to the prophylactic value of
this local treatment the author observes, that he has not seen a
single case of diphtheritis of the mouth and throat in which the
disease spread and reached the larynx after having been thus
treated. But even in diphtheritic croup, nitrate of silver is use-
ful in combination with the internal treatment; the application
is, in this case, made by means of a whalebone probang having
a pencil ofcharpie attached to its extremity, or finely-powdered
lunar caustic (gr. iij-iv) quickly blown in through a quill, the
tongue being depressed by a spatula. In some cases the author
prescribed, at the beginning of the disease, an emetic of ipecacu-
anha, and found it decidedly useful. In regard to the internal
treatment of diphtheritis, it is particularly necessary to enjoin a
generous diet, (good broth, Liebeg's extract of meat, coffee, beer,

1859.] On Labial Oaru 563

wine, etc.) The best internal remedy is quinia, given with al-
ternate doses of chlorate ofpotassa, (3ss-j to 5 iij i v of distilled
water;) the latter remedy exerts a very favorable influence upon
the local diseases of the mouth and throat. A useful adjuvant
in the treatment of diphtheritic angina and laryngitis is the local
application of moist heat by means of compresses soaked in
water, and covered over with a dry linen cloth, or other mate-
rial to retain the heat and moisture. . The author finally cautions
against the treatment of diphtheritic croup by bleeding, mercu-
rial ointment, calomel, tartar emetic, etc. By making a careful
examination of the patient, and by taking the constitution and
the previous history of the child into consideration, it will not
be difficult to distinguish diphtheritic from true laryngeal croup.
[CEsterreichische Jahrbiicher fur Kinder heilkunde, and North
Amerian Med. Chir. Review.

On Labial Cancer. By Professor Riberi.

In a notice of the forthcoming third volume of Professor Ribe-
ri's " Lezioni Orali," an account is given of his experience with
respect tg labial cancer at the Turin Clinic. The ages of the 81
patients were as follows : 2 between twenty and thirty, 3 be-
tween thirty and forty, 11 between forty and fifty, 28 between
fifty and sixty, 20 between sixty and seventy, and 17 between
seventy and eighty. Of these, 69 belonged to the peasantry class,
a predominance perhaps attributable to their unnutritious food,
their abuse of peppers, garlic, vinegar, and the like condiments,
their neglect of personal cleanliness, and their exposure to vicis-
situdes of the weather. Another predilection of the disease was
for the male sex and the lov:er lip, inasmuch as only three of the
cases occurred in women, and in only four instances was the
upper lip affected, two of these occurring in men and two in
women. In all but one patient the sanguineous temperament
was manifested in a greater or less degree, showing the influence
of the conditions of the blood-vessels and of the blood in this
disease as compared with that of the nervous system. In seven-
ty-six of the subjects the constitution was good, robust, or even
athletic. This confirms the observation made by Pravaz, that
the general belief is erroneous which supposes that lymphatic,
delicate, cachectic constitutions, are most liable to cancer. Per-
sons become cachectic and enfeebled as the disease advances, as
its result, not as its cause.

In most of the patients an unhealthy state of the skin prevail-
ed, and there were few cases in which some complication was
not observed, arising from disturbances of the respiratory of
circulatory organs, varix, varicose ulcers, chronic gastro-hepati-

N. S. VOL. XV. NO. VTTL 40

564 On Labial Cancer. [August,

tis, pellagra, etc. After awhile the glands in the vicinity en-
large, and it is of importance to determine whether their increase
be merely sympathetic or symptomatic of invasion of the disease.
In the former case, a single gland only usually becomes enlarg-
ed, being of recent origin, round or oval in form, movable, and
liable to spontaneous changes in size ; it is painful and tender
to the touch, the skin being warmer than usual, and in some
cases slightly reddened. In symptomatic enlargement, two or
more glands are almost always affected, large and indurated
lymphatic cords stretching between them, and often down the
side of the neck. After awhile, the glands may acquire a large
size, assuming an irregular form, becoming more or less fixed
at their base, being but slightly movable, and not undergoing
spontaneous change in size.

Before proceeding to the operation, M. Riberi submits his
patients to hygienic and medical treatment calculated to relieve
any complication or subdue any inflammatory action that may
be present. Some cases of cancroid would indeed be cured by
such procedures had the patients sufficient patience to await the
result. Believing the employment of caustic mischievous in almost
all other forms of cancer, M. Riberi regards them as of great
utility in epithelial cancer, especially of the face, when the base
is small enough to admit of its entire destruction. But as the
tissue of the lip is very soft and yielding, and cancer soon sends
widely-spread roots into it, and as patients usually do not apply
until the lesion has thus become extensive, the employment of
caustics is not admissible. Moreover, considerable deformity
may result from its application, and an aggravation of the dis-
ease may be produced when the whole has not been extirpated.
The operation with the V incision, having its base toward the
labial edge, and conjoined when necessary with cheiloplasty, is
that to which Professor Riberi gives the decided preference.
He enters into considerable details upon this part of the subject,
for which we have not space. Whatever form of the operation
be adopted, he insists upon the necessity of removing during its
performance all glands that may be symptomatically affected.

Of seventy-eight persons operated upon, seventy-three left
the clinic cured ; some of these, however, returned at the end
of more or less long periods suffering from other cancerous dis-
eases, two succumbed to a reproduction of the disease while in
the clinic, and three died after the operation from causes not
connected with it. The following are the conclusions drawn
from a consideration of the cases of eighty-one patients: 1.
The disease almost always commences as epithelial carreer or
epithelioma of the skin or mucous surface of the lip, spreading
thence to the parenchyma, and very rarely begins in this lastr
extending thence to the surfaces. 2. The skin is almost always

1859.] Changes of the Urine in Diseases. 565

primarily affected, and only in some rare instances by morbid
diffusion from the mucous surface. 3. Although very frequent-
ly unaffected at first, the mucous membrane becomes almost
always implicated in the course of the disease. 4. The cellular
tissue of the parenchyma is always simultaneously affected, as
are very frequently the mucous and sebaceous crypts, to the
great number of which in the lips Benjamin Bell attributed the
frequency of labial cancer. 5. The muscular tissue is sometimes
unaffected, sometimes participates slightly in the disease, and in
some cases is so involved as to become entirely destroyed. 6.
Whatever our nosological distinctions may be in respect to the
species of cancer, nature shows how ill founded they are, by ex-
hibiting more than one of these together; but facial cancers are
those in which this junction is seldomest observed. [British
and Foreign Med. Chir. Review.

Observations on the Changes of the Urine in Diseases. By Dr.
Brattler.

Dr. Brattler has made a series of very accurate investigations on
the changes of the Urine in typhus, morbilli, scarlatina, dis-
eases of the heart, etc., which he laid down in an elaborate
treatise, entitled "Beitrag zur Urologie in Kranken Zustande;"
Miinchen, 1858, Joh. Palm's Hofbuchhandlung.

The author gives the following summary of his urological
observations:

Casting a retrospective glance upon our investigations
and experiments, we find that the urine does not suffer in dis-
ease any changes peculiar to the different morbid conditions,
but that these changes are in relation with definite processes
going on in the organism. The urine of a case of typhus, pneu-
monia, cholera, or Bright's disease, may have one and the same
qualities, for the very reason that certain processes, which modi-
fy the secretion of urine, may take place in any of these diseases.

The Quantity of Urine. ft is diminished : In the commence-
ment of nearly all febrile diseases; in diseases of the kidneys,
when the uriniferous tubules are obstructed (morbus Brightii.)

In diseases in which the organism suffers great losses of se-
rum, as excessive diarrhoea, cholera, copious prespi ration.

In diseases of the circulatory and respiratory organs, in con-
sequence of which less blood is furnished to the aortic system,
and therefore to the kidneys, as disease of the heart, and pleu-
ritic exudation.

It is augmented : By the resorption of hydropic effusions and
exudations.

In polydypsia, diabetes insipidus.

566 Changes of the Urine in Diseases. [August,

Urea. It is diminished : In the reconvalescencefrom all acute
diseasesT in which the organism has suffered a considerable loss
of substance through fever, as in this case the nourishment car-
ried into the system is used for the reparation of the lost nitro-
genous tissues.

In diseases of the digestive organs which hinder the resorp-
tion of the ingesta, as chronic vomiting in atrophy after typhus,
and cancer of the stomach.

In diseases of the kidneys, interfering with their functions
(morbus Brightii.)

In diseases of the circulatory and respiratory organs, in con-
sequence of which less 'blood is furnished to the aortic system,
and therefore to the kidneys.

It is augmented : In all diseases accompanied by fever, viz ;
by elevation of temperature. (The frequency of the pulse bears
mo constant relation to the secretion of urea.) The secretion of
urea is the greater the higher the temperature rises.

An exception takes place only when in febrile diseases the
function of the kidneys is at the same time interfered with, be it
by diseases of these organs themselves, or secondarily by
the influence of other organs.

In diseases in which the urea has been retained for a long
time in the blood by functional disorder of the kidneys, after
removal of the difficulty, as morbus Brightii, cholera, and dis-
ease of the heart.

By the resorption of hydropie effusions, as morbus Brightii,
and dropsy from disease of the heart.

Chlorides. They are diminished :

In all diseases in which exudations or transudations take
place, these effusions being rich in chlorides, as typhus, pneu-
monia, pleuritis, Bright's disease, cholera, acute rheumatism, etc.

In the diseases of the digestive organs which hinder the re-
sorption of the ingesta.

In diseases or functional disorders of the kidneys with dimin-
ished urinary secretion, as Bright's disease, and disease of
the heart.

They are augmented : By the resorption of hydropic effusions.

Phosphoric Acid. It is diminished:

In diseases or functional disorders of the kidneys with di-
minished urinary secretion, as Bright's disease, and disease of
the heart.

In diseases of the digestive organs which hinder the resorp-
tion of the ingesta.

It is augmented : In acute febrile diseases by the increased
metamorphosis of tissues containing phosphorus.

The increase of phosphoric aicid is, however, not as constant
as that of urea. In diseases in which the phosphoric acid has-

1859.] Inflammation of the Fallopian Tubes, &c. 567

been retained for a long time in the blood by functional
disorder of the kidneys, after removal of the difficulty, as
Bright's disease and cholera.

According to Bence Jones, in acute nervous diseases, and in
osteomalacia. [Medicinische Central Zeitung, and. Virginia Med.
Journal.

On Inflammation of the Fallopian Tubes as a Cause of Puerperal
Peritonitis. By Prof. E. Martin.

In one of the meetings of the Gesellschaft fur Geburtskunde of
Berlin, Professor E. Martin gave a very interesting lecture on
inflammation of the Fallopian tubes as a cause of puerperal peri-
tonitis. An experience of many years has convinced Prof.
Martin that with the exception of severe injuries of the geni-
tals during the act of labor, which may cause the death of the
patient in different ways within the first few days the most
common cause of death among lying-in women is pyaemia and
emboly, which may be either produced by thrombosis of the
veins of the uterus and of the vagina, or by the reception and
generation of pus in the lymphatic vessels of the genitals, and
which give rise to fever and a great variety of symptoms.

Besides this kind of puerperal disease, the author has, how-
ever, observed another less frequent, but just as fatal a one,
which depends upon a propagation of the endometritis into the
Fallopian tubes, and an effusion of the purulent products of this
salpingitis into the peritoneal cavity. This effusion of the con-
tents of the Fallopian tubes into the cavity of the abdomen is
followed in most cases by fatal peritonitis. In spite of the open
abdominal end of the tubes, their contents are not generally
discharged at once into the peritoneal cavity, but only after
some unusual movement, etc., during which the abdominal mus-
cles contract and press upon the tubes; this is easily explained
by the fact that the external portion of the canal of the tube
enlarges itself into a sinus as soon as fluids accumulate within
the tube. According to the author's opinion, the metrosalpingi-
tis observed in lying-in women, does not always originate first
during confinement, but sometimes during pregnancy, and oc-
casionally even previous to that. One of the principal circum-
stances which speak for the long existence of the catarrhal in-
flammation of the tubes, is the considerable enlargement and
textural change of the canal, as the author has observed it in all
his cases in which a post-mortem examination was made; also
in unimpregnated women Prof. Martin has observed this affec
tion ; it was then the consequence of a metritis produced by a
gonorrhoea! infection ; after the painfulness of the vaginal por-

568 Inflammation of the Fallopian Tubes, &c. [August,

tion had disappeared, and nothing remained but a mucopuru-
lent discharge, a lively pain was again felt in the depth of one
or the other inguinal regions (without there being any swelling
of the adjacent ovary perceptible; ) this pain was increased on
pressure; it generally yielded to the application of leeches, cata-
plasms, and tincture of iodine. As adhesions of the tubes to
neighboring organs are a post-mortem appearance, frequently
found in prostitutes, there is good reason to assume that salpin-
gitis often occurs in consequence of sexual excitement, particu-
larly if the latter is combined with infection.

As regards the symptoms of metrosalpingitis, the principal
one, in the acute form of the disease, is pain ; this is of pretty
intense character, and is felt in both inguinal regions, if the dis-
ease exits on both sides, as it usually does. The seat of the
pain offers the principal reasons for suspecting the presence of
the disease, and, by resorting to the method of exclusion, this
diagnosis may be rendered more probable. Sometimes it is
possible to feel on external, but particularly on internal explo-
ration, the swelled and enlarged tubes in the form of oblong
rolls. The disease under consideration requires, however, dur-
ing the first days of confinement, the greatest precatuion in
making palpation, as each strong pressure is connected with
the danger of effusion taking place into the peritoneal cavity ;
it is, therefore, often necessary to be satisfied, under these cir-
cumstances, with an only conjectural diagnosis.

The prognosis of metrosalpingitis in lying-in women is not
unfavorable as long as the products of inflammation remain in
the cavity of the tube, as a part of them may be removed by
absorption, while the rest becomes concrete; there are also, in
the generality of cases, adhesions formed between the respective
tube and the neighboring organs. Both these changes are gen-
erally followed by sterility. In connection with this subject, it
is well not to overlook the possibility of the products of exuda-
tion undergoing tubercular degeneration ; in fact, tubercular
masses are more frequently met with in the Fallopian tubes,
than in any other part of the female organs of generation.
Sometimes, when the abdominal opening of the tube has been
closed by adhesions, dropsy of the tube follows. With all this,
life may continue for a long time, although it may be accom-
panied by various troubles, arising principally from the incura-
ble changes of form and position which the internal genitals
have been subjected to. Sometimes, finally, after the dilated
tube has formed adhesions with the abdominal parietes, its se-
cretion may be discharged externally, and thus health may be
restored to some degree. If the contents of the dilated tube
are effused into the peritoneal cavity, the preservation of life
seems to be possible only when the secretion is not of a puru-

1859.] Editorial 669

lent, but of a mucous character, and when the consequent peritoni-
tis remains confined to a certain locality. Of this, the author has
convinced himself in several cases, in which, on the post-mor-
tem examination of individuals who had suffered, many years
before their death, from puerperal peritonitis, membranous ad-
hesions of the tube and of the ovary were found confined to
only one-half of the cavity of the pelvis.

The treatment of metrosalpingitis in lying-in patients must be
antiphlogistic ; the principal condition for recovery is, of course,
long-continued rest in one position, and the avoidance of every
movement requiring exertion. (Monalschrift fur Geburtskunde,
and North Amer. Medico Chir. Review,

EDITORIAL AND MISCELLANEOUS.

Action of Quinine. In a series of Clinical Lectures on the Patholo-
gy and treatment of Dysentery, delivered at Jackson Street Hospital, to
the Medical Class of 1857-8, and published in our 14th volume, the
Junior Editor of this Journal, stated distinctly the proposition that,
" Quinine exercises its primary action upon the middle or fibrinous coat
of the Bloodvessels, and that upon its influence in that tissue, all its ob-
served effects depend." The essay from which we make the following
extract, is too lengthy for publication entire, at the present time ; we
therefore furnish to our readers, the several propositions which haro been
argued in full, and strengthened both, by illustrative experiments and
clinical observations as set forth in the paper itself.

Quinine. The Fibrinous Chat of the Bloodvessls the seat of its ulti-
mate Therapeutical action. By Robert Campbell, M. D., of Augusta,-
Georgia.
The following Propositions form the basis of an essay presented by us

to the Medical Society of the State of Georgia, April 10th, 1859, and

ordered for publication.

propositions.

1st. That Quinine does not act primarily upon the Nervous System.

2nd. That its effects upon the Nervous System are neither those of a
Stimulant nor Sedative.

3rd. That its manifest, uniform phenomena are at variance in charac-
ter with those of any known neurotic.

4th. That there is no concordance between the degree of its apparent
influence over the Nervous System, and the size of the dose as obtains
with all neurotics.

570 Editorial. [August,

51 h. That its phenomena are varied in character and degree, more
in accordance with an associate condition of the vascular, than of the
nervous system.

6th. That its action is primarily exerted upon the Vascular System,
by a specific agency directed to the fibrinous coat of the vessels, and
having the power of condensing or contracting that tissue probably by
chemical union with its element?, similar to that of the vegetable astrin-
gents. By virtue of this property, it overcomes all engorgements
of the vascular system by constringmg the vessels. Thus, it re-
lieves entirely or partially, all those diseases which depend upon
engorgement, resulting from vascular exhaustion or debility, such
as would proceed from relaxation in the middle coat whether occurring
in a vascular organ, as Lung, Spleen, or Liver or in a nervous centre,
as Brain, Spinal Marrow, or Ganglion.

7th. That this interpretation is the only one which can furnish a
satisfactory explanation of the phenomena consequent upon the adminis-
tration of Quinine.

Forthcoming Medical Work. We are pleased to see by the follow-
ing announcement, that our whilom contributor, Dr. John Stainback
Wilson, of Columbus, Ga., is engaged in the preparation of a useful work.
From the present notice it appears, that the book is to present a popu-
lar, as well as a professional aspect. We are too well acquainted with
the high principles which control our valued and able correspondent,
to have the least fear that he will compromise himself or his profession
in any particular, even under the most trying and delicate circumstances .
Without seeing a line of his manuscript, we cordially wish him
abundant success :

" Woman's Rome Book of Health. As our previous notice of the
work in preparation by Dr. Wilson, of this county, has been quite ex-
tensively copied by the press, and as many may have been led into the
belief that the work will consist of a mere compilation of the articles
on Hygiene furnished by Dr. W. for the Ladies' Book, we give the title
in full: 'Woman's Home Book of Health: A work for Mothers and
Daughters ; on a Plan, New, Safe and Efficient, showing in plain language
how diseases may be Prevented and Cured, without the Use of danger-
ous remedies : Embracing, First : A brief Description of the Structure
and Functions of the Human Body. Second : A full Exposition of the
Laws of Health and the Means of Preventing Disease. Third: The
Causes, Symptoms and Treatment of the principal Diseases of Women.
Fourth : Midwifery, and the Diseases and Accidents of Childbed, &c. &c.
With a Chapter on the Management of Infants.' It will thus be seen
that the work will be quite comprehensive ; and as just such a book as
this is much needed, and as the announcement of its forthcoming has

1859.] Editorial 571

met with the most flattering reception in various quarters, we predict
lor it decided success, and hope that it will not be long before its pub-
lication."

Journal de la Physiologie de F Homme et des Animaux, Published under
the direction of Dr. E. Brown-Sequard.

The first volume of this valuable Journal, is just completed, and the
four numbers of last year make an elegant and most instructive book of
850 octavo pages.

No one perhaps, but Dr. Brown-Sequard could have projected or so
well sustained an enterprise, at once so novel, and seemingly so
forlorn, as that of a Journal devoted in the present age, we may
say entirely, to Physiology. His energy, great experimental re-
sources, and his wide spread reputation on the two continents,
have contributed largely to secure for this Journal an abundant
success. Almost every number of the volume just closed, is enriched
by lengthy papers from the pen of the able and indefatigable editor,
while such men as Dr. Claude Bernard, Dr. Charles Robin, Dr.
Charles Rouget, M. Oilier, and others of nearly equal reputation, dis-
cuss in profound and lengthy communications, all of the most interesting
and obscure Physiological Questions, of the present rapidly advancing
age. The Secretions, the Nervous System, the Blood, the regenera-
tion of Tissues deep questions in Pathology ; indeed every thing rela-
ting to Biological Science, find place in the pages of this splendid work.
Books are not the places to read and keep up with any depart-
ment of science. The knowledge of books is always at least one or
two years old, it has nearly all been put forth in journals, and The Jour-
nals are really the true source for a progressive man in this progressive
age, to go and seek his knowledge. Otherwise, when he has just risen
from the perusal of the very latest and newest leather-bound work, in
some particular department, congratulating himself that he has reached
the utmost boundary of the researches about which it is conversant, he
will find himself, but only on the frontier, that a large country stretches
out before him, which has been cleared, leveled, and builded on, even
while he was toiling through the ponderous tome. All this is done in
journals. Journals are the true chroniclers of Science as they profess
to be. Is it not a wonder, that not until now, with all the rapid ad-
vancement made in the department of Physiology and Pathology, no
well sustained journal has had place in Medical Literature? Perhaps it
is best that it has been so ; several failures might have settled the im-
practicability of the work and have discouraged even the energy and
daring enterprize which has now, so ably entered upon it.

572 Editorial [August,

To those of our readers who have not subscribed to the first
volume, we now say that, at this moment, they have an opportunity of
subscribing for the second, just opening with the initial number. The
work is published in Paris, but for the convenience of American sub-
scribers, an American Agent has been appointed in New York, who
will promptly attend to the regular transmission of the work, Messrs. B.
Westermann & Co., 440 Broadway, New York, are the American Agents.

Removals, Changes and Demises.

A full history of the changes in the Journal Literature of our country,
would occupy far more space than we can afford, yet we deem it a duty
to our readers as well as a proper courtesy to our Confreres, to record
all important changes which they sustain during the year.

We have already noticed the change in the New Jersey Medical
and Surgical Reporter, from a Monthly Journal, edited in Burlington,
N. J., to a Weekly, and its transfer to Philadelphia. Dr. S. W. Butler,
its Senior Editor, has associated with him, Dr. R. J. Levis, of Philadel-
phia. The Reporter has been entirely metamorphosed in its appearance,
much improved in its matter, and doubtless increased in its circulation
and general prosperity.

Our valued confrere, Dr. Austin Flint, Jr., has removed to New York
city. He still retains the Editor-ship of the Buffalo Medical and Sur-
gical Journal, whose second number of Volume XV., comes to us under
the lengthened title of The New York Monthly Review of Medical and
Surgical Science, and Buffalo Medical Journal.

We suppose that this rather inconveniently long title, is but a tem-
porary expedient resorted to, to retain old associations under the
change of place, and will be continued no longer than necessary to a
general understanding among its readers. This Journal has always
been a favorite with us. We wish it the same abundant success under
the above change, that it has heretofore enjoyed and deserved, under
the more simple and familiar name of Buffalo Medical Journal.

The Savannah Journal of Medicine, is now conducted by our Friend
Prof. Juriah Harriss, as Senior Editor ; Dr. J. S. Sullivan having resigned
that position, held by him for the last two years. In making the an-
nouncement, the present Editor remarks, " Our association as Junior
Editor with him, has been most cordial and friendly, indeed such inter-
course as a gentleman of high tone and intelligence, will ever guaran-
tee to others in the Profession." Prof, R. D. Arnold will continue as
Associate Editor of the Journal, while Dr. Sullivan is promised, as still
a contributor to its pages.

1859.] Editorial 573

The Nashville Monthly Record of Medical and Physical Science,
has also undergone a change in a part of its editorial corps. Dr.
Richard 0. Currey has resigned his position of Associate Editor, while
Prof. Daniel F. Wright will be hereafter assisted by Professors John H.
Callender and Thomas L. Maddin, all of the Shelby Medical College.
Professor Currey's resignation from the Journal is simultaneous with,
and perhaps, consequent upon his resignation of the chair of Chemistry
in Shelby Medical College.

The vacancy left by his resignation, has been filled by the appoint-
ment of Dr. Henry Erni to the chair. The above multiplication of
laborers and division of labor, will doubtless add much to the useful-
ness of this already, valuable Journal.

The Chicago Medical Journal has, during the past year, undergone
several changes. Its January and February numbers present the
names of Drs. X. S. Davis and W. H. Byford, both of the Rush Medical
College. In the March number, we find that the Journal is again con-
ducted by its former able Editor, Professor Daniel Brainard, Professor
of Surgery in Rush Medical College, and the same issue imforms us of
the resignation of Professors Davis and Byford, not only from the Journal ,
but in company with Professor Johnson, from their places in the Facul-
ty also. The June number is impressed with the name of Dr. Edward
Powell, Demonstrator of Anatomy in Rush Medical College, as assistant
to Dr. Brainard. While we deeply regret the loss of Drs. Davis and
Byford, we cordially welcome Dr. Brainard and Dr. Powell, into the
ranks of our fraternity.

We regret to say that we have to record this discontinuance of sever-
al Journals, some of which have been valued exchanges for many years,
others, of but more recent date.

The Medical Chronicle of Montreal, the only Medical Journal of the
Canadas, has been abandoned by its able and heretofore indefatigable
Editors, Drs. Wright and McCallum, for the want of support. Readers,
money, or enthusiasm must be at a low ebb in the Provinces, that a
single journal, and one so useful and ably conducted as the Chronicle,
could not be supported in all that region. Although we have thus lost
Drs. Wright and McCallum from our exchange list, we feel assured that
the profession will still receive the benefit of their contributions through
some other and more widely circulated and better sustained medium.

The Maine Medical and Surgical Reporter. This Journal begun in
March of the present year, under the Editorial management and pro-

574 Editorial. [August,

prietorship of Drs. W. R. Richardson and R. W. Curamings. We re-
gret to say, that after a continuance of not quite a year, marked by de-
cided ability in its editorial conduct, it has been obliged to suspend for
want of patronage. " 'Tis not in mortals to command success ; they
can do more, deserve it."

The Philadelphia Medical and Surgical Journal, and The Louisville
Medical Gazette, are each suspended, very properly and justly disheartened,
that faithful, long and arduous labors, brought no adequate reward. We
record these obituaries, one and all, with sadness of heart, and with a
regret as in parting with old and much prized friends.

Nil Desperandum ! Let retiring and disheartened laborers from any
Literary field, remember; that they have not energized in an entirely bar-
ren soil, nor made their painful record in the shifting sand ; far from
it. The result of their many years of hard toil, their " much study,"
their " weariness of the flesh," will still remain in the libraries and on
the bookshelves of thousands of appreciating and admiring readers,
who will still, in years to come, resort to them as valuable store-houses,
whence to draw treasures of counsel and instruction. Obelisks of Gran-
ite, of Marble, and of Brass, endure through long ages, and, in their
sphynxine mystery, puzzle the beholders, generation after generation.
Temples, Porticos, Pillars, and Pyramids, are scarcely more than grand,
crumbling enigmas, but half revealing the splendor and magnificence of
mighty nations, long melted into the mould on which they proudly stood.
But the written page must still endure. That magnificent record of God's
will and man's inspiration, our Holy Bible, the Homer of antiquity,
mythic and sacred through the long ages of their endurance, but grow
brighter with each succeeding decade. How much longer do they
last, how much more plainly do they speak! Words are but breath
written language but ink intelligibly spread paper and parchment are
more perishable far, than even man himself but ob, consoling thought,
most comforting reflection ! The Ideas which these words enwrap and
which the ink and the paper chronicle, shall last forever for mind is
more enduring than adamant, more permanent than brass, and lasting
as the everlasting hills.

Medical and Literary Weekly. We have received the several
numbers of this well conducted periodical which began^ its existence
early in May last. The professed object of the work is certainly a very
laudable one, viz : the extension and diffusion of medical knowledge,
and correct medical ideas among the people and the discountenancing

1859.] Editorial bib

of quackery. Each number contains a considerable amount of Medical
and Scientific matter, such as is found in strictly Medical Journals, and
which will be of interest to medical readers but in addition to this, a
large portion of the paper is devoted to polite literature and popular
reading. We have noted the title of the Medical and Literary Weekly,
upon our exchange list and w?sh its enterprising editors a full measure
of success.

The work is published weekly in the city of Atlanta, and edited by V.
H. Taliaferro, M. D., and A. G. Thomas, M. L>. Price $2.00 per
annum.

"Here a Little and There a Little." We have several times, in
pleasant terms, called attention to the financial matters of this Journal.
At each time, we have with pleasure acknowledged, that few periodicals
can rejoice in a more promptly paying subscription list than our own.
Each month, until recently, a long list of "credits" met our eye, and
gratified our hearts, convincing us that our own labors are appreciated,
and that our worthy Publisher, upon whom fall the entire pecuniary res-
ponsibility, and the most arduous toil, is not only " a laborer worthy of
his hire," but that, that " hire1" is, upon a fair average, promptly gen-
dered over. For some months past, however, these payments have
lessened, to an amount quite inconvenient to him and rather discourag-
ing to us. The toil and the labor continue unabated, but the reward
and the yield of labor begin to wax low. Can it be that our " honeyed
hints" are failing to entice " the flies ?" And must we in despair, aban-
don our patent gentle method, for the more distasteful " vinegar" of
actual dunning ? With the July number, all unpaid accounts have
been submitted to subscribers some have responded and many have'
not. We now call attention to these missiles, and earnestly request, on
behalf of our Publisher, a full and early response. " Here a little and
there a little," either in losses or in gains are, individually, unimportant,
but in the aggregate, they often either sustain or embarrass the most
magnificent enterprises. Let our " little and little" be on the side of
receipts, and from what we know of the liberality of our Publisher, each
succeeding year will only mark a steady advancement as heretofore, in
the size, beauty, and value of this Journal.

In a town of Wurtemburg, a Mr. Helgerad has established, with most
perfect success, a printing house, which is carried on solely by 160 deaf
and dumb individuals. [Cincinnati Lancet and Observer.

Dr. Silas Durkee, of Boston, will bring out shortly, through Mr. Jewett,
his publisher, a work on Gonorrhoea and Syphilis. [Ibid.

576 Miscellaneous, [August,

A New Instrument for Vesico-Vaginal Fistula. By H. F. Camp-
bell, M. D., of Augusta, Ga. We have recently devised a pair of For-
ceps to facilitate the paring of the edges of the Fistula in the above
operation. The principle applied, is that used by Civiale, and other
Lithotritists in the construction of the Stone-Crusher ; viz. the Shoe-
maker's measure. Messrs. Tiemann <fe Co., of New York, have made
the Instrument for us, and we hope to present a clear wood cut of it
and a detailed account of several successful operations in the September
number of this Journal. Let the present notice be our compte rendu.
Augusta, Ga, July \6th, 1859.

Tannin in Large Doses in Albuminous Anasarca. In an interest-
ing memoir published in the Archives of Medicine, Dr. Gamier calls the
attention of practitioners to the use of taunin in large doses, in the treat-
ment of albuminous anasarca. In three cases which he reports, and
which he has compared with analogous observations taken from several au-
thentic records, Dr. Gamier employed with success the following formula :
R. Acid tannic, gr. xxxij.

Aquae distil. - gj.

Syr. cinchon. - gj.

M. S. a teaspoonful three times a day.

Dr. Gamier arrives at the following conclusions : Tannin in doses of
from thirty to sixty grains a day will cure anasarca or oedema passively
developed and coincident with albuminous urine. Its curative action
manifests itself by an abundance of urine, which gradually assumes its
physiological character ; by the cutaneous transpiration ; by the easy
alvine evacuations ; by the apetite, etc. These favorable signs appear
on the second day after the administration of tannin. [Li1 Union Medicate,
and Jour, of Materia Medica.

Citrate of Iron and Strychnia. Among the numerous contributions
of modern chemistry to the materia-medica, we notice in the American
Journal of Pharmacy a formula for what we are disposed to regard as
a valuable preparation of the citrate of iron and strychnia in the pro-
portions of one of the strychnia to forty of iron. In appearance this
salt resembles the citrate of iron, but in taste, besides the peculiar,
slightly ferruginous taste of that of salt, it adds a moderate bitterness,
due to the strychnia. Three grains is a dose, which may be increased
or diminished according to circumstances, and it may be used in chronic
nervous affection with debility, also in certain forms of chlorosis, &c.
We have used the remedy in one or two cases, but are not prepared at
present to pronounce on its merits ; but would invite the attention of
our readers to it, as it can be obtained from our drug dealers. [Jour,
of Materia Medica.

Easy Method of Extracting Foreign Bodies from the Eye. Dr. Leon
Renard, in a note to the editor of the Union Medicate, describes the
following method of extracting small substances which have become

1859.] Miscellaneous. 577

lodged in the groove formed by the reflection of the conjunctiva from
the upper lid to the sclerotic, and which often cannot be seen, even when
the lid is inverted. The lid being seized at its angles between the thumb
and forefinger of each hand, is to be gently drawn forward and down-
ward, as far as possible, over the lower lid, and retained there for about
a minute. On allowing the upper lid to return to its normal position,
the flow of tears will carry oft' the foreign body, which will usually be
found on the lower lid, or one of the lashes, or on the cheek. The
writer states that he has ofteu found this simple method of the greatest
utility and convenience. [Boston Med. and Surf/. Journal.

Homoeopathy not a Science of course not. The great medical suit
which has recently been decided in Paris, in which homoeopathy was
arraigned against the regular profession, after a full hearing, has gone
against the infinitesimal gentry. The case was simply, the editor of the
Union Medicale, sometime since, stigmatized homoeopathy as a pretended
science, and its professors as charlatans. Whereupon twenty-four homoe-
opathic practitioners of Paris brought an action against the editor for
libel. The trial involved the truth or falsity of the charge, and after a
hearing of several days, the Court dismissed the action, and mulcted the
homoeopaths with the costs for their trouble. So that, according to the
decision of the French Court, homoeopathy is not a science, anymore
than anv other tom-foolery of the age. [St. Louis Med. and Surg. Jour.

Dr. Thomas W. Evans, of Paris, having made application to the Sar-
dinian Government in regard to the medical and surgical wants of the
Saidinian army, in view of the employment of American surgeons, the
Minister of that government has responded to the effect, that while
government appreciates the good feeling that prompted the offer on the
part of the American surgeons, the wants of the Sardinian army are, for
the present, supplied. [Med. and Surg. Reporter.

The Woman who lives without Eating" There is no absurdity too
great, no impositiorj^too barefaced, no deceit too often exposed, for human
credulity. The p<^ ession of the highest intellectual powers is no abso-
lute protection against imposition. Men will be cheated. The more
difficult a thing is to be believed, the more readily some people believe it.
Credo quia impossibile est. When rational and sensible men (so consid-
ered) believe that a grain of charcoal so infinitessimally divided that
each individual of the human race could be supplied daily for ages with
a portion is capable of producing appreciable specific effects on the
system, or that the spirits of the departed can and will communicate
with surviving friends through the medium of ignorant and cunning
men and women, who make a trade of their pretended powers, what
more need we say on the subject ? An illustration of this truth is shown
in the story of Mrs. Hayes, who succeeded in making many people believe
that she lived two years without eating, and without having an evacua-
tion of the bowels or of the bladder. One of our correspondents paid a
visit to this woman, and came away a firm believer in her pretensions.
Another correspondent has sent us an elaborate article, explaining the

678 Miscellaneous.

phenomena on physiological grounds, and making it quite plain that a
human being might live two years without eating, and without faecal or
urinary evacuations. Unfortunately for his ingenious theory, the fact it
was intended to explain has been proved not to exist. On being watch-
ed, Mrs. Hayes was discovered regaling herself on crackers and beef!
There is nothing very unusual in all this. Every physician has met with
similar cases of attempted imposition by hysterical females; and the
only remarkable thing about it is, that so many medical men should be
deceived by a very common trick. Strange as it is, howrever, they will
be deceived by it, again and again; and this natural susceptibility of
human nature to imposture ought to make us charitable in our judgment
of the frailties of others, not knowing when we ourselves may become
the victims of delusion. [Boston Med. and Surg. Jour.

Conviction of an Abortionist. The second trial of the notorious Dr.
David R. Brown has been brought to a close by a verdict of manslaugh-
ter. There is evidently a reluctance on the part of juries to convict in
cases like this, where the offence is so very common. Either Dr. Brown
was guilty of murder, or was innocent even of manslaughter. If he was
justified in procuring an abortion, on account of the condition of the
patient, or if she died in consequence of abortion supervening upon treat-
ment intended for a different purpose, he ought clearly to be acquitted.
If he attempted to procure abortion illegally, and the woman's death
was the result, it is equally clear that he ought to have been convicted
of murder. Under the present state of feeling on the subject, it strikes
us that it would be almost worth while to mitigate the severity of the
penalty, rather than allow so many criminals to escape scot free, as the
majority do. When the penalty for forgery was death, in England, it
was almost impossible to obtain convictions, and the crime became ex-
ceedingly common. As soon as the punishment was changed to im-
prisonment, forgeries were of more rare occurrence. We would suggest
the propriety of changing the penalty for procuring abortion, from death
to imprisonment for life. [Ibid.

Marking Papers. The Postmaster General de^es that a pen or
pencil mark, made for the sole purpose of attracting uie eye to a particu-
lar article or portion of printed matter, does not subject matter to letter
postage, as insisted on by some Postmasters.

A King Fetching the Doctor. A few days ago, says a Munich letter, a
female fainted in one of the streets of this city. An elderly gentleman, who
approached the spot where she was lying, requested some of the persons
present to go and fetch a medical man. They all replied that they
knew not where to find one. " Well, then, (he said,) I will go myself."
And in a few minutes he returned with a doctor, who applied the proper
remedies. The kind-hearted old gentleman was King Louis of Bavaria.

We learn that Dr. Alfred Still e has resigned the Chair of Practice in
the Medical Department of Pennsylvania College, which he has filled with
such distinguished honor to himself and advantage to the school.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XV.] AUGUSTA, GEORGIA, SEPTEMBER, 1859. [No. 9.

ORIGINAL AND ECLECTIC.

ARTICLE XIX.

Veratrum Viride in Chorea and other Convulsive Diseases. By
Paul DeLacy Baker, M. D., of Eufaula, Ala.

Quinine in its early history, wras known as an agent only valua-
ble in paroxysmal fevers ; in these latter days, of a more ad-
vanced Pathology and enlightened Therapeutics, its application
has been so far extended, that in Southern latitudes especially,
it has become almost equally a specific in many affections, not
at all characterized by febrile action. Somewhat analogous, I
believe, will be the history of Yeratrum Yiride.

The chief object of this communication, therefore, is not to
set forth the value of this agent as a controller of arterial and
vascular excitement ; for, it is believed that this power is now
recognised and conceded to it generally, by the medical Pro-
fession. Indeed, a consideration of this property would not be
here entered upon at all, except for the reason, that the writer's
attention has been recently attracted by an article, in which it
was declared that " Yeratrum Yiride had seen its day," that its
glory had departed !

Now, if this communication succeeds in recalling one wander-
er from the path of truth, or induces one skeptic fairly to test
the fact he disbelieves, then, will the writer be amply rewarded.
His only object is the advancement of his profession, by de-

W. 6. VOL. XV. KO. IX. 41

580 Baker, on Veratrum Viride in Chorea, &c. [September,

fending and sustaining the truths that -render it a useful and
glorious science.

Those who deny the virtues of the Yeratrum, object to it, as
they say, because, though it reduces the heart's action, it does
not cure disease ; and moreover, it is a dangerous remedy,
which cannot be entrusted to nurses in general.

To the first of these objections, viz : that though the Yera-
trum controls the heart's action, it does not cure disease, it
may be replied, that no Doctor nor remedy ever cured a disease ;
and that the only province of the one, or power of the other, is
to lend assistance to nature, for it is she at last, who alone can
work the cure ; this is plain when it is remembered that disease
is only perverted healthy action. Moreover, when one reflects
and understands what an inflammation is, and properly com-
prehends its commencement, progress, and results, having a
clear perception of the local changes, wrought by it, (which may
be called the mechanical difficulty,) and an adequate idea of
the necessarily irritable and excited state of the nervous system
during its progress it is indeed wonderful that he could throw
aside, untested and uncared for, an agent which it is acknowl-
edged has power to control the circulation ; for, always let it be
remembered and never forgotten, that Yeratrum Yiride controls
the circulation by its sedative influence upon those nerves,
whose " aberrated action" forces the heart and arteries into such
an unnatural and dangerous turmoil ; and this quieting of the
great force-pump of the circulation, prevents the rushing cur-
rent from impinging with destructive force upon the inflamed
and suffering organ, and from too rapidly crowding globule
upon globule, upon its already congested and stagnant capilla-
ries, and thus, by affording what may be considered a mechani-
cal assistance, gives the sanative powers of nature time and
opportunity to remove the obstruction and work out the cure.
Let it also, not be forgotten, that all the while the hitherto ex-
cited and irritated nervous system, is primarily calmed into normal
quiet, and that consequently, all the workings of the organism,
as they are under its " superintending influence," must move on
in their natural course ; thus is it, that the equilibrium is re-
stored, which ensures that harmonious order which characterizes-
and makes perfect, the grand and beautiful works of God.

1859.] Baker, on Veratrum Viride in Chorea, &c. 581

Thus is it, that the modus operandi of Veratrum in inflamma-
tory diseases, accomplishes all, and more, than can be claimed for
the lancet. Venesection is alone beneficial in such cases, in
two ways ; first mechanically, by lessening and weakening the
force of the circulating current, and thereby guarding against
the dangers of its too frequent and forcible impulse upon the
seat of inflammation ; and secondly, by its sedative influence
upon the nervous system, whose excitability is largely and ir-
regularly developed, in proportion to^ the violence and extent
of the phlegmasia ; and under which condition of the nervous
system, the bloodvessels, whose function is controlled by it,
tend to continued and augmented action. But, let it be re-
membered, that the Veratrum accomplishes, as has already
been shown, both these results, only in a far more safe, perma-
nent and satisfactory manner. That this assertion may be pro-
ven to the unbeliever's mind, let the relative virtues of the two
agents be tested by the touchstone of comparison.

The mechanical benefits of venesection are accomplished at
the expense of an abstraction of a portion of the life's current
from the body, the ultimate consequences of which waste is
always to be deplored ; in addition to this, the immediate advan-
tages obtained by the operation are only temporary, since, what-
ever fluids may be subsequently taken into the stomach, pa*s
directly into the circulation, and soon the bulk and force of the
current is as full and strong as before, without, however, being
as nutritive and sustaining.

On the other hand, the same advantages are attained by the
action of the Veratrum, but in a different way ; by its in-
fluence, the heart's action is simply held in check, and the
force of the circulation reduced to nature's standard, every drop
of the precious pabulum vitoz is preserved ; and thus, after the
storm is over, a more speedy and perfect convalescence is en-
sured.

The sedative influence of venesection upon the nervous sys-
tem, is also too often merely temporary, and, in individuals
whose nervous system is very impressible, is often followed by
reaction to such an extent, as to produce an exaltation of
organic action, even perhaps to a greater degree than before the
operation. In such cases, the remedy is at an end, a repetition

582 Baker, on Veratrum Viride in Chorea, &c. [September,

of the bleeding would be dangerous in the extreme, as it would
only increase the existing difficulty.

Even in persons who endure well the abstraction of blood,
venesection is a remedy that cannot be persisted in. If it con-
quers, it must do so at a blow, which blow, though a victory,
is yet, too often, like Pyrrhus' hard fought battle, almost a de-
feat, and a repetition of which, would result in utter vanquish-
ment. On the contrary, the sedation procured by the action of
Veratrum Viride, is perfect and without the danger of inordi-
nate reaction, as the remedy may, without evil consequences,
be continued for days, and, if necessary, even weeks, as is pro-
ven by my having, in a case of typhoid fever, with excessive
arterial excitement, kept the heart's action controlled for thirty
days, merely with the view of saving its machinery.

Let the question of the " danger" of Veratrum, be now con-
sidered. From a tyro-experience, I can readily comprehend
how the idea might originate, and be, too, so impressed upon
ones mind, as not to be easily eradicated. It was the writer's
fortune soon after entering upon the practice of medicine, to
have a case in which it was determined to test the efficacy of
Norwood's tincture of Veratrum Viride, the object being to con-
trol the circulation. The subject was a lady laboring under a
high grade of fever. The medicine was administered, accord-
ing to the directions upon the bottle, by giving eight drops
every three hours, increasing each dose by one drop, until the
effects were produced. The result was, that suddenly and
shortly after the third dose, there ensued the most distressing
nausea and vomiting, together with frequent purging, (this last
occurring from relaxation merely,) and a most excessive and
alarming prostration a degree of muscular relaxation, that
seemed to portend a fatal collapse, and an icy coldness which
simulated the chill of death itself sorely was my mind oppress-
ed, for I felt sure my patient was dying ; terrible and afflicting
was the grief and consternation of the family, one of whom
gave free vent to her belief, that, the " Doctor had killed her
mother." Friends and relatives were hurried for to see her
die, but the tumult was, after a while, quieted, by the applica-
tion of sinapisms, and a few portions of morphine and brandy,
and the lady sank into a sweet sleep, with a soft, slow and regu-

1859.] Baker, on Veratrum Yiride in Chorea, &c. 583

lar pulse ; the fever seemed jugulated, but after a lapse of eight
or ten hours, the heart's action began to increase, and the fever
was allowed again to develop itself, because, at that time, all
the demands of Golconda could not have induced me to resort to
the Veratrum again ; I thanked God that my patient had not
died, and resolved that, if ultimately she did not recover, she should
expire under such circumstances, that disease should share with
me the responsibility of her death. She recovered.

I have related the above experience, not only for the purpose
of showing how a belief as to the danger of the Veratrum might
originate, but also, because, from a constant recollection of the
phenomena, produced by its action upon that occasion, and a
continued reflection in reference to them, I have been taught
much of the value of the remedy, its mode of administration,
and its unequalled power to assist nature in working cures. I
also record it, for the reason, that a recollection of it, suggested
to my mind years after, that Therapeutical power, the publication
of which, is the chief purport of this article. The above experi-
ence, corroborated by subsequent observation and experiment,
has also taught me these additional facts, viz : that though to Dr.
Norwood the honor and gratitude of the Profession is due and
cheerfully rendered, for having furnished us with this most invalu-
able agent of the Materia Medica, yet, that the directions that
he has labeled upon the vials, and which are to be found in the
last editions of the U. S. Dispensatory, have done more to re-
tard aud prevent its employment, than any other thing. The
doses mentioned, are too large for general use, and their effects
have intimidated many practitioners, to the extent, that they re-
fuse to administer it. And even when this is not the case, the
nurse or family to whom its administration is committed, in
consequence of their uneasiness and alarm at its effects, cease
to give it with any certainty or regularity. The Physician
consequently being disappointed in its results, leaves off the
remedy, declaring that though it was pushed to the most dis-
tressing vomiting, it ultimately did no good. All this is the
more probable, as the Veratrujn, besides being exceedingly
energetic, is also, accumulative in its effects. The truth of this,
may be recognized, by the sometimes sudden and violent out-
burst of symptoms, as well as from the fact, that when the sys-

584 Baker, on Veratrum Viride in Chorea, &c. [September,

tern has once been impressed by it, its effects may be perma-
nently retained by the occasional administration of a drop or
two of the medicine, at long intervals. All these facts have
convinced me, that when it is desired to continue the remedy
for any length of time, it should be commenced in much smaller
doses, and that so far from increasing the quantity each time, it
should, on the contrary, be diminished, and the intervals even
lengthened. In this way, the proposed result may, though
slowly, be unfailingly obtained, without too, the slightest unto-
ward symptom.

When I have twelve or fifteen hours to go upon, and desire to
obtain the specific effects of Veratrum Viride, I usually adminis-
ter it to an adult, in five drop doses every two hours, until two
or three portions have been taken, after which, the interval is
lengthened to every three hours. Before each and every dose,
after the first, I always carefully note the pulse, and if it exhib-
its the least tendency to depression, the dose is diminished or
the interval still further prolonged. This is done for the rea-
son, that some constitutions are extremely susceptible to its
action, as was the case of the lady already mentioned. This
caution, is, however, preserved only to avoid unpleasant symp-
toms, and unnecessary alarm on the part of the patient and
friends, and not by reason of any apprehension as to the danger
of the remedy ; for, I have been convinced that the utter pros-
tration capable of being induced by it, is without any greater
degree of danger than that condition, which the steamers produce
by the abuse of lobelia, and which in their jargan is styled "the
state of alarm." Still it is not easy to convince the friends and re-
latives of this, and if the Physician allows his patient to pass into
such a "state," he will certainly find himself hurried after with
the greatest dispatch, and with the startling announcement, that
his patient is dying! and though he may find him quiet and
comfortable, it will be difficult to have his directions car-
ried out in reference to a continuation of the medicine.

Thus it is, that I have endeavored to show the modus operan-
di of Veratrum Viride, and tl^ proper method of its adminis-
tration, in inflammatory diseases, designing, and hoping, to
convince the timid doubter of its incomparable virtues and
entire safety.

1859.] Baker, on Veratrum Viride in Chorea, &c. 585

Did my space admit, I could here record scores of cases,
demonstrating the wondrous powers of this agent; prov-
ing it a specific in Pneumonia, and showing it capable of rob-
bing puerperal fever of its deadly terrors. But, I trust that I
have written that which is sufficient to convince the Pathologist
that it is, at least, a remedy not carelessly to be discarded.

In leaving this portion of the subject, I would remark, that
the virtues of this agent are not alone manifested in sthenic in-
flammations, but that its administration is equally applicable in
conditions where the very opposite obtains. I have often de-
rived the utmost satisfaction from its use, in the very worst
forms of Asthenic Pneumonia, and I have now in my mind,
such a case, wherein the administration of five drops of Veratrum
combined with five grains of Quinine, every three hours, wrought
in the space of twelve hours, a change that seemed almost a
miracle.

I come now, to direct special attention to the most important
truth, which my experience and observation have developed
in reference to the Veratrum Viride, and that, which is the truth
I propose to offer on these pages. I have hitherto declared
that it exerted a sedative influence upon the nervous system ; I
say now, that it is eminently a nervine, whose primary influ-
ence is spent both upon the cerebro-spinal and ganglionic sys-
tems, and that all the manifold indications, so successfully ful-
filled by it, are alone dependent upon this fact. Now, all that
has been published, either in the U. S. Dispensatory or else-
where, concerning the remedial powers of this agent, was writ-
ten in reference to its value in the treatment of febrile and in-
flammatory diseases. Indeed, in Dr. Norwood's pamplet upon
" the Therapeutical powers and properties of Veratrum Viride,"
its virtue as a controller of vascular and arterial excitement,
constitutes the chief burden of his song, and, but an incidental
mention is made of its other equally prominent and valuable
powcis. It is true, that Dr. Norwood has said that Veratrum
was nervine, not narcotic, that he also remarked that Prof.
Frost of Charleston, had employed it with benefit in Cancer*
and epilepsy, also, that its emetic effects relieved the symptoms
of acute chorea, and that it was valuable in the convulsions of

* The Italics are my own.

586 Baker, on Veratrum Viride in Chorea, &c. [September,

children accompanied -with, febrile action. Yet all these remarks
were made so disconnectedly with each other, so incidentally,
and in such connections, as clearly to show that, the Doctor
had no adequate idea, of the real nervine properties of his reme-
dy, or just conception of the full therapeutical powers of the
priceless boon he was offering the Profession. Under the
force of such facts and circumstances, I hope that I am justified
in recording an experience, which tends to show that Yeratrum
Yiride is as valuable a nervine, as an antiphlogistic, and that in
the treatment of certain neuroses, it stands as prominent and
as unrivalled, as it does in the management of inflammatory

On the 19th of February, 1857, 1 was called to a stout, healthy
man, of sober habits, reported to be having " fits." I found
him sitting on the side of the bed, seemingly well and perfectly
intelligent, unaware, however, that he had had convulsions ; all
that I could ascertain of his previous history, was that he had
been similarly affected in childhood. While conversing with
him at his bed-side, he was suddenly, and without apparent
premonition, seized with a frightful convulsion, occasioning
frothing at the mouth, and the most violent jactitation of all
the voluntary muscles. I immediately opened a vein and bled
him profusely, but without the desired result, for, after the lapse
of a certain period, with as perfect a return of consciousness as
before, there occurred another convulsion of equal severity. In
this emergency, the excessive muscular relaxation capable of
being produced by Yeratrum Yiride, occurred to my mind, and
I reflected that such an effect could only be produced by an
influence primarily exerted upon the cerebro -spinal system of
voluntary nerves. I instantly determined to act upon the
( reflection, and administered the Yeratrum in full and frequent-
ly repeated doses, desiring and confidently expecting to produce
the same train of distressing symptoms that so alarmed me some
years previously. In this, I was disappointed, for, though the
convulsions were arrested, there occurred no other symptom
than a relaxed skin with profuse perspiration. In this case, I
do not remember the number of drops given, but I do well re-
collect that the doses were large, and that the same quantity, in
a less excited state of the nervous system, would, beyond all

1859.] Baker, on Verairum Viride in Chorea, d-c. 587

question, have produced the effects exhibited in the case of the
lady, already related. Since then, I have- administered Vera-
trum Viride in numerous cases of eclampsia in children, with
such satisfactory results, as have established beyond all doubt,
the power of this agent to arrest CONVULSIONS. Indeed, I feel
perfectly assured that it is a physical impossibility for convulsions
to continue, after die system has been fully impressed by the remedy.
My experience is, that in these cases, ilte medicine is tolerated in
much larger doses tlian under ordinary circumstances.

I have had but one opportunity to test its powers in puerpe-
ral convulsions, from the fact, that I have met with but one
case occurring after delivery had been accomplished, and I have
always withstood the temptation to administer it before, in con-
sequence of a strong belief, if not certain conviction, that its
action would arrest uterine contraction.

About two months ago, I was called with my friend, Dr.
Terry, to see a woman suffering with puerperal convulsions.
We found labor advancing, and though the convulsions were
severe and frequent, we determined to leave its accomplishment
to nature, and to endeavor in the meantime, to check or control
the convulsions, by the inhalation of chloroform, there being
certain symptoms which seemed to contraindicate venesection.
Dr. Terry having been called away, I remained to watch the
case and administer the chloroform; but as the labor made slow
progress, and the convulsions increased in frequency and se-
verity, I bled the woman copiously and sent for Dr. T. to return
and bring instruments. He soon came and the woman was
delivered, by means of the forceps, of a dead child weighing
eleven and a half pounds. I remained with the case an hour,
when, being called out of town, I left the lady quiet and
comfortable. Upon my return, four or five hours later, I found
her in a most violent convulsion, which was reported to be the
seventh since delivery. I immediately gave her fifteen drops of
Veratrum Viride, and directed that she should take ten more in
two hours, after which, the intervals should be prolonged to
three or four hours, according to circumstances. There occurred
no more convulsions, and the woman recovered perfectly, she was
not even nauseated, though the medicine was given at regular inter-
vals during the whole night.

588 Baker, on Vcratrum Viride in Chorea, dec. [September,

I will now record my experience with the Veratrum Viride,
in a case of Chorea.

On the 7th of June, 1858, 1 was called to a young lady suffer-
ing from a violent attack of Chorea. The mother informed me
that, it had been very gradually coming on, for a month or
two ; her symptoms, when first visited, were distressing to the
last degree; her entire muscular system was in continuous and
tumultuous commotion, so much so, that it was with difficulty
that she could be kept upon the bed. This case passed on from
bad to worse, notwithstanding the most assiduous attention and
energetic treatment ; tonics, antispasmodics and anodjmes, were
exhausted without avail. The spine and nucha were cupped
and blistered without benefit, chloroform was administered both
internally and by inhalation in fact, every remedy that could
be legitimately suggested was resorted to, but without success,
and it seemed at last, that the girl must die from exhaustion and
want of sleep. Opium, and its various preparations, appeared
to make her worse ; once or twice I suggested the employment
of Yeratrum Viride, but it was postponed, until on the 18th of
the month, when my partner, Dr. Thornton, under whose espe-
cial care the case had been, was called off to Georgia. On that
day, just as I was starting to visit her, my friend Dr. Terry,
hearing of the unusual violence and obstinacy of the case,
stopped me and proposed that I would give Veratrum Viride a
trial, assuring me that he had thrice used it in Chorea with the
most satisfactory results. So, I concluded, both from my own
experience, and from his positive statement, to withdraw all
other medication and give the Veratrum Viride a full and fair
trial. The family had given up all expectation of her recovery.
I told them, however, upon my arrival, that I had come with a
a new remedy, the last and only one that had not been tested,
and that I felt convinced that the girl would recover under its
use. I at once commenced its administration, and as she was
gradually brought under its influence, the turmoil began to
cease ; the face which had been worked by its muscles into the
most ludicrous and horrible distortion, became placid and intel-
ligent, the head had ceased its everlasting jerking, the extreme-
ties lay still, the body left off writhing, and the patient quietly
passed into a 'peaceful and profound slumber. This sleep was

1859.] Baker, on Yaratrum Yiride in Chorea, dec. 589

deep and long, as it was the first, with few and slight excep-
tions, that she had had in nearlj- two weeks, and the quiet that
the muscles now received, was all that had occurred, save dur-
ing those few and short slumbers. At a subsequent visit, I
found the family cheerful and hopeful, and the patient quiet
and sleeping, the pulse but little depressed ; there had occurred
no vomiting. I roused her, and, to my great satisfaction, when
awake, there was no jactitation of the extremities, and but
very little twitching of the muscles of the face.

In this case, I thoroughly tested the influence and power of
Veratrum Yiride, for the first few days; if its administration was
withheld, the commotion began gradually to return, but all
would again become quiet, upon resuming its employment. At
first, so continually did she sleep under the quiet that it in-
duced, that the family called the Veratrum preparation " the
laudanum mixture," notwithstanding they were aware that she
had taken large quantities of morphine, without benefit, in our
efforts to induce sleep. The Veratrum was continued for sever-
al days, the convulsive movements ceased altogether, the mus-
cles became completely obedient to the will, and the lady re-
turned to perfect health and blooming beauty, under a judicious
and properly regulated tonic course of treatment.

In corroboration of my experience, I will here relate three
very interesting cases, politely furnished me by my friend Dr.
Terry, of Eufaula, Alabama, formerly of Georgetown, Georgia.

"Case 1. I was called in Randolph Co., Ga., to visit a child
aged twelve years. It had been confined to bed for three weeks,
and was reported to have been under treatment for about six
weeks, first, for worms, with calomel, spigelia, wormseed, &c,
and subsequently for chorea, (with which I found it suffering,)
with cemicifuga, iron, quinine, and the usual routine treatment,
until the child was apparently dying.

It is not in the power of language to to convey a proper con
ception of the truly pitiable state in which I found this child ;
no description can afford any adequate idea of its appearance
and condition. It had slept none, neither had it taken any
nourishment for days ; it was evidently dying from exhaustion
and inanition, the muscular commotion was violent, universal,
and unaffected by sleep ; the lips embossed with foam, worked

590 Baker, on Veratrum Viride in Chorea, &c. [September,

up, by a continual champing of the teeth. I instituted the
following treatment: three drops of Yeratrum Viride were ad-
ministered every three hours ; the vehicle for each dose being a
teaspoonful of gum water, a small portion of which was intro-
duced into the mouth every few minutes, until the whole was
given, the medicine being in this way, rather absorbed from the
mouth probably, than swallowed. In twenty-four hours, I had
the gratification to see the symptoms greatly improved. The
muscles were much quieter, and the child could swallow with-
out difficulty, (the trouble in this respect, had constituted the
greatest embarrassment in the treatment.) I continued the Ye-
ratrum Yiride in connection with iron and quinine. At the
end of the fourth day, all convulsive action had ceased ; the Y.
Y. was still farther continued, though in smaller doses, and at
long intervals. Quinine, iron and generous diet completed the
cure promptly.

Case 2. Girl, aged fifteen years. This was an ordinary case.
She was purged freely ; after which four drops of Y. Y. were
administered every three hours. Under its use, the convulsive
phenomena soon disappeared, after which the Y. Y. was
continued for a few days at long intervals. This case also
promptly convalesced under the use of iron, quinine and gener-
ous diet.

Case 3. Woman, aged thirty-six years ; had borne no child-
ren ; was subject to menorrhagia, immediately after an attack of
which, she was taken with chorea, marked by continued nod-
ding of the head, and violent convulsive action in one arm,
together with slight jactitation of one leg. In this case I direct-
ed six drops of Y. Y. every three hours ; the fourth dose occa-
sioned slight nausea, and after the fifth dose, the convulsive
action ceased, when the Y. Y. was withheld. There followed
in the course of eight or ten hours, a return of the symptoms ;
the medicine was again resorted to with the former quieting re-
sult. The doses were then reduced, but continued for several
days at long intervals. This case, like the others, recovered
under the use of quinine, iron and generous diet."

Such is the experience, and such are the facts, that have
taught me that Yeratrum Yiride is the most valuable, safe and
certain agent in the treatment of those neuroses characterized by

1859.] Wilson, on Hie Treatment of Inflammation, d-c. 591

convulsive phenomena, and I here would suggest it to the Pro-
fession as a remedy to be considered, if not relied upon, in the
management of those direful maladies, tetanus and hydropho-
bia. I have never had an opportunity to test it in either, but
were a case submitted to my care, such is my faith in the Vera-
trum Yiride in all convulsive affections, that I would place
more reliance upon it than upon any other agent of the Materia
Medica.

ARTICLE XX.

Remarks on the Treatment of Inflammation and Ulceration of the
Womb ; and more particularly on Irrigations in Ulcerated and
Inflamed Os Uteri. By John STAINBACK WlLSON, M. D.,
of Muscogee County, (near Columbus,) Georgia.

In the treatment of the above disorders, our means should be
directed mainly to the removal of the local inflammation and
congestion. To accomplish these ends, there is nothing more
safe than the topical and general application of water. It is
hardly necessary to say any thing to physicians as to the inti-
mate connection between the skin and mucous membranes, or
to remind them of the immense amount of blood that may be
diverted from the internal organs, to the vast network of cuta-
neous capillaries. We have treated some very obstinate cases
of chronic inflammation and ulceration of the uterus, which
had resisted the persevering use of the ordinary remedies, after
the following fashion, with the most satisfactory results. We
began by sponging the whole body, daily, with tepid water,
gradually reducing the temperature, as the patient was able to
bear it, and following each application by active friction with
the hand, or with a coarse towel, or a piece of grass cloth, which
is excellent in such cases. This of course produced a strong
determination to the skin, relieving the local vascular conges-
tion of the womb ; to say nothing of the equalizing, sedative
and tonic effect on the nervous system, which is often so much
disturbed and unbalanced in these affections. In addition to
this general application, we have frequently prescribed a short

592 Wilson, on the Treatment of Inflammation, &c. [September,

cold hip-bath, two or three times a day, to be followed by a
good rubbing around the hips, back, loins, lower part of the
abdomen, &c. This bath has but seldom been continued more
than from one to three minutes each time, the object being to
produce a revulsive reactive determination to the skin, over the
affected part, rather than a profound, direct, sedative effect on
the womb itself. Besides the sponging and hip-bath, we have
been in the habit of prescribing a cold wet bandage over the
womb, and not unfrequently over the lower part of the back.
This, by its action on the capillaries, sometimes causes an erup-
tion on the skin, almost as severe as that from tartar emetic,
thus acting as a counter-irritant, and powerfully aiding the
strong diversion already obtained by the baths, frictions, and
the continuous action of the bandage which has been for some
time preceding the eruption, in constant contact with the skin.
This eruption is the "crisis" of the hydropaths, but its appear-
ance can be readily explained without the absurd assumption
that it originates from the elimination of drugs, poisons, the
materies morbi, <c, which escaping in a tangible form, tear the
body like so many devils. In using the bandage, we have
generally continued it day and night, re-wetting it whenever
it became dry or uncomfortably warm. For the removal of the
headache and palpitation of the heart, which frequently attend
this protean disease, we have found the following plan very
efficacious: For the palpitation, we have prescribed cloths wet
with cold water and applied over the region of the heart; and
where there was much heat and excitement about the chest,
the cloths have been exposed to the air without any covering,
and changed frequently. We recollect a case in which the heart
palpitated most violently, intermitted and cut up a great many
strange capers, much to-the annoyance of the poor patient, who
sometimes thought that her hour had verily come. The wet
cloth as above, and the hot foot-bath, which is a valable adju-
vant, never failed to give relief in this case, until the original
cause of the palpitation, inflammation and ulceration of the
womb having been removed, the cardiac difficulty gradually
disappeared.

Headache is best relieved by the hot foot-bath, by strict atten-
tion to diet, to the bowels, and to the state of the mind. We

1859.] Wilson, on the Treatment of Inflammation, &c. 593

have commonly succeeded in regulating the bowels by simple
enemata and a laxative diet. This is far preferable to the
habitual use, even of mild purgatives. But the main object of
this paper, is to call attention to a remedy in inflammation and
ulceration of the womb, which, if we may decide from our limit-
ed observations, is inferior to none in safety and efficacy ; and
in some cases is superior to all others.

Uterine Irrigation is recommended by Colombat in cancer of
the womb ; (Meigs's Translation, page 34-i,) but we are not
aware that the remedy had been used to any extent in this
country, in cancer, or any other form of uterine disease. The
apparatus for this womb-bath, is quite simple, and can be fitted
up extemporaneously by any one. It may be prepared by
having a common funnel, a stool, of the proper height, and long
enough to stand astride the patient, with a hole through it for
the funnel ; and all that is necessary besides this, is a gum elas-
tic rectal tube which may be fitted to the pipe of the funnel with
a little bee's wax. We have used such an apparatus as this in
a very severe case of ulceration, involving both lips of the os
uteri, and which had resisted the repeated use of that excellent
remedy, nitrate of silver. In this case, the mouth of the womb
was not only ulcerated, it was swollen and livid ; so much so,
as to excite the most serious apprehensions of malignant dis-
ease ; besides this, the patient was two or three months advanced
in pregnancy, and her general health was very much impaired ;
indeed she had an almost endless list of disagreeable symptoms,
such as palpitation of the heart, headache, dyspepsia, with all
its horrors, mental hallucinations, gloomy forebodings, and in
short, all the undescribed, and never- to-be-described sypmtoms
embraced in the comprehensive and vague term, nervousness.
Yet under the use of cold uterine irrigations, the inflammation
subsided in a few weeks, the ulceration healed in due time, and
her general health became better than it had ever been in any
of her previous pregnancies, she having had four children be-
fore. And all this without a single dose of medicine, using the
latter word according to its conventional and popular significa-
tion. Yet if medicine means any thing that cures, water must
be a most excellent medicine indeed, to accomplish such results.

And in this connection we may be permitted to add, that

594 WlLSOK, on the Treatment of Inflammation, &c. [September,

even we physicians are too much prone to fall into the popular
error, that medicines are confined to the shelves of the apothe-
cary, that they consist exclusively of the simples and compounds
of the druggist and chemist. And thus are we liable to forget
those great medicines manifested in nature's grand laboratory,
and which, in many cases, are far more safe and efficient than
the most subtle and refined productions of art.

In the case under consideration, the irrigations were used for
awhile, as long as six hours in a day, with short intervals of
rest. The rule should be to continue the application as long as
possible, each time, so as to produce a decided sedative and con-
stringing effect on the excited and conjested vessels of the affect-
ed part ; and as soon as reaction occurs, which will be manifest-
ed by increased pain, the irrigations should be repeated until
the effect becomes 'permanent, until the vessels contract to their
proper size, and the inflammation subsides.

Since her confinement, the subject of this case has had a re-
turn of the ulceration, and as the inflammation seems to be more
indolent, the cold water has not succeeded so well as before, and
as she is strongly prejudiced against the nitrate of silver, from
her former experience, a very strong decoction of red oak bark
has been applied, by pouring it into a glass speculum, and let-
ting it remain in contact with the ulcer from three to ten minutes.
The immediate effects of this, are pains in the back and consid-
erable local irritation, but in a few days there is a marked im-
provement in all the symptoms. What will be the alternate
result of this treatment, time must determine, as the case is still
on hand.

In conclusion we would remark, that we know how strong
popular prejudices run against the use of cold water in uterine
affections, and we are not sure that the profession does not par-
ticipate to a considerable in these feelings; yet we cannot pos-
sibly see any ground for fear in the use of uterine irrigations in
inflammation of the os uteri, in the absence of any special con-
traindication, of which the physician is to judge. In cases
where the local and general symptoms are decidedly asthenic,
the remedy might be inappropriate ; and the same thing might
be true in cases where some pulmonary or other complication
exists, or where there is extreme sensitiveness to cold. But in

1859.] Mathews, on Placenta Prcevia. 595

cases where the excitement is great, where the inflammation is
as an acute or sub-acute character, we cannot possibly imagine
any remedy that would be more likely to produce the most
happy effects, than the direct and continuous application of cold
water to the inflamed part. And even where inflammation is
more indolent, where the symptoms of excitement are slight,
our observation has taught us that nitrate of silver and such like
remedies, sometimes produce a morbid irritation, and aggravate
the disease. The only disagreeable symptom that we have
seen from cold uterine irrigations, was a muscular soreness, or
a rheumatic affection of the muscles, and facia of the abdomen.
This readily yielded to the application of warm cloths over the
painful parts.

ARTICLE XXI.

Ergot and the Tampon in Placenta Prcevia. By William A.
Mathews, M. D., of Fort Valley, Georgia.*

I have had it in contemplation for a length of time, to report
through the pages of the "Southern Medical and Surgical
Journal,'1 my views of the treatment of " Placenta Prcevia" or
41 unavoidable Haemorrhage ;" illustrated by the details of one
or more cases. My only motive in making this report, is to
save the young and inexperienced members of the profession,
from, at least, some of that intense anxiety, always attendant
upon the management of those alarming cases. Hoping to
make some suggestions that will render the treatment simple,
and at the same time safer, to the unfortunate woman.

I do not presume to cast any additional light upon the
nature or causes of the haemorrhage in these cases ; nor make
any suggestion as to their prevention ; neither do I claim for
the mode of treatment much, if any thing, original. There are
but few Physicians who have been long in practice, who have
not met with one or more cases of "unavoidable Haemorrhage,"
and who have not felt the want of that clear and satisfactory
conviction, as to what course of treatment would best subserve
the safety of his patient, and been subjected to that tantalising

* The above communication was sent on the loth of May, 1859.
N. S. VOL. XV. NO. IX. . 42

596 Mathews, on Placenta Prcevia. [September,

uncertainty, which sometimes results, in either too much tem-
porising on the one hand, or temerity on the other. Trusting
too long to astringents and the tampon, or resortiug too early
and unnecessarily to manual aid or delivery by turning.

It has been my misfortune to meet with a number of cases of
" Placenta Prsevia," and some of the most painful reminiscences
connected with my past professional life, are associated with
this always precarious condition. I have seen some in my
earlier practice, die, who might, I honestly believe, have been
saved by, the practice which has been pursued by me in several
other cases, within the past nine years. And if I can aid the
young and inexperienced in safely conducting such cases, and
thus contribute to saving the life of one dear devoted mother,
one beloved, affectionate wife, I shall be abundantly compen-
sated for making this communication.

Wishing to occupy as small a space as practicable in your
valuable Journal, I will proceed to give the history from memo-
ry, of two cases which came under my observation and treat-
ment, within the five past years.

During the winter of 1854, I visited Mrs. S. of an adjoining
county, who I had learned some weeks before, had occasional
attacks of " flooding," each attack more violent than the pre-
ceding. On arriving I found Dr. H., the family physician, pre-
sent. The day being cold, I went into an adjoining room to
warm, and while Dr. H. was relating the condition of his pa-
tient, a messenger came in and stated that Mrs. S. seemed to be
in great distress, was very restless, and seemed worse. On
going into her room we found her as represented, presenting
all the symptoms of great exhaustion from loss of blood, which-
seemed to have come on within ten or fifteen minutes, as the
Doctor had discovered no cause for great alarm when he left
his patient's room, about the time of my arrival. A very large
quantity of blood was found in the bed, and the discharge still
profuse.

Upon examination, the os uteri was found quite soft, and
dilated to the size of a dollar, and a small part of the placenta
lying in it. She was complaining, and had been for some time,
of rather irregular pains.

In a few words, I explained the peculiar and very precarious

1859.] Mathews, on Placenta Previa. 597

condition of the lady, and feeling the absolute importance of
checking the loss of blood, suggested the tampon, which was
forthwith applied. We then commenced the administration of
ergot in free doses, which in less than an hour, brought on
active uterine contraction, and in two and a half hours, the
foetus was expelled, preceded by the placenta and tampon.

So great was the exhaustion, that syncope ensued soon after
delivery, and continued to recur, rendering it necessary to use
stimulants internally and externally, and to place the patient's
head below the line of her feet, by elevating the foot of the
bedstead.

Mrs. S. gradually recovered, and has borne one or two child-
ren since. She was delivered at about the end of the eighth
month, as well as I recollect.

Gase 2d. Sometime in the month of March last, I was request-
ed to see Jane, a servant of Mr. M., near this village, who, I was
informed, was suffering with a painful swelling of the veins of
her legs. Jane was about six months and a half advanced in
pregnancy, about twenty-five years of age, and the mother of
three children. Finding her laboring under severe febrile ex-
citement, I bled her moderately, advised some aperient, and
rest in a recumbent posture, &c. Some four or five weeks after
the above, I was called to see the woman in some haste, and
found her laboring under " uterine haemorrhage," not however,
at all alarming in character. I learned, on enquiry, that Jane
had been attacked without any premonition, while upon her feet.
The history of the case was such as satisfied me, that it was one
of " placenta piaevia." I explained to her mistress her peculiar
situation, that nothing could be done only to palliate, advised
some astringent and absolute rest, with an anodyne at night if
she did not sleep, or suffered increased uneasiness in her back, of
which she was then complaining, and requested if the haemor-
rhage considerably increased, to be notified immediately.

I visited my patient next day by request ; was informed that
the flooding was much less during the night, but had greatly
increased since breakfast. I now for the first time, examined
her per vagina, found a quantity of blood in the bed and a large
coagulum nearly filling the vagina. The os uteri was con-
siderably dilated, soft and flaccid, and at least two-thirds covered

598 Mathews, on Placenta Prcevia. [September

by the placenta. She was suffering from pretty regular pains,
and loosing blood constantly. Conceiving delivery absolutely
necessary, I commenced with the ergot, giving it in free doses.
In some forty or fifty minutes, the uterine contraction increased
in force and frequency, expelling at almost every one, considera-
ble quantities of blood. Watching my patient's pulse, I con-
tinued the ergot in increasing doses.

In about two hours and a half after commencing the ergot, I
found on examination, the membranes entire and near the vulva,
becoming during the uterine contraction very tense. Hoping
to bring on more efficient contractions, I ruptured the mem--
brane and gave exit to a large quantity of "the waters." The
pains now entirely ceased, and my patient remained for about
one hour free from all uneasiness.

After waiting some fifteen minutes for a return of pain, I
examined again, found the os still more dilated, and nearly
filled with the placenta, and blood flowing copiously.

Discovering some symptoms of exhaustion, and finding it
necessary to save as far as practicable the loss of blood, I resort-
ed to the tampon. Continuing the ergot in large doses, and
using friction over the womb, I watched with great anxiety the
strength of the woman. At the expiration of the hour, I had
the gratification of seeing the uterus resume its action ; the con-
tractions became expulsive in character, and in twenty minutes
more, the foetus was expelled, preceded by the placenta, and
my patient was safe.

As in nearly all the cases I have seen, the foetus in both these
instances was dead from exhaustion. I have thus in as condensed
a manner as is compatible with perspicuity, given the details in
the treatment of the above cases, upon which I will offer but few
reflections.

When called to a woman laboring under "uterine haemor-
rhage," about the seventh month of utero gestation, if the attack
come on suddenly without any premonition, or if the woman be
at any stage of pregnancy between the six and a half and eighth
month, the physician may pretty safely diagnose "Placenta
Praevia." If the loss of blood be not alarming in quantity, en-
join rest and prescribe some astringent, of which I know of
nothing preferable to alum] and if the woman complains of occa-

1859.] Mathews, on Placenta Pro via. 599

sional pain, give an anodyne. If the loss of blood has been
great, and the flooding continues, resort to an examination.
Should the os be found undilated or not soft and dilatable, use
the tampon. If the condition of the mouth of the womb be
different, that is, soft and dilatable, or considerably dilated, the
ergot may be resorted to with safety. Until, however, such is
the condition of the os, the tampon is the only efficient remedy,
and one that generally meets all the indications until the use
of the ergot will be safe.

It will be seen that I rely almost entirely upon the tampon
and ergot. The former is always important in excessive " ute-
rine haemorrhage," except such as succeed immediately or within a
few hours upon delivery. Such is the relaxing influence of the
loss of large quantities of blood upon the muscular system, it
will very rarely happen, that the specific property of the ergot
may not be called into requisition in ample time to save the
patient.

I am aware that many of high authority object to the use of
the tampon in such cases, supposing, that by causing the blood
to coagulate about the bleeding vessel, the coagula thus form-
ed, would still farther separate the placenta from the uteri, and
thus increase the difficulty. With all due deference, I consider
such objections altogether imaginary.

In the administration of ergot, two conditions are absolutely
necessary ; a proper condition of the soft parts, and such a pre-
sentation of the faetus as will admit of its expulsion by the con-
tractions of the uterus.

Of delivery by turning, I will only say, as a dernier resort
remedy, it can always be had recourse to, when the ergot fails.
But if the ergot is good, and freely administered, it may be re-
lied upon with great confidence.

[Professor Henry Miller of Louisville, in a recent excellent Treatise on Obstet-
rics, strongly recommends the Tampon and the rupture of the membranes. His
remarks thus far, strongly corroborate the views of our correspondent ; " The
supervention of Labor the evacuation of the liquor amnii these, in their order,
are the great bulwarks of floodiug women no matter where the placenta is im-
planted. A contracting uterus cannot bleed when emptied of its waters, at
any rate, if it bleed, the hemorrhage is no longer dangerous."] Editor* S. Med.
and Sur. Jour.

600 Glycogenic Function in Fcetal Life. [September,

The Glycogenic Function in Fcetal Life. Two Communica-
tions by M. Claude Bernard and M. Serres, to the Academy
of Sciences, Paris, at its Sitting of January 10th, 1859. (Trans-
lated for the Nashville Monthly Eecord, by Daniel F.
Wright, M. D.)

I. On a New Function of the Placenta, by M. Claude Ber-
nard. The object of my communication is to establish anatom-
ically and physiologically that the placenta, with other uses
which are undoubtedly varied and numerous, is destined during
the earlier stages of fcetal development to accomplish the gly-
cogenic function of the liver, before the latter organ has acquir-
ed that development of structure which subsequently enables it
to perforin that function.

I have been for a long time led aside from the result towards
which my researches aimed, through making my experiments
upon the placentae of the ruminant animals, which are easily
procurable at the shambles of Paris. During several years I
fruitlessly made repeated observations upon calves and lambs
taken at every stage of intra-uterine life, and was still unable to
find any part of the placenta of these animals which contained
the glycogenic matter. Spite of these early failures, I afterwards
had recourse to the placentae of rabbits, guinea-pigs, etc.

I found that there is in the placenta of these animals a white
substance formed by epithelial cells or agglomerate glandules.
I moreover determined that these cells, like those of the liver
in the adult animal, were filled with glycogenic substance. This
mass of glycogenic cells appeared to me to be chiefly situated
between the maternal and the foetal portion of the placenta, and
subsequently to its development seemed to be atrophied in pro-
portion as the foetus approached the period of its birth. I have
since ascertained that the placenta ofrabitsand guinea-pigs is
formed of two portions having distinct functions : the one, vas-
cular and persistent till birth ; the other, glandular, preparing
the glycogenic matter, and having a more limited duration.

Meanwhile the negative observations made upon so large a
number of the ruminants arrested my attention : negative ex-
periments which were to me just as indubitable as those from
which I obtained the above positive results.

In repeating my researches, I succeeded in establishing a re-
markable arrangement which no one before had distinctly point-
ed out: that while the vascular portion of the placenta repre-
sented by its various cotyledons accompanied theallantois and
was distributed on its external surface, the glandular portion
was distinct from it and was developed on the internal surface
of the amnion. Whence it results, that if in the rodentia, and
the other animals with a simple placenta, we find the vascular

1859.] Glycogenic Function in Fatal Life. 601

and glandular portions of the placenta mixed together, in the
ruminantia, on the other hand, we find the vascular and gland-
ular portions of this organ developed separately on distinct
membranes, and capable, in consequence, of being examined
separately in their respective evolution. Thanks to this
anatomical arrangement, we are able to prove clearly that the
vascular portion of the placenta persists and grows until birth,
while we see that the glycogenic portion attached to the amnion
increases during the earlier periods of gestation, and attains its
greatest development towards the third or fourth* month of
intra-uterine life, then disappears by degrees, passing through
the various forms of atrophy and degeneration ; so that at the
birth of the mammifera there no longer exist any traces of that
temporary hepatic portion of the placenta. But we ought
moreover to add, to arrive at the true character of these organs,
that during the whole period while the hepatic placenta of the
amnion is growing and performing its function, we observe that
the foetal liver does not yet possess its appropriate structure or
functions, and that it is precisely at the moment when the liver
is developed, and its cells, having acquired their characteristic
form, commence secreting glycogenic matter, that the hepatic
organization of the amnios has a tendency to disappear.

The hepatic patches of the amnios appear in ruminants from
the earliest periods of embryonic life. They are developed by
degrees on the internal face of the amnios, covering over the
umbilical cord to a point where a well defined line separates
the fcetal integuments from the amnion. Afterwards these
patches, which, particularly along that portion of the membrane
which invests the cord, assume the appearance of villosities, ex-
tend themselves along the other portions of the amnios, in pro-
portion as the blood-vessels which accompany them are develop-
ed. They gradually increase in volume ; formed at first of a
transparent matter, they become at a later period opaque, espe-
cially towards their edges, which are elevated a little, and some-
times cause them to resemble in their appearance patches of
lichen. At other times they have quite varied appearances,
flattened or filiform, and are sometimes blended one with anoth-
er so as to become confluent. At their complete development,
the patches attain a thickness which sometimes amounts to three
or four millimetres; those which are filiform often present a
considerable length, and are sometimes enlarged at their extrem-
ity in the form of a club. At a later period these hepatic patch-
es of the amnion cease to be developed ; at certain points they

* I am only able to give here these limits approximately, by reason of the
impossibility of ascertaining the age of those calves which* are procured at the
shambles.

602 Glycogenic Function in Fcetal Life. [September,

become yellowish, of a fatty appearance ; in other places they
fall off and float in the amniotic fluid, and leave on the mem-
brane a kind of cicatrices which afterwards completely disap-
pear.

We can determine with great ease the presence of glycogenic
matter in the hepatic patches of the amnion at all periods of
their development. From the time when they first appear, it is
easy to recognize this matter under the microscope with the aid
of iodine. Until the patches are completely developed we can
obtain from them their glycogenic matter in large quantities
and study its characters. To obtain it easily, the process will
consist of digesting the amniotic membrane in boiling water,
which will enable the patches to be easily detached for the pur-
pose of rubbing them in a mortar, and extracting the matter
from them by boiling, exactly as we proceed for the extrac-
tion of glycogenic matter from the liver.

As regards its characters, we may say that the glycogenic
matter of the amniotic patches exhibits the most perfect identi-
ty with the glycogenic matter of the liver. It is dissolved in
the water, giving it a milky appearance; it may be precipitated
by alcohol and crystalized by acetic acid. Iodine communicates
to it an intense vinous red color, which disappears when heated
and reappears on cooling. This coloring of the glycogenic
matter of the amniotic patches by iodine takes place not only
when the matter has been extracted from the cells by boiling,
but it may be observed also in the cells of the organ themselves,
as we shall see presently. Like the glycogenic matter of the
liver, that of the amniotic patches also changes into dextrine or
fermentible sugar (glucose) with great ease under the influence
ofdiastatic ferments, both animal and vegetable, and by the
action of boiling with strong acids.

While we study the structure and the histological develop-
ment of the hepatic patches of the foetus, we can follow out very
distinctly the formation of the glycogenic cellules, as well as the
development of their contents.

The amniotic membrane in the calf seems to be at first desti-
tute of any well-marked epithelium, and we find its tissue chiefly
constituted of fibres of elastic tissue with nuclei contained in a
network of cells of a fusiform aspect. At the very moment of
the appearance of the patches we discern under the microscope
on the internal face of the amnios, and continuously along that
part of the membrane which invests the umbilical cord, a kind
of spots formed of epithelial cells ; then in the centre of each
spot we observe groups of glandular cells in very small number
at first, and soon we are able to observe the patch at its very
origin and composed of only one or two glandular cells. We
very easily distinguish the glandular or glycogenic from the

1859.] Glycoyenic Function in Fcetal Life.

epithelial cells which accompany them, both by their appear-
ance and by their reaction with iodine. In fact, when we add
to an amniotic papilla or patch on the stage of the microscope
a little tincture of iodine acidulated with acetic acid, we soon
see the glycogenic cells assume a vinous red tint, while the
epithelial cells continue colorless or become faintly yellow. By
degrees during development the groups of glycogenic cells in-
crease and assume the form of papilla?, especially on that part
of the membrane which invests the cord. Examined under the
microscope, these papillae are formed of glycogenic cells covered
with an epithelium; as soon as we add the acidulated tincture
of iodine, we see the glycogenic cells of the papillae colored of a
vinous red, especially at their base, which is \ery definitely
separated from the surrounding tissue. The hepatic patches are
composed of the same elements as the papillae ; it is always diffi-
cult to ascertain whether as regards their agglomeration they
ought to be considered as consolidated papillae, or as having
another mode of growth. All we are able to say is, that we can
see them spread in the direction of their circumference, which
exhibits well-developed glycogenic cells, while in the centre
these cells sometimes appear to be at a less advanced stage of
development.

When we bruise the patches or the papillae and mechanically
separate their histological elements, we obtain isolated cells pro-
vided with a nucleus and sometimes a nucleolus, and containing
a granular substance: the granular substance is colored wine-
red by the acidulated tincture of iodine ; the nucleus, the volume
of which seems to me to vary under the influence of reagents,
never assumes the same color by the action of iodine. The cells
of the hepatic patches of the amnion offer a great resemblance
in form and reaction to the cells of the liver in a state of func-
tion. In fact, we can isolate both the cells of the amniotic
patches and those of the liver by allowing a small portion of
the tissue of these organs to macerate for some time in a concen-
trated alchoholic solution of caustic potash ; we then see that
the contents of the two orders of cells continue insoluble in this
reagent, and fall to the bottom of the liquor in the form of a
white deposit which offers under the microscope both the origin-
al form of the preserved cells an dan amorphous granular matter.
When, again, under the microscope, we saturate the excess of
potash with crystallizable acetic acid, and afterwards add tinc-
ture of iodine, we see the wine-red color appear, and that with
greater intensity than when we operate on the fresh cells.

When the hepatic patches of the amnios begin to grow yellow,
to fall off, to be absorbed, or to degenerate into fatty matter, we
perceive changes in their microscopic structure; the glandular
cells in general lose their nucleus at the same time with their

F. 8.- VOL. IV. KO. IX. 43

604 Glycogenic Function in Foetal Life. [September,

glycogenic matter, so that upon treating a fragment of these
altered patches with the acidulated tincture of iodine, we see a
mixture of cells, some of which assume the wine-red color,
while others remain uncolored. It is evident, moreover, that
the cells which remain uncolored are destitute of nuclei and of
granular contents. We sometimes perceive a transition between
these two extremes, that is to say, we see cells in which the
nucleus and the granular matter have nearly disappeared, and
in which the wine- red color is scarcely perceptible.

A little later, when the patches of the amnios form mere cica-
trices, we find only the flat cells, destitute of nuclei, and in
which it is impossible to detect the slightest trace of glycogenic
matter. These cells at a later period finish by disappearing
themselves. When the patches, instead of falling off and disap-
pearing, degenerate into fatty matter, we observe under the
microscope the presence of a tatty matter at the same time that
we see mixed with it very fine octahedral crystals, which exhibit
all the characteristics of oxalate of lime, so far as to be insoluble
in water or in acetic acid. It is needless to add that there is,
besides, a complete absence of glycogenic matter in these degen-
erated hepatic patches.

If now we institute an examination of the structural develop-
ment of the liver, parallel with that which has just been made of
the evolution of the glycogenic patches of the amnios, we shall
be struck with the constant inverse relation which we observe
between the development of the cells of the liver and of those in
the amniotic patches.

At the early periods of embryonic life,* when the amniotic
patches are well filled with glycogenic matter, it appears that
the liver of the foetus, still very soft, is made up of rudimentary
cells rounded or fusiform, soluble in the alcoholic solution of
potash, deriving no color from iodine, and showing none of the
characteristics of glycogenic cells. At this period the tissue of
the liver does not give the least trace of glycogenic matter.

At the end of their period of growth, when the glycogenic
cells of the amniotic patches begin to disappear or degenerate,
we find in the liver of the foetus cells which have acquired their
definitive forms as liver-cells including one or more nuclei with
granular contents, not dissolving in an alcoholic solution of
potash and deriving the wine-red color from the contact of iodine,
after we have saturated the alkali with acetic acid. It is at this
period that we begin to be able to separate from the liver of the
foetus, which has become more firm, glycogenic matter exactly
similar to that which the adult liver produces.

* At the commencement of embryonic life in the embryo calf while from two
to three centimetres long, I have not as yet perceived the amniotic patches.
Perhaps hereafter glycogenic cells will be discovered in the umbilical vesicle.

1859] Glycogenic Function in Fcetal Life. 605

Later still, when the patches have entirely disappeared or de-
generated into fatty matter, and the foetus is near the period of
its birth, we find that the tissue of the liver, now grown as solid
as in the adult animal, is now made up of elements which have
assumed their definitive form: all the cells of the liver are then
filled with glycogenic matter, and at that period we can separ-
ate from the liver of the foetus glycogenic matter, as abundantly
as in the best nourished adult animal.

To resume : From all the facts which are contained in this
paper, I think we can make the following inferences :

1. There exists in the placenta of the mammifera* a function
which till now had remained unknown, and which appears to
take the place of the glycogenic function of the liver during the
earlier periods of embryonic life. This function is located in a
glandular or epithelial structure of the placenta, which in cer-
tain animals is mixed with the vascular portion of that organ,
but which in ruminants appears separate, so as to form on the
amnion patches of an epithelial appearance, which, every one
has doubtless seen, but the significance of which has been hith-
erto unknown.

2. This temporary hepatic organization of the placenta, by
permitting us to study directly in an insulated anatomical
element the production of glycogenic matter, confirms and com-
pletes by a new example that which I have long ago maintain-
ed, that the formation of the glycogenic amylaceous matter is a
common faculty of the animal and vegetable kingdom. The
observations contained in this paper furnish us with further
novel analogies, as we see glycogenic amylaceous matter form
around the embryo animal, just as in plants it accumulates in
their seeds around the embryo vegetable.

3. The glycogenic function in animals commences, then, from
the origin of fcetal life, and before the organ in which thai func-
tion is located in adult life is developed. But then it. is located
in a temporary organ belonging to the fcetal appendages.

4. All which has been said in this paper relates exclusively
to the glycogenic function of the liver ; but it will be really a
question, to examine whether the biliary function which the
liver possesses in the adult is equally accomplished by the pla-
centary hepatic organ which we have described. The question
should be put in these terms, viz. : Whether the same glandu-
lar cells are charged with two functions which thence must be
consolidated and united ; or whether, on the contrary, the liver

* In birds, (the chicken,) I have ascertained that before the development of
the glycogenic cells of the liver there exist glucogenic cells which are developed
in the* walls of the vitelline sac; but not having as yet completely followed out
their evolutions, I will treat this subject in another communication, confining
myself at present to speaking of the mammifera.

606 Glycogenic Function in Foetal Life. [September,

ought not to be considered rather as a complex organ in which are
found mixtures of anatomical elements distinct from one another,
and destined, the one for the formation of the amylaceous mat-
ter, the other for the biliary secretion ? This question, which
as yet has not been solved, in spite of the numerous histological
labors of which the liver has been the object, appears to me
capable of being illustrated and even decided by physiological
researches, made, on the one hand, on the embryonic develop-
ments of the function, and, on the the other, upon the inferior
animals. I have entered upon some researches on this subject,
of which I will give an account to the-Academy as soon as they
shall be terminated.

II. On Glycogenic Bodies in the Umbilical Membrane of Birds.
by M. Serres. The important communication of M. Bernard
on the glycogenic function of the placenta has dissipatad some
doubts which, in studying the embryogeny of birds, had arisen
in my mind concerning the use of certain small glandular
bodies which have been observed on the surface of the umbili-
cal membrane of the chicken in the process of formation.

We know that in the course of the second or third day of in-
cubation there is developed on the opaque portion of the area
germinativa in the hen's eggr a membrane composed of capillary
vessels so numerous that its whole surface is entirely covered
with them.

These vessels originate about the twentieth hour of incubation
with the appearance of minute cells, which become the puncta
sanguined of Wolff. Without communication with one another
at first, these cells become covered about the twenty-fourth hour
with capillary vessels extremely delicate; they soon form vas-
cular islets, isolated at first, but forming unions with each other
from 4he thirtieth to the fortieth hour, so as to form the most
beautiful capillary plexus which can be witnessed in the animal
organism. These are facts already known.

But (which is hitherto unobserved) there are little glandular
bodies interposed between the vascular islets, and scattered over
the whole surface of the umbilical membrane. They maybe
seen under the microscope from the twenty-fourth to the thir-
tieth hour of incubation ; their pale color renders them easy to
distinguish from the vascular islets, which are of a reddish hue;
at the thirty-fifth hour they become of a bright yellow color, and
the volume which they have acquired permits us to distinguish
them more easily.

It is at this period, so important in the development of the
embryo chick, that I have caused them to be represented in the
Archives of the- Museum. In the embryo which was used in de-
signing that figure, their number reached to five hundred.

1859.] Glycogenic Function in Fcetal Life. 607

They were disseminated not only over the area opaca of the
umbilical membrane, but i lso over nearly the whole space of
the area pelt 'ucida, in which they were more distinct from the
fact that at that period the area vasculosa of the germinal
membrane, still clouded, is not yet traversed by the capillary
vessels which afterwards form in it. From the thirtieth to the
sixtieth hour their volume continues to increase, but the fulness
of the arteries and veins partly conceal them.

As I have already said, the nature of these little bodies as
well as their use was entirely unknown to me ; but on hearing
the clear and precise demonstration which M. Bernard has given,
of the glycogenic cells or glands of the placenta, I have no
longer any doubts but that these bodies were their analogues
in the class of birds a class in which the placenta is represent-
ed by the umbilical membrane in part and partly by the allan-
tois.

If the analogy of these bodies be established, shall we not be
justified in saying that there exists in birds a diffused hepatic
organ or a transitory liver analogous to that of which M. Ber-
nard has demonstrated the existence in the placenta of the
ruminautia?

In submitting these observations to our colleague, I will take
occasion to remark that those which he has presented on the
retarded action of the ordinary liver in ruminants are perfectly
established in birds. Although in that class the liver appears
as a double diverticulum of the intestinal canal at the end of the
third day, nevertheless the corresponding vascular system of
the portal vein is not developed till much later. From the slow
formation of the structure of that organ, it is not till towards the
eleventh or twelfth day of the formation of the chick that it is
in a condition to enter upon its functions. Now it is just at this
epoch that the umbilical membrane and its system of blood-
vessels is replaced by the allantois, on the surface of which we
do not see the glycogenic glands.

In relation to general embryogeny, one of the consequences of
the discovery of M. Bernard is to establish, as he has done, that
in the course of embryonic life there exist two glycogenic organs:
the one transitory, residing in the placenta ; the other, permanent,
which is the hepatic organ. lie proves in this manner the con-
tinuity of the glycogenic process in the blood through the entire
duration of intra-uterine life.

Applied to the normal development of the embryo, this view
is very just; but in the abnormal condition, when a degraded
embryo without an hepatic organ and with a placenta sometimes
so rudimentary that it scarcely equals the hundredth part of an
ordinary placenta, how does the glycogenic function then be-
come established ? We know that in these abnormal beiogs,

608 Glycogenic Function in Fcetal Life. [September,

which through their frequency constitute the greater portion of
monstrosities by defect we know, we say, that they are all des-
titute of liver, of heart, and of head, and that their placenta is
extremely reduced in its dimensions. In this condition their
existence would be incomprehensible if Nature did not supply
that placentary imperfection. She supplies it, then, by trans-
forming the tegumentary covering of the acephalous monster
into vast pouches filled with a sero albuminous liquid, and the
walls of which are covered with a network of capillary, venous,
and arterial vessels vessels communicating by special trunks
with the general vascular system of the body. Beyond this ar-
rangement, so favorable for supplying the imperfection of pla-
centary respiration, the interior of these pouches is lined by a
membrane of a serous nature, beneath which are found certain
round yellow bodies, sometimes forming little patches by their
union : are not these bodies glycogenic glands? In an acephal-
ous monster, plates of which I have caused to be made in the
work which appeared serially in Yol. XXY., of the Memoirs of
the Academy, the subscapular pouches each contain more than
eighty of these bodies, the posterior scapular pouches contain
each from thirty to forty, and the axillary sinuses have from
fifteen to twenty ; the dorsal and inguinal pouches likewise pos-
sess them, but in smaller numbers.

It is needless to add that before the communication which we
have just heard, I was eutirely ignorant of the nature and use
of these bodies. Such are the observations which I desire to
submit to the attention of our colleague, M. Bernard.

[Note by the Translator. The communications of MM. Bernard
and Serres reminded us of the ancient nomenclature, in which
the placenta was called the Liver of the womb, Jecur Uterinum.
Thinking that we might find something pertinent to the present
subject, we turn to our old books, and were interested at dis-
covering that the term was used not merely with reference to a
fancied resemblance in form, texture, etc., between the placenta
and the liver, but with the belief that the placenta actually per-
formed functions during fcetal life which were afterwards assum-
ed by the liver.

We have before us a copy of the "Anatomy of Human Bodies,
etc., by Isbrand de Diemerbrock, Professor of Physic and Anato-
my in Utrecht. Translated from the last und most correct and
full edition of the same, by William Salmon, Professor of Physic.
London, 1689." The original work of Diemerbrock was pub-
lished in Latin about the middle of the seventeenth century.

In commencing the history of intra-uterine life, he gives the
first place to the placenta, speaking of it under that name which

79.] Glycogenic Function in Fatal Life.

"_-.- -,.;; -.-.-.-.- zri: . - z .".-:. I :: :: cj 7 .-.'.'. : : .:?, ':. :: aiiinr. *' J'.'-rr?,
from its resemblance in use, color, and substance, call it the
Uterine Liver P After giving a very satisfactory account of its
form, texture, growth, and connection with the umbilical ves-
sels, he enters upon the uses of the organ, which portion of his
subject he opens by the following quotation from the illustrious
Harv The placenta concocts the nutritive juice coming

from the mother for the nourishment of the birth." Wherein
this concoction consists, according to the theories of humoralism.
and vital spirits prevalent in those days, it would not profit us
to inquire; but the description he gives of it is precisely the
same as he assigns to the liver in extra-uterine life, so that " the
uterine liver performs that function alone, which in men born
the liver and spleen perform together. . . . Those bowels,
therefore," [the liver and spleen,] "not being able" [to per-
form these functions,] u by reason of their tender constitution,
provided nature has substituted in their place, for the time, a
uterine liver, which supplies the office of both from the time that
the blood begins to flow from the birth through the umbilical
arteries into the uterine liver till the delivery;"1 adding, after-
wards, that another reason for this "concoction? taking place in
a different organ is, that " the jevmentaceous liquor that is to be
mixed with it [the blood] ought to be less acrimonious, and,
by the same consequence, ought not to be prepared and concoct-
ed in the liver and spleen as in man born, bnt only in the
uterine placenta, to the end it may be more mild and temperate
when it enters the birth.w

The function, then in the performance of which the placenta
or uterine liver anticipates during foetal life the functions of the
liver is the concoction of a fermentaceous liquor, which for some
reason or other, Diemerbrdck does not know why, (nor, for that
matter, does Bernard or Series,) must be constantly mixed with
the blood in order to keep up its nutritious properties.

Of course the discovery of M. Bernard is not the less original
or valuable for having been anticipated some two hundred years
by an opinion of Diemerbrock. Discoveries in the present day
are grounded upon industrious research, multiplied experiments
and observations, and rigid induction whereas the opinion we
have exhumed is based upon nothing but the vaguest conjeo-
-:ed by slight physical resemblences between the
t and the placenta. But if these old anatomists only con-
jectured where the moderns demonstrated, it must be admitted
that their guesses were sometimes wonderfully happy; and for
a brilliantly successful guess as this, the name of Diemer-
brock, now a feet fading from the memories of medical philoso-
phers, shall be heard once more before it sinks in the limbo of
things forgotten ; hnjermmbaeoom Uamtm ihall be Lcjulviec s.de

610 Dropsy and Albuminous Urine. [September,

hy side with the glycogenic matter of modern physiology, and
the placenta shall again be known as the " Liver of the
Womb."]

Dropsy and Albuminous Urine: A Clinical Lecture, delivered at
the Baltimore Infirmary, June, 1859. By Professor Charles
Frick, M. D., &c.

During the past few weeks, gentlemen, there have been several
cases of disease admitted to the wards, having certain features in
common, but which nevertheless depend on different pathologi-
cal conditions : these are dropsy and albuminous urine. And
as the material is sufficiently abundant, 1 propose to speak
to you of the relation they bear to each other, and of the various
alterations with which they are associated.

In the first place, I must tell you that dropsy is an effusion
of serum from the bloodvessels, into the cellular tissue, or one of
the serous cavities, or both ; and that it is produced by two
causes. The one, a mechanical impediment somewhere in the
course of the vessel, whereby the blood is prevented from re-
turning to the heart, which thus becomes engorged to such a
degree, that the serum soaks out, to relieve the distension ; and
the other, an alteration in the composition of the blood, which
has become more watery, and readily escapes into the surround-
ing textures, more particularly as the coats of the vessel have
undergone some alteration, in consequence of their being im-
properly nourished. Now, these two causes combined that is,
mechanical obstruction and thinning ol the blood when they
exist together, are almost certain to occasion dropsy, although
either may do it separately. And, as we shall see presently,
when any pathological condition exists in which these two are
present to a decided degree, then are we most apt to have a
large amount of dropsj^. But you are also aware that fluid is
poured out as the result of acute inflammation. You have
remarked occasionally, that common plegmonous inflamma-
tion gives rise to pitting from oedema of the surrounding
cellular tissue ; and you have had ample opportunity to observe
the frequency with which a liquid effusion attends an attack of
pleurisy. Now, in these cases, neither of the conditions I have
just alluded to, are necessarily present ; the blood is not altered,
nor is there any mechanical impediment to its return. But one
circumstance, however, is particularly remarkable. The fluid
does not consist of serum alone, as in the first instance, but of
liquor sanguinis; that is, serum, with fibrin in addition; the
latter undergoing coagulation, and producing the fibrinous

1859.] Dropsy and Albuminous Urine. 611

bands and adhesions, so commonly a result of acute inflamma-
tion, and which no doubt serve, in many instances, to repair in
a measure the injury inflicted by the disease. I say that the
effusion in one instance is serum, and the other, liquor sangui-
nis. This is not invariably true, but is so commonly correct,
that practically we may assume it always occurs.

The effusion, then, in these two cases, is entirely different;
and without attempting to enter too deeply into the explanation
of this difference, I will merely say, that if the accident in the
first case is attributable to mechanical causes principally, inde-
pendent of the bloodvessels; in the latter, the bloodvessels alone
are concerned. In ordinary dropsy, the serum escapes, because
the blood is thin, and is prevented from returning to the heart ;
while in an inflammatory effusion, liquor sanguinis is poured
out, because the capillary vessels of the part are the seat of a
morbid accumulation, from some cause inherent in the part
itself. And I beg you to bear these two distinctions clearly in
view, for otherwise you will scarcely have a just appreciation
of the two different pathological conditions that is, dropsy on
the one hand, and inflammatory effusion on the other. It is
true, you cannot always say which of the two is present in a
case under consideration, yet, nevertheless the principle is cor-
rect, and generally the one can be recognized from the other
with tolerable certainty.

But to return to dropsy. If you will bear in mind that a
serous effusion, whether in a serous cavity, or in the cellular
tissue, is due to mechanical obstruction and impoverished blood,
you will realize that when the dropsy is local, the cause must
be local ; and if general, the cause must be general. Thus,
aneurism of the popliteal artery produces oedema of the leg be-
low the knee: femoral aneurism of the whole leg; and an en-
larged uterus, by the pressure it occasions upon the iliac veins,
will oftentmes be attended by dropsy of both lower extremities.
These are instances of simple mechanical pressure. Again, if
the obstruction be seated somewhere in the heart, so that the
lower cava is interfered with, the whole of the lower part of
the body is involved ; while a thoracic aneurism, pressing on
the vena innominata, has more than once given rise to dropsical
swelling of the upper portion of the body alone ; and you can
understand also, that if the portal vein, whieh you know carries
the blood of the intestinal canal through the liver, be obstructed
in its course, the resulting effusion must make its appearance
in the peritoneal cavity. These, too, are examples principally
of mechanical pressure. As an illustration of dropsy occurring
in persons whose blood is more watery than in health, you will
observe that women whose constitution is weak, and whose
tissues and muscles are flabby, are prone to have their legs

612 Dropsy and Albuminous Urine. [September,

swollen after standing or walking, and that this puffy condition
is always aggravated towards tfce close of the day. But, as I
said just now, dropsy, to any extent, most often depends upon
the two conditions combined.

Now, the explanation of the dropsy resulting from kidney
disease is not so obvious as others. You are aware that a large
portion of the kidney is made up of small tubes, communicating
with bloodvessels, and these in turn with the malpighian bodies,
which are so largely distributed through the cortical portion of
these organs. And you can readily understand, that if structu-
ral alteration has taken place in these tubes, so that the circula-
tion through the gland is obstructed, they must become more or
less congested, and serum will be poured out, which, mixing
with the urine, passes off by the bladder, and its albumen may
then be coagulated by heat and nitric acid. And the same re-
sult will take place from congestion occurring from other causes.
This serous drain, then, in a very short time, has a decided effect
in deteriorating the blood, rendering it thinner and more wa-
tery ; and as the obstruction to the blood in the kidneys, from
the proximity of the renal arteries to the aorta, would be very
soon felt in the circulation generally, we would have presented
the two conditions most likely to occasion dropsy, namely, de-
teriorated blood, and interference with its transit through the
vessels. But there is this peculiarity about renal dropsy. It
usually makes its first appearance in the looser portions of the
cellular tissue, as the eyelids, the scrotum, &c, or in those places
where it meets the least resistance, and which are most distensible.
And now you will understand why it is that general dropsy
must be due to some general cause, interfering with the circu-
lation ; why cardiac dropsy should be first evidenced in the
lower extremities; that from diseased liver in the peritoneal
cavity, and renal dropsy in the looser portions of the areolar
tissues. So much, then, for dropsy.

I have just said, that when the circulation through the kid-
neys is interfered with, serum escapes with the urine, and its
albumen may be detected by heat and nitric acid. And if, in
addition to this obstruction, the blood is deteriorated, either
from the drain of albumen constantly going on, or from causes
seated elsewhere than the kidneys, the escape of serum is more
decided, and its albumen more abundant. You will readily
appreciate, then, that albuminous urine does not always denote
disease of the kidneys. It is often occasioned by heart disease,
and may be produced by pressure on the renal veins; and I
need scarcely remind you, that if the urine contains pus, the al-
buminous liquor in which the globules float, is coagulable by
heat. When, therefore, albuminous urine is present, you can-
not necessarily diagnose renal disease ; for this is to be made

1859.] Dropsy and Albuminous Urine. 613

out by other phenomena, and by- the assistance of the microscope,
of which I shall have more to say to you another time.

Now let me endeavor to show you, in a few words, the ap-
plication of the principles I have thus iar laid down to several
cases of disease which we have had under care witiiin the past
few weeks.

Case I. The first is the man who entered the Infirmary
April 28, and left on May 20, named Lynch. I found him
much emaciated, and very pallid. His legs and scrotum very
edematous, and there was a considerable amount of fluid in his
abdominal cavity. He had very decided dyspnoea, and coarse
rales could be detected over both lungs posteriorly. His pulse
was weak, intermittent, and irregular, and beat one hundred
and eighteen times in the minute. His urine very high colored,
of a sp. gravity of 1.023, and amounted to thirteen ounces in the
twenty-four houra Both heat and nitric acid threw down a
copious precipitate, but under the microscope nothing was per-
ceptible but a few amorphous crystals of unc acid. On examin-
ing his heart, I detected a loud, rough murmur, taking the
place of the first sound, ami most evident towards the apex of
the heart. He told us that he had had rheumatism some years
since ; that for some time he had labored under difficulty of
breathing, particularly in mounting ascents; and that the drop-
sy, which first made its appearance in the lower extremities, had
commenced about four months previously. Now what was the
alteration in this case? Manifestly an insufficiency of the
mitral valve, allowing regurgitation. And I recognised it in
this way. The heart, in contracting, forces the blood through
the aortic and pulmonary orifices, and at the same time, the
auriculo-ventricular valves should close, so as to prevent the
blood passing from the ventricles into the auricles. And syn-
chronous with this, the first sound occurs. A murmur depen-
dent on valvular alteration occurring with the first sound, must
therefore be due either to stricture of the aorta or pulmonary
artery, on the one hand ; or to an insufficiency in the mitral
or tricuspid valves on the other. As it was more evident to-
wards the apex of the heart, I concluded it wTas the latter; and
there was no regurgitation in the veins of the neck ; and as dis-
ease of the left side is more common than the right, I assumed
it to be in the mitral valve. Now, in what way are the dysp-
nceaT the dropsy, and the albuminous urine dependent on this con-
dition ? In the first place, if the blood regurgitated into the left
auricle, this would be first distended, then the pulmonary veins,
then the pulmonary artery, and in turn, the right ventricle, the
right auricle, and the cavas. The distention in the pulmonary
vessels would give rise to the dyspnoea, and in time the obstruc-
tion of the cavas, particularly the lower, from its having gravity

614 Dropsy and Albuminous Urine, [September,

to overcome, would become more distended, and allow the es-
cape of serum into the cellular tissue of the legs lirst, and subse-
quently into the abdominal cavity. The same cause would pro-
duce congestion of the kidneys through the renal veins, and the
serum thus poured out would pass otf by the kidneys. That
the albuminous urine did not depend on structural alteration of
the kidneys, I was satisfied ; partly because there was no evi-
dence of such a condition revealed by the microscope, and part-
ly because the whole phenomena could be explained by the
cardiac affection. The indications for treatment were very
plain ; to lessen the amount of fluid in the circulation generally,
either by the skin, the kidneys, or the bowels, and to support
the strength. Accordingly, he was ordered squill, assafcetida,
and the oil of juniper. Under this treatment, his urine was
increased to twenty-three ounces, but with no marked benefit.
He was then ordered sal rochelle, which occasioned two or three
loose serous discharges daily, under which his dyspnoea subsided,
and his dropsy sensibly diminished. He left us, however, in.
the course of a few weeks, his condition more comfortable, but
not materially improved.

Case II. The second case is at present, under treatment, and
is of more interest. Lewis Snyder, aged 45, in St. Vincent's
Ward, entered the house June 7th. He is a pallid man, and
says he was not sick until six weeks before his entrance. Has
never had rheumatism, but admits for some time past he has had
difficulty in mounting ascents. He had no dropsy, his dysp-
noea was extreme, and his pulse small, contracted, irregular, and
one hundred and twenty-eight. His urine had been very co-
pious, but latterly has undergone a marked diminution, and
was at entrance seventeen ounces, high colored, specific gravity
1.022, and highly albuminous. Dullness over his heart much
increased, and the pulsations very vigorous, although irregular.
The apex is felt in its normal position, but there is also dis-
tinct pulsation at the ensiform cartilage. Above the sternum
there is no unusual pulsation, nor can any blowing sound be
heard any where in the cardiac region. There was nothing
unusual in his lungs, except rales throughout, mixed also with
dry sounds. A microscopic examination of the urine revealed
nothing of importance.

Now what is the diagnosis in this case? The most marked
symptom was the difficulty of breathing, produced evidently by
swelling in the membrane of the bronchial tubes, and the secre-
tion poured out in them as a consequence. This was scarcely
catarrh ; it did not commence as such attacks do, and moreover,
was associated with a very irregular action of the heart, and a
kind of dyspnoea, which I have more than once pointed out as
belonging rather to the heart than the lungs. That the right

1859.] Dropsy and Albuminous Urine. 615

ventricle is hypertrophied in this case, is proved by the increased
dullrtess and pulsation at the ensiform cartilage, while at the
same time its apex is found in the normal position. For al-
though the heart may be displaced to the right side by various
causes, so that the apex may be frit at the ensifbrm cartilage,
yet in such cases, there will be no pulsation in the normal posi-
tion. The right ventricle, then, is enlarged, but will this ex-
plain the difficulty ? I think not. Regurgitation of the tri-
cuspid or mitral valves, would give rise to a decided blowing
gound, which there is not ; while contractions of the tricuspid
would be more likely to occasion dropsy, and pulsation of the
jugular veins. But assuming that there is contraction of the
mitral valve, the solution is easy. In the first place, the
blood passes from the auricle to the ventricle, partly by the con-
traction of the first, and partly by the dilatation of the latter,
Nor is it impelled with sufficient lbrce to give rise to a murmur,
while the healthy semilunar valves, flapping back into their
place, are quite sufficient to occasion a clear second sound. If,
then, the valve be contracted, the usual amount of blood is not
received in the left ventricle, nor sent by the aorta to the vari-
ous arteries, ^'he pulse, therefore, was small and contracted.
In the second place, the auricle must have been unnaturally
distended, and thus an excess of blood was accumulated in the
pulmonary vessels and the lungs. This explains the dropsy.
This accumulation would be felt more or less throughout all the
organs, the kidneys among the rest, and the albumen found in
the urine was but a result of these organs relieving themselves
of the superabundant serum thus forced upon them. So much,
then, for the diagnosis.

The indication for treatment was manifestly to relieve the en-
gorged vessels by some drain, which would at least aftbrd tem-
porary relief, and at the same time to support the general strength.
Accordingly, he was ordered

Assafcetidae, gr. j.

Scillae pulv., gr. iij.

01. Juniperis, gtt ^, every 4 hours.

I did not prescribe digitalis, veratrum viride, or any similar
agent, although the pulsations were both too frequent and too
forcible, because I considered these were hut evidences of the
degree to which the heart was obliged to labor to overcome the
impediment; and a sedative of this character might lower the
frequency and moderate the impulse, but it would unquestiona-
bly render the heart more irregular, and increase the dyspnoea.
In two days after the commencement of the treatment, our pa-
tient was able to lie down, and his cough had much diminished.
In a week all difficulty of breathing had disappeared, the pulse

616 Dropsy and Albuminous Urine. [September,

became fuller, more infrequent, and perfectly regular. The ab-
normal impulse of the heart had altogether subsided, and his
strength had decidedly improved. I would recall to your re-
collection the fact, that in twenty-four hours the quantity of
urine had increased to thirty-five ounces; the next day to fifty-
six, and has continued between fifty and sixty ounces up to this
time. The albumen, too, has notably diminished, and latterly
I have ordered him sulph. iron and quinine, for the purpose of
improving his strength.

You will remark that, in both of these cases I have endeavor-
ed to drain off the fluid from the kidneys, in preference to the
bowels, and it is for this reason : When liquid discharges from
the bowels are produced, it is always a serous fluid, containing
various other matters ; and as this serum is derived from the
blood, such a drain, continued for any length of time, must ne-
cessarily weaken the patient to a very great degree, and thus
tend to keep up the very causes which originally produced the
disturbance. The kidneys, on the contrary, drain off principal-
ly the water, and unless the specific gravity of the urine thus
voided is high, it can scarcely be said that any material waste
is going on. Do not understand me to impty that waste, and
very great waste, may not be produced by diuretic remedies.
On the contrary, when the agents are properly selected, as, for
instance, the alkalies in rheumatism, very decided emaciation
may be produced by their use in a short time. You have more
than once seen rheumatic patients in these wards, waste most
rapidly under the use of large quantities of bicarb, potass., and
have remarked at the same time, that the urine, instead of con-
taining six hundred or seven hundred grains of solids, had in-
creased to one thousand two hundred, and even one thousand
eight hundred in twenty-four hours; and this for days together.
Indeed, herein lies, according to the views I hold, as I have
more than once told you, the efficacy of these salines in rheuma-
tism. Not, as has been assumed, in neutralizing some assumed
element, but in producing general waste, and of course wasting
the rheumatic elements, whatever they may be, at the same
time. But what I desire to explain to you now is this : When
the object is to produce an alterative effect, as in rheumatism
and analogous diseases, and the kidneys are the means selected
to eliminate the morbid substances, the solids are of every im-
portance, the fluids in which they are dissolved of little or none.
Thus, eight hundred grains of solids in such cases is a decided
improvement over four hundred; but whether the eight hun-
dred grains is dissolved into twenty or forty ounces of water, is
of secondary importance. On the contrary, when it is desired
to obtain a diuretic action, as in heart disease or dropsy, the
fluid is all important, the solids less. Here, then, a material

1859.] Treatment of Astiima by Stimulants, &c. 617

point is gained, if the urine is increased from twenty to forty
ounces; but different from the other case, it is much preferable
that the solids should remain at four hundred grains, rather
than be increased to eight hundred, for there is no object in
producing waste of tissue. For this reason, eolchicum, the sa-
lines, &c, are preferable in the first instance, but squill, juni-
per, and similar agents in the latter. And in the patient to
whom I have just referred, although his urine was increased
from seventeen ounces to sixty, yet the specific gravity fell from
one thousand and twenty-two to one thousand and nine; so
that the waste of solids was not materially increased, and he
therefore, under good diet, has improved in strength.

Still more interesting than the two cases I have spoken of
to-day, are three patients laboring under dropsy and albumi-
nous urine, dependent on kidney disease; but these I must re-
serve for another occasion. [American Med. Muntldy.

Treatment of Asthma by Stimulants. Tlieory of the Modus Ope-
randi of Stimulants. Illustrated by Coffee. Curative Influ-
ence of Violent Emotion. Its Action analogous to that of
Stimulants : Acts also as a " Nervous Derivative.1'' Cases. By
Hyde Salter, M. D., F. R. S., Assistant Physician to Char-
ing Cross Hospital.

Ove of the commonest and best-reputed remedies of asthma, one
that is almost sure to have been tried in any case that may come
under our observation, and one that in many cases is more effi-
cacious than any other is strong coffee. To the question, " Have
you tried strong coffee ?" the asthmatic is pretty sure to answer
" Yes;" and he is also pretty sure to add that it gives him relief.

About the modus operandi of this remedy, 1 was long puzzled ;
I could not make it out ; and it is only lately that I think I have
stumbled upon it. The rationale of its efficacy is, 1 think, to be
found on the one hand, in the physiological effects of coffee the
particular nervous condition that it produces and, on the other,
in a feature in the clinical history of asthma which I have long
observed, and of which I think the efficacy of coffee is highly
corroborative.

This fact is, that sleep favors asthma that spasm of the bron-
chial tubes is more prone to occur during the insensibility and
lethargy of sleep, than during the waking hours, when the senses
and the will are active. I have already referred to this in my
observations on the " Clinical History of Asihma,"* in explaining

* Medico- Chiruryical Review, July, 1856 and 1859.

618 Treatment of Asthma by Stimulants, &c. [September,

why the paroxysm invariably, (or almost invariably) chooses the
hours of mid-sleep for its onset. Let me just refer to this subject
again; for it is both interesting and important, as it explains a
curious and very constant phenomenon in asthma -the hour,
namely, of the attack is highly illustrative of its pathology, and
furnishes the key to some of its treatment.

I think, then, that sleep favors the developement of asthma in
two ways :

1st. By producing insensibility to respiratory arrears.

2d. By exalting reflex action.

The way in which sleep favors the development of asthma, by
producing insensibility to respiratory arrears, and exalting reflex
nervous action, I have already sufficiently explained in the papers
on the Clinical History of Asthma, to which I have referred.

There can be no doubt that sleep does exalt reflex nervous ac-
tion. It is a fact, so abundantly inculcated by the history of dis-
ease, as hardly to require illustration or proof. The phenomena
of epilepsy, cramp, lead tremors and other examples of deranged
muscular action, all teach it. It is just as sleep comes on, just as
the will is laid to rest, or during sleep, that these different forms
-of involuntary muscular contraction must commonly occur.
Any one, to convince himself of it, has only to fall asleep sitting
on the edge of a chair, in such a position that it shall press on
his sciatic nerves. As long as he is awake, his legs will be mo-
tionless; but the moment he falls asleep they will start up with a
plunge and suddenly wake him. As soon as he is awake they
are quiet and still again, with no disposition to start, till he again
falls asleep, and that moment they start again and wake him ; and
so he may go on as long as he likes. He changes his position,
sits back in his chair, and they start no more. I need not explain
what so clearly explains itself. I heard, some years ago, of a
case of what might be called chronic traumatic tetanus, in which
the source of irritation the excito motory stimulant was ex-
tensive disease of the hip-joint. The moment the patient fell
asleep he was seized with opisthotonos, which, of course, imme-
diately woke him. On awakening, the tetanus vanished ; on
again falling asleep, it reappeared ; and this alternation of falling
asleep and waking continued for weeks, if not for months, the
patient getting no continuous rest till he was quite worn out.
As long as he was broad awake, the tetanus never appeared.*
Hosts of similar facts, illustrative of the same truth, might be
cited.

Anything that exalts, reflex nervous action, increases, of

* I was further informed, respecting this case, that, after everything else had
failed, sleep was procured, with an immunity from the tetanic spasms, by put-
ting the patient into the mesmeric state. In this way he got rest, and greatly
improved ; but what was the ultimate issue of the case, I do not know.

1859.] Treatment of Asthma by Stimulants, &c* 619

course, the potency of reflex stimuli. Now, I have elsewhere en-
deavored to show that the phenomena of asthma are, in almost
every case, those of excito-motory action, and that the exciting cau-
ses of asthma are, in the great majority of instances, such as act by
a reflex circuit. They would, therefore, on the asthmatic's falling
asleep, immediately acquire a potency they did not before pos-
sess, just as the pressure on the sciatic nerve did, in the illustra-
tion I have given. Thus it is we see that the asthmatic may
gorge himself with unwholesomes, and yet, as long as he keeps
himself awake, suffer no consequential asthma; the irritant is
there, the undigested food is in the stomach, but as long as he is
awake, as long as the will is dominant, it is inadequate to the pro-
duction of reflex phenomena. But let him fall asleep, and in an
hour or two the paroxysm will be established.

And not only will sound sleep determine, by this exaltation of
reflex susceptibility, the production of asthma by its exciting
causes, but a small dose of the same condition sleepiness, drow-
siness will favor the supervention of asthma in a proportionate
degree. Not only is drowsiness a premonitory sign of an attack,
but a powerful predisposer to it; and the asthmatic knows that
he yields to it at his peril. I have often noticed in asthmatics,
that the sleepiness that is so apt to come on after dinner, will be
accompanied by a slight asthmatic oppression and wheezing : as
the drowsiness deepens, so does the asthma, and in this way it
may settle down into an attack ; but if the patient rouses himself,
or if anything occurs to engross his attention so as to wake him
up, broad awake, the asthma quickly vanishes. It is in this way,
I think, that is to be explained the fact, that asthmatics can dine
out late and unwholsomely with impunity ; while, if they dine at
the same time and in the same way at home, asthma is sure to
come on. At home they want that excitement which at a dinner
party, keeps the animal functions in a state of exaltation and the
mincl vividly awake, and effectually banishes the least approach
to drowsiness. Of the fact, there is not the slightest doubt. I
know an asthmatic, who can with impunity, dine out at seven
o'clock, as dinner-eaters of the nineteenth century are apt to
dine shirk nothing from soup to coffee walk home at ten
o'clock, a distance perhaps of four miles, with the wind of a deer-
stalker go straight to bed, and get up the next morning scathless;
but if he were to dine at home at six, or even at five o'clock, he
would be wheezing at nine, and by four the next morning, down-
right asthmatic.

I believe a certain amount of the curative influence of fright,
or other strong mental emotion, is to be explained in the same
way.

" But why," it may be asked, " all this round-about digression ?
What has all this to do with the curative influence of coffee?"

N. 6. VOL. XV. NO. IX. 44

620 Treatment of Asthma by Stimulants, <&c. [September,

I believe it is simply its explanation. For, what are the physi-
ological effects of coffee? They consist in the production of a
state of mental activity and vivacity, of acuteness of perception
and energy of volition, well known to those who have experienced
it, and to a certain extent very pleasurable, and which is the
very reverse of that abeyance of will and perception, which, in
drowsiness or sleep, so favors the development of asthma. In
sleep, will and sense are suspended ; after taking strong coffee,
they are not only active, but exalted. It produces rapidity of
thought, vivacity of spirits, clearness of apprehension, increases
tenfold the working powers, and altogether intensifies mental pro-
cesses. Not only is there no disposition to sleep, but sleep is im-
possible ; the thoughts hurry one another through the mind ; the
bodily movements are energetic and rapid ; and if the effects of
the drug are pushed far, a very unpleasant condition is produced,
something like that of delirium tremens, minus its hallucinations.
Now, if the suspension of the will, or its depression, favors the
production of excito-motory phenomena, and thus favors the de-
velopment of asthma, is it unreasonable to suppose that its exalta-
tion should prevent or cure it? It must do so if not positively,
at least negatively, by removing the predisposing condition. And
bearing in mind this marked physiological effect of coffee that
this exaltation of the animal nervous functions is exactly what it
produces it certainly does seem to me reasonable to suppose
that this is its modus operandi. And if of coffee, then of strong:
tea, and alchol, and ammonia, and ether, and other stimulants of
undoubted value in asthma.

To show that this is the rationale of the cure of asthma by
stimulants, I do not think it is necessary to show that it is only
when the asthmatic is drowsy, or has been sleeping, that they do
good. If anything that rouses the asthmatic to a state of wake-
fulness, will put a stop to asthma, that was creeping on him while
he was sleeping or sleepy, d fortiori anything that carries him be-
yond a state of mere wakefulness that gives him an active, not
a mere passive wakefulness, will be still more efficacious, and will
be adequate to the checking of an attack, that, in spite of his be-
ing broad awake, was gaining on him.

The very frequency with which coffee gives relief, makes it
hardly worth while for me to narrate the history of any cases. I
should think, from my own experience, that coffee relieves asthma
in two-thirds of the cases in which it is tried. The relief is very
unequal, often merely temporary, and sometimes very slight ;
sometimes it is complete and permanent. It is often taken in
the morning; and patients will tell you that, previous to taking
their coffee, they are not fit for anything, can hardly move about ;
but that taking it is immediately followed by freedom of breathy
ing, and an ability to enter at once on their daily occupation.

1859.] Treatment of Asthma by Stimulants, &c. 621

There are two or three practical hints with regard to the ad-
ministration of coffee, that are worth bearing in mind.

1. It cannot be given too strong. Unless sufficiently strong to
produce its characteristic physiological effects, it does no good,
out rather harm ; moreover, if given very strong, it need not be
given in much bulk, and quantity is a disadvantage its effect
is less rapid, and it oppressively distends the stomach.

2. I think it is best given without sugar or milk pure ca/6
noir.

3. It should be given on an empty stomach ; if given on a
full stomach, it often does great harm, by putting a stop to the
process of digestion ; indeed, so much is this the case, that I con-
sider coffee accompanying a meal, especially late in the day, so
peculiarly apt to induce asthma, that it deserves to be classed
among its special provocatives. I have mentioned elsewhere the
case of an individual who never dared to take the usual after-
dinner cup of coffee it would make the simplest dinner disagree
with him. But the same asthmatic found in strong coffee, on an
empty stomach, one of the most valuable remedies.*

4. For some reason or other, I don't know why, it seems to act
better if given hot very hot.

I adverted just now to the influence of mental emotion on asth-
ma, and stated my belief, that the modus operandi was, like that
of coffee or other stimulants, by producing an exaltation of sense
and will an intense activity of the intellectual part of nervous
action and proportionately lessening the tendency to excito-
motion ; and this it does to a much greater degree than stimulant
remedies, and its effects are, therefore, proportionately more sud-
den and complete. It was indeed, the curative influence of vio-
lent emotion, and the observation that it and coffee-taking, alike
banish that condition in which asthma is most prone to come on,
that first suggested to my mind the theory of the action of stimu-

* Since writing the above, I have received the following account from an
asthmatic gentleman, singularly confirmatory of my own observations:

"I used to think," writes my informant, " strong coffee the best of all remedies.
I remember one instance especially, only a pattern of many others, but more
striking when told. With bent back, high shoulders, and elbows fixed on the
chair arms, I had been laboring for breath all the afternoon. About five o'clock
I had two breakfast cups of strong coffee. The hard breathing disappeared
rapidly and completely. My sisters were dancing in the next room, and in less
than an hour I was dancing with them, quite free from asthma.

" Of late, coffee has often had an opposite effect upon me. The after-dinner
cup of coffee, to which I have been for several years habituated, now produces a
sensation of stuffing of the chest, and incapacity of moving about. I believe this
is because it stops digestion ; and the reason I did not suffer for some years, I take
to be, that my originally most excellent and enduring stomach, could stand it so
long and no longer. Coffee, on an empty stomach, I still deem a most valuable
remedy. I do not share the prejudice against putting milk and sugar into coffee
that is used as a medicine, provided that it remain cafe noir and be not made
cafe an laiu"

622 Treatment of Asthma by Stimulants, &c. [September,

lants on asthma, that I have just endeavored to propound. I
think, too, that mental emotion acts, if I may so express it, as a
nervous derivitive. There are many phenomena, both in health
and disease, that seem to show that only a certain amount of
nervous activity can be in operation at a certain time ; and that,
if a nervous action of one kind comes into operation, another that
had been previously going on is immediately depressed or arrest-
ed. Such is the explanation of the well known experiment of the
two dogs, one of which was taken hunting immediately after a
meal, while the other was allowed to sleep. In the one that was
taken hunting, digestion, on its return, was found hardly com*
menced ; in the other it was completely over, and the stomach
empty. In the sleeping dog, the whole vital dinamics, not being
otherwise employed, were appropriated by the function of digestion -r
while in the hunted dog, they were entirely taken up by its ener-
getic locomotion, and drafted away, as it were, from that nervous
superintendence of digestion without which the function cannot
be carried on .*. The power of strong emotion, or hard study, in-
retarding digestion is an analogous fact. Just in the same wayr
I think, the extraordinary activity and exaltation of thought and
perception, that characterize the stale of mind that the tak-
ing of coffee, ether, and other stimulants produces, acts as a ner-
vous derivative in asthma, and diverts from the nervous system
of the lungs, that morbid activity which engenders the spasm of
the bronchial tubes.

The cure of asthma by violent emotion, is more sudden and
complete than by any other remedy whatever ; indeed, I know
few things more striking and curious in the whole history of the-
raputics. The remedy that stands next in speed and efficacy
tobacco pushed to collapse takes time, a few minutes at least;
but the cure of asthma by sudden alarm, takes no time 'r it is in-
stantaneous, the intensest paroxysm ceases on the instant. This
is a fact so little known, as far as I can see, and yet so practi-
cally important and theoretically interesting, that I think it will
not be unprofitable if I endeavor to impress it more deeply by
the narration of some cases of its occurrence.

Case I. A gentleman suffering an unusually severe attack,
so bad that he had been unable to speak or move all day, was
suddenly alarmed by the illness of a relative ; he ran down two-
flights of stairs and up again, and administered the restoratives
he had procured, and then observed, to his astonishment, that his
asthma was gone. This gentleman tells me, that on many other
occasions, different forms of mental emotion have cured his
asthma.

Case II. C. R., a confirmed asthmatic, states that, when he

* See Dr. John Reid's experiments in Todd's Cyclopaedia of Anatomy, vol. iii.,
p. 899 ; also those of Bernard and of Bishoff, in Muller's Archiv. 1843.

1859.] Treatment [of Asthma by Stimulants, &c. 623

was suffering from an unusually severe attack, a fire occurred
just opposise his house. Previous to the occurrence of the fire,
he was in bed, breathing with the greatest difficulty, and unable to
move. When the excitement of the fire was over, he found that
be had been standing in his night-shirt, looking with the rest,
out of the window, and that he had quite forgotten all about his
asthma. On another occasion, when he was suffering from an
attack, some sudden anxiety arose about two of the irembers of
his family being out late ; the alarm from which he suffered, re-
lieved his asthma, but not so suddenly as in the case of the fire.
On another occasion, a sister of his was seized with sudden illness
that seemed to threaten suffocation ; he was suffering severely
from asthma at the time, and was in bed ; he jumped out of bed
in great alarm, and found then that his asthma was perfectly
cured. He was sufficiently well to run for a doctor, and contin-
ued well throughout the day.

Case III. Not long ago I was informed by a patient at the
hospital, who had suffered greatly for many years, that, however
severe an attack might be, venerial excitement would almost in-
variably cure it. He told me also, that, when a youth, he had
been guilty of the practice of onanism, and that the unnatural
excitement thereby produced, had just the same curative effect
on his asthma. Indeed, he pleaded this effect of it as a sort of
excuse for the practice ; and assured me, that when his breath
was very bad at night, he used to resort to it for the purpose of
curing it.

I have known two or three cases in which sexual excitement
has had just the same effect.

Case IV. The following account of the curative influence of
mental excitement I have received from a medical friend, who
has suffered from asthma all his life : " On one occasion I was
sitting with fixed elbows on a sofa, breathing hard ; a lady came
into the room whom I had known very well, and whom I had not
seen for several years. I got up to receive her, and sat down
again on a music-stool; with no especial purchase, therefore, for
the respiratory muscles, and yet with comparative ease of breath-
ing. This ease lasted for about an hour, and then the difficulty
of breathing came on again. I attribute the temporary amend-
ment to the diversion of nervous energy. Just the same thing
has happened to me more than once. On another occasion I
was suffering a good deal at a farm house. I got on horseback
with some difficulty, and an anxious hope that the horse would
go quietly, to fetch myself an emetic from a town three miles off.
The horse ran away with me. I pulled in, at first weaklv and
almost despairingly, but the need of exertion brought the power ;
after a run of about a mile, I succeeded in pulling up, and was
delighted to find my asthma gone. Another time I was breath-

624 Oxalate of Lime in Urinary Sediments. [September,

ing very hard, and a friend engaged me in an argument. At
first I could only get out a sentence in successive gasps ; but
gradually, as I got excited, the hard breathing went off, and I
could talk fluently."*

From the foregoing observations, then, I think we may con-
clude

That, since the abeyance of the will favors, in proportion to the
degree of the abeyance, that development of asthma, and since the
effect of strong coffee is to dispel such suspension or depression
of volition, and restore the will to its wonted, (or even an un-
wonted) activity, it is by thus exalting the will, and so disfavor-
ing the development of excito-motory action, that this remedy
relieves asthma.

That the same interpretation applies to the relief of asthma by
all other stimulants whatever.

That thus strong coffee and mental excitement, although appa-
rently so different, belong to the same category of remedies for asth-
ma. Edinburgh Medical Journal, and American Med. Monthly.

Oxalate of Lime in Urinary Sediments.

M. Gallois read a memoir on this subject before the Academie
des Sciences, the purport of which is contained in the following
resume :

Oxalate of Lime is a substance that can be readily recognized
in the urine of the healthy human being, at all ages. It appears
in considerable proportion under the influence of certain kinds
of food, and probably of certain medicines. It is very com-
monly met with in the urine of the sick, but excretion does not
constitute, in itself, disease. Oxaluria is thus not a morbid enti-
ty, but only a symptom common to affections very diverse in
character. Nevertheless it is proper to say that oxaluria has
been observed very often in spermatorrhoea, and in certain dis-
eases of the nervous system, especially in dyspepsia.

There is a substance which very frequently accompanies oxa-
late of lime in urinary sediments, as well as in gravel and cal-
culus, and this is crystalized uric acid. The very common co-
existence of these two, seems to explain the formation of the
oxalate in the system.

The connexion supposed to exist between oxaluria and dia-
betes, cannot be admitted;

The oxalic acid (and consequently the oxalate of lime,) ap-

* For additional cases of the cure of asthma by mental emotion, I must refer
the reader to a paper on Pathology of Asthma, in the British and Foreign, Jfedi-
co-Ohintrgical Review, for July, 1858.

1859.] Eliminating Grains of Powder from the Skin. 625

pears to be derived from the uric acid, and should be considered
as a higher degree of oxidation of this body, or of the elements
that form it, so that wherever uric acid or its elements are found
in the body, oxalic acid can be produced under the influence of
a higher oxidation, which is effected in the blood.

Oxaluria requires ordinarily no other treatment, than that
appropriate 10 the physiological or morbid condition with which
it is connected. Hence, the contradictory character of the medi-
cation heretofore proposed for its treatment: to abstain from
food and medicine containing oxalic acid, to use small doses of
nitro-chlorhydric acid in a bitter tonic infusion, or nitrate of
silver, (in the sandy form of oxaluria,) or colchicum in some
cases, or phosphate of lime, &c, &c.

Gallois is satisfied that alkaline mineral waters are the most
efficacious in hindering the excretion of oxalate of lime, especi-
ally where there is a coincident deposition of uric acid, a condi-
tion which seems to him most frequent. Gaz. des Hopilaux,
and Ibid.

Means of Eliminating Grains of Powder from the Skin. By
Prof. Busch, of Bonn.

Prof. Busch has taken the idea of this treament from the
method employed by M. Hebra, for freckles. This method con-
sists in provoking, by applications of a strong solution of cor-
rossive sublimate, and eczematous inflammation, after the cure
of which the spots on the skin disappear. As the pigment in
freckles is not in the epidermis, but in the rete mucosum, (rete
Malpighii,) M. Busch concludes that in the development of the
eczema, the epidermis not only is raised, but that the most super-
ficial layer of the dermis is acted upon ; and on this account, he
has been led to propose this means for eliminating grains of
powder from under the skin, when it is a recent case, and they
are too numerous to be removed by an instrument.

In a case treated in this manner, M. Busch made use of a
solution of corrosive sublimate, of the strength of five grammes
(Biv.) to a quart of water, the application of which, on account
of the recent injury, was not continued more than an hour the
first day ; but the succeeding days, as the patient felt only a
slight burning sensation, these applications were made successive-
ly during many hours, until the fifth day, when the whole in-
jured part was covered with a considerable eczematous eruption.
The applications were then suppressed, and the next day a part
of the vesicles simply dried, while others produced their crusts.
"When one of these crusts was elevated, on its under surface,

626 Sequelce of Measles and Scarlatina. [September,

grains of powder could be seen, and below these, an epidermis
of new formation. As this new epidermis was very tender, M.
Busch waited for twenty -four hours, then elevated with a spa-
tula, all the crusts and scales of the epidermis, and at the same
time a great number of grains of powder. In this manner,
almost all the grains of powder which Were situated between
the new and old epidermis were detached, and were easily elimi-
nated, with the exception of a small number, only appreciable
by a very close examination, and which were situated deeper
than the rest. Whether this method can be employed in old
cases, experiment only can prove. M. Busch adds, that all
agents strongly irritant can be employed for inducing this in-
flammation, in order to produce the elimination of the foreign
body ; but the sublimate solution is preferable, because the
degree of irritation can be exactly graduated by it, and after
the eczema it produces has disappeared, the skin preserves its
normal color. [Gaz. des Hopitaux, from VirchovSs Archives, and
Ibid.

Treatment Preventive of the Sequelae of Measles and Scarlatina.

Many precautions are adopted by physicians to prevent the
unfortunate sequelae of these diseases, and the confinement to
the sick-chamber for several weeks after convalescence ranks
among them. To avoid this, M. Scoutetten, of Mentz, has de-
vised the following method, which we find in the Gazette Heb-
domadaire, for April 1, 1859 :

As soon as convalescence commences, that is to say, when the
skin is no longer red with the eruption, he rubs over the whole
body slightly warmed, oil of sweet almonds or olive oil, and
puts the patient in bed again, for two hours. The next day he
gives him a tepid bath for an hour, then places him in bed,
and if the skin is very dry, a new friction with the oil is made.
These two frictions and one bath are usually enough to remove
all danger. Still, in severe cases, it is well, to avoid any risk,
to repeat the means indicated from time to time, until the skin
regains its supleness. These precautions taken, convalescents
may be permitted to go out without fear of bad results.

In order to justify this method and explain its importance, it
is necessary to remember the state of the skin in infants affected
with measles or scarlet fever. At the commencement of the
disease, the dermis is red and swollen ; during convalescence
the tissues return to their normal condition, but the epidermis,
which has been distended, not being elastic, becomes detached,
and falls off in the shape of fine powder when the attack of

1859.] Chronic, Organic Diseases of the Heart. 627

measles has been light, or is removed in large scales when it
has been severe, and especially when the eruption has been that
of scarlatina. The skin beneath is dry and harsh ; perspira-
tion and transpiration are badly performed, and the functions
of this important organ are impeded Or suspended. When the
skin acts badly, the kidneys and the mucous membrane of the
air-passages or of the digestive apparatus, undertake to supply
its place ; thence arises a thick, sedimentous, and sometimes
albuminous urine, severe diarrhoeas, which terminate in ema-
ciation and death; obstinate coughs, sore throats, croup, pneu-
monias, pleurisies with effusion ; finally, serous infiltrations into
the areolar tissue of the limbs, or accumulations of liquid in the
abdomen, and in other cavities where serous membranes exist.
These severe symptoms occur after an exposure to cold of the
skin, which inflammation has rendered more sensitive, and the
functions of which are interfered with by an inert epidermis,
which obstructs its pores. The object of the treatment pro-
posed by M. Scoutetten, is to oppose the causes of these symp-
toms. Amer. Med. Monthly.

On the Treatment of Chronic, Organic Diseases of the Heart. By
Professor Lebert.

i
The treatment of chronic organic diseases of the heart, offers
one of the most difficult tasks to the practising physician ; it is
nevertheless certain that a proper and thorough treatment of
these diseases, may do a great deal toward alleviating the con-
dition of the patients, and towards prolonging their lives. Prof.
Lebert advises especially, great care with blood-letting, purga-
tives, and all debilitating measures in the treatment of organic
diseases of the heart. In valvular disease, he employs venesec-
tion but very rarely. If in the course of the disease, an acute
inflammation, in the form of pericarditis or endocarditis, occurs,
it is often useful to extract blood to the amount of six ounces,
by means of cups or leeches ; if, after this, an energetic treat-
ment is still necessary, such advantage will be obtained from
the application of a large blister, and the endermatic use of half
a grain of morphia daily. The author's observations on the
use of digitalis we may omit, as generally known. Most allied
to digitalis, in regard to its therapeutic effect, is aconite. Al-
though it acts less heroically and more slowly than digitalis,
and does not decidedly diminsh the frequency of the pulse,
aconite is nevertheless a remedy which is capable of lessening
considerably the dyspnoea, palpitation, and the various subjec-
tive symptoms of the patient, even the tumultuous excitement

628 On the Use of Tannin in Large Doses. [September,

of the heart. A very important point to be considered in
the treatment of advanced diseases of the heart, is the general
cachexia and debility of the patient gradually developed. Le-
bert has examined for several years, the muscular structure of
diseased hearts, in order to see how far the gradual decrease of
the functional capacity of the same depends upon changes in the
muscular fibre itself. From these investigations it results that
very frequently a small degree of fatty degeneration of the
primitive cylinders of the muscles of the heart exists, even in
cases where the color and consistency of it does not indicate the
fact. The gradual increase of general debility and of the local
weakness of the heart, the progress of anaemia and hydraemia,
lead to the question, what effect tonics, especially iron, would
have in organic disease of the heart.

The better the patients are nourished (with the avoidance of
strongly stimulating food,) the longer they resist the evil influ-
ence of the disease ; the patient should, therefore, not be restrict-
ed to a vegetable diet, but a moderate amount of animal food
should be allowed with it. Of beverages, tea, coffee, alcoholic
liquors, and wine in large quantities ought to be avoided, where-
as, infusion of cocoa, or decoction of roasted acorns, are very
appropriate, particularly for breakfast. Light beer, or small
quantities of old wine mixed with water, may be allowed at the
table. Besides an amalystic diet, the use of iron is indicated,
particularly in the later anaemic and cachectic period of the
disease. Lebert recommends especially, iron reduced by hydro-
gen, (gr. ij. at each meal,) or twenty to twenty -five drops of the
tinctura ferri pomati, if necessary, in connection with equal
parts of tincture of aconite. The tartrate of iron and potassa
(three to five grains three times daily,) is a very useful prepa-
ration ; and as the effect of iron is perceptible only then, when
its use is persisted in for a long time, it is necessary, occasional-
ly, to make a change in the preparation employed. The author
has not derived much advantage from the application of blisters,
setons, and moxas. [Wien. Medizin. Wochenschrift, Mediz.
Neuigk., and Ibid.

On the Use of Tannin in Large Doses in Albuminous Anasarca.
By Dr. Garnier.

Pure tannin, tannic or gallic acid, was at first prescribed in
haemorrhages and diarrhoea, in pretty small doses, as it was con-
sidered a poison. Later, many practitioners recommended its
use in nocturnal sweats, in diabetes, and in atonic diseases. Dr.
Garnier, of Paris, was induced to try tannin in the albuminous

1859.] Yirchow's ailular Pathology. 62&

anasarca, consecutive to scarlatina, a disease which so obstinate-
ly resists ordinary measures. From the observations he has
lately published in the Archives Generales de Mt'decine, it results
that under the influence of large doses of this agent, the gener-
al infiltration of the cellular tissue, and the presence of'albumen
in the urine, have simultaneously disappeared. Dr. Gamier
gives the following conclusions at the end of his treati.-

1. Tannin, in the dose of fifteen to thirty grains through the
day, cures anasarca or oedema which has been passively devel-
oped, and co-exists with albuminous urine. 2. Its curative ac-
tion manifests itself by copious urine, which gradually assumes
its physiological characters, by perspiration, loose stools, etc. 3.
These symptoms appear on the second day of the administration of
the tannin. 4. Given in solution of about three to eight grains,
tannin does not derange the digestive organs. 5. The action
of tannin seems to be primitively directed upon the fluids of
the economy, the albuminous principles of which it coagulates
and plastifies ; its action upon the solids seems to be consecu-
tive, tonic, and astringent.

The facts reported by Dr. Gamier, are quite interesting; it is,
however, important to remark, that tannin has been given only
in cases of transitory albuminuria, following congestion of the
kidneys, and that albuminous or granular nephritis, is not at all
in the question. This distinction should be made, in order to
appreciate therapeutic methods properly. [Archives Generates,
and Ibid.

Virchow1 s Cellular Pathology.

The object of Dr. Yirchow's work on Cellular Pathology is to
establish a new foundation for the creation of a Philosophi-
cal Medicine. Dr. Virchow desires to put an end to all the
one-sided theories now in vogue to the theories of the hnmor-
ist and the solidist; to the crasis, exudation and blastema, iatro-
chemical and iatro- mechanical theories. In the place of all these
partial stories, he proposes a knowledge of the fine organic pro-
cesses of cell-life, as the only foundation of a rational doctrine of
disease. The cell-theory, and its relation to practical medicine,
however, is not altogether a novelty ; but according to Virchow,
it has as yet, only reached a certain stage of progress. What
has been heretofore done, stands as a mere forerunner to his
cellular pathology just as ideas stand to deeds, and imagina-
tion to investigation. The foundation upon which he fixes his
deductions, are actual histological facts, which he places before
his disciples in the shape of microscopical preparations and

630 Virchow's Cellular Pathology. [September,

drawings. It will be said by some, that there is nothing new
in the founding of pathology on histology. And on this score
reference may be made to the last edition of Eokitansky's work,
which is filled with numerous microscopic representations of
diseased'structures. It may be indeed asserted that Rokitansky
even laid the axe to the root of his earlier, and somewhat hu-
moral, style of pathology. He has rejected the doctrines of
Crases. In his third edition, Eokitansky says: " The origin and
increase of cells and nuclei take place, either immediately out of a
blastema, as free cells and nuclei, or in mother-cells and mother-
nuclei, endogenously ;" and he adds, "the extra-cellular origin
of these elements out of a free blastema, cannot be doubted, in
my opinion, at the present moment." Virchow, on the other
hand, utterly rejects the theory of the origin of free cells in a
structureless blastema; just as elsewhere, men reject the theory
of equivocal generation. He asserts, that only out of ready-
formed structures arise cells; and that out of old cells there is a
continual growth and development of new cells, omnis cellula ab
celluld. He substitues a cell-growth theory for the blastema
theory. He does not consider exudation as a peculiar product
of the capillary vessels, containing plastic and other constitu-
ents; but he regards it as an ordinary transudation mixed with
the product formed in the diseased structures outside the vessels,
among which products may be mentioned fibrin, pus, mucus,
etc. Hence, then, according to Virchow, the inflammatory pro-
cess does not take place in the capillaries, but in the elements
of the tissues themselves in the cells which through an increas-
ed activity attract the blood to them, and become thickened
and swollen. In this manner, by cell-growth and by attraction
of the juices, likewise arise all other new formations; the homo-
geneous, as well as the heterologous and malignant, so also new
areola, or bony tissues, pus, tubercle, sarcoma, and cancer, the
disease of plants, etc. The history of heterologous forms is this:
in a particular place, or at a particular time, or in a particular
degree, there arises a growth which is not proper to the part.
Some other structure normal in some parts of the body, is sub-
stituted at the part for the structure normal to it, forming what
Yirchow calls a pathological substitution of tissues. The malig-
nancy of heterologous growths consists in this: that the tissue
affected is, by its vascularity, disposed to form a fluid, which is
injurious to the structures around. The dyscrasias, also, can
only arise through the propagation, by means of the blood, of
the products of certain existing local affections. For example,
the so-called phlogistic or fibrinous crasis depends originally
upon a local production of fibrin in an inflamed tissue fibrin
being always a local product, and never arising in the blood.
Many other blood-diseases also depend upon diseased states of

1859.] History of Kervous Diseases of Syphilitic Origin. 631

the spleen and lymphatic glands those being glands in which
white and red blood corpuscles arise. The disease which au-
thors call pyaemia, consists partly of thrombosis and embolir
partly of ichonhaemia, of leucocythemia; the substance which
forms the obstruction in phlebitis not being pus, but a purulent-
like detritis. Pus arises only out of tissues. Life and disease,,
in fact, cannot be explained by physical or chemical actions, but
are the developments and processes of organized elements.
Schmidt's Jahrb. Med. Times and Gazette, and Amer. Med.
Monthly.

Contributions to the History of Xervous Diseases of Syphilitic Ori-
gin. By Dr. Gjor.

The description of these diseases is based upon the acurate ob-
servations of thirty cases. Fourteen of the patients were less
than thirty-five years of age, eleven were from thirty-five to
forty years, and only one individual was more than forty-five
years old.

In the great majority of the cases, the invasion of the disease
was preceded by distinct prodromic symptoms; they consisted
of pain in the lumbar region or in the extremities, or of an ob-
stinate headache, with nocturnal exacerbations.

Most frequently the characteristic signs were of a paralytic
nature ; the symptoms which accompanied the commencement
of the paralysis, were in general not very serious, and rather
fugacious ; fifteen times attacks in the form of apoplexy occurr-
ed, but were of but little intensity ; five times only, these at-
tacks gave rise to a complete loss of consciousness, and consecu-
tively to weight in the head ; twice the loss of consciousness
was associated with convulsions; in two cases the apoplectiform
attack occurred twice. Of these fifteen cases, there were only
four in which the paralysis supervened suddenly, and without
the health having been seriously impaired; in the eleven other
cases, it developed itself imperceptibly. N

In half of the cases hemiplegia was notieed ; eight times,
paraplegia; twice, facial hemiplegia; in three cases, paralysis
confined to one extremity ; in two, a general weakness of the
movements of the four extremities ; in nine, anaesthesia; and
in two, hyperaesthesia. The paralysis of the extremities, was
accompanied, in several cases, by paralysis of the sphincters,
and in four cases by amblyopia, with dilatation of the pupil.

The interval which separated the first symptoms of constitu-
tional syphilis from the paralytic attacks, was scarcely obvious
in two patients ; several months to a year, in eleven ; one to
five years, in eight patients. In the rest of the cases, the ap-
pearance of paralytic symptoms was retarded still longer.

632 Treatment of Porlapsus Ani in Children. [September,

It seemed that the patient who had suffered from several re-
lapses of the symptoms of constitutional syphilis, were not any
more exposed to the nervous diseases, than those in whom these
symptoms had been observed only once; the number of cases
of the first category is, is fact, only ten in the statistics of Dr.
Gjor ; he observes, however, that the number of his cases is not
sufficient to deduce from them unobjectionable conclusions.

The treatment of the nervous diseases of syphilitic origin, has
not given up to the present time, very satisfactory results. Of
the thirty patients of Dr. Gjor, only five were cured ; in twelve,
a more or less decided amelioration was obtained ; in six cases, no
change took place, and seven times the disease had a fatal
termination.

Dr. Gjor employed particularly the iodide of potassium, and
often combined with it strychnia, or the preparations of arni-
ca ; this remedy has afforded him the most advantageous and
prompt results. Mercury was employed in five cases, and was
not successful in a single one. Dr. Gjor tried syphilization
several times ; in one case only it produced a rapid cure, in the
six other cases, it was not followed by any improvement ; in
all syphilized patients the state of the general health was, how-
ever, much improved.

The three autopsies reported by Dr. Gjor, prove, at least,
that nervous diseases of syphilitic origin, are not always owing,
as was formerly supposed, to exostoses situated in the cavity
of the cranium or of the spine; in one case, Dr. Gjor found
softening of the brain ; in the two others, no lesion of the ner-
vous centres could be detected. [Schmidt's Jahrbucher, and
N. A. Medico- Chir. Review.

On the Treatment of Prolapsus Ani in Children. By M. Guer-

SANT.

In a small hospital in London, to which patients suffering from
diseases of the rectum alone are admitted, prolapse of the anus
is not treated by operation. According to Dr. Salmon, this
disease can be cured, not only in children, but also in adults, by
the evacuation of the bowels in the recumbent posture, as in
this position the patient cannot strain much, thus, generally,
preventing the descent of the intestine. After the observance
of this treatment for some time, the relaxation of the parts,
which permitted the prolapse, disappears, and a cure is effected.
At the same time vegetable astringent injections are employed,
although alum will be found useful. As a local application
strychnia may also be mentioned. This was first employed

1859.] Treatment of Prolapsus Ani in Children. 633

successfully hy Duchassoy, who made two or three very small
blisters around the margin of the anus, and dressed the raw-
surfaces with the ointment of strychnia. Dr. Johnson treated
in 1854:, two cases by the local application of the same remi
he states that in the lighter and mure recent forms of prolapse he
obtained a cure by regulating the bowels, employing astringent
injections, and administering tonics. In neglected cases, when
the sphincter is much relaxed, strychnia may be of some user
but it is not, however, to be recommended, as it is unreliable
in grave, and superfluous in light cases; it is, moreover, trou-
blesome, and not without danger. Dr Johnson considers cauteri-
zation after Guersant's method more valuable.

In the Metropolitan Free Hospital, Mr. Hutchinson employs
the tincture of nux vomica, in very small dosesT since he be-
lieves it imparts tone to the sphincters and walls of the intes-
tines.

Sir Benj. Brodie prescribes, internally, calomel and rhubarby
and uses injections of the dilute tincture of the chloride of iron,
Mr. Ashton maintains that in children suffering from this
affection, the liver is principally to be attended to; and Mr.
Curling recommends the use of cod-liver oil, after sufficient pur-
gation.

Mr. Salmon treats recent cases in children in the following
way : First the patient must evacuate his bowels in no other
but the recumbent posture ; second, the prolapsed part is thor-
oughly moistened with a decoction of oak-bark and alum ; thirdr
internally, he employs calomel and rhubarb ; when he orders,
fourthly, tonics, and a nourishing diet.

When the usual remedies have been en ployed without effect,
and the symptoms remain obstinate, M. Guersant advises cau-
terization of the skin and sphincter muscles with the hot iron.
He does not cauterize the whole of the protruded mucous mem-
brane, as was formerly done, as he considers the measure bar-
barous and hazardous. He proceeds, generally, in the following
manner: The child is subjected to a certain diet, and shortly
before the operation an injection is administered to clean out
the lower bowel. The patient is placed upon his side, his thighs
are flexed, and the protruded rectum reduced ; an assistant
drawing away one buttock, while the operator controls the
other. The cautery is about the shape of that used by dentistsr
either curved or straight, and terminates in a small ball, which,
above, runs out into a little point. It is applied at opposite
points around the anus, and must penetrate the sphincter in
order to be efficient. It is als< necessary to draw the margins
of the anus well apart on applying the cautery, and allow the
small ball, after its point has penetrated the sphincter, to act
upon the margins of the skin and mucous membrane. The

634 Physiological Researches on Dropsy. [September,

patient must be placed under the influence of chloroform, and
the iron be used at a white heat. If the rectum protrude during
the operation, it should be pushed out of the way of the instru-
ment. Cold-water dressings are the only applications made
after the operation.

M. Guersant recommends this plan of treatment as an excel-
lent, but not infallible means. In a few rare cases the children
are cured in one day ; more frequently, however, the prolapse
returns in a few days, and the cure is not completed before the
eighth or tenth day, when cicatrization has taken place. Some-
times a second cauterization will become necessary. [Behrend
und Hilderbrand1 s Journal fur Kmderkrankheiten, and North
Amer. Med. Chir. Review.

Anatomical and Physiological Researches on Dropsy consecutive to
Typhoid Fever. By Dr. Leudet.

The different kinds of dropsy following typhoid fever have
been described by a great many pathologists ; in France this
subject has received less attention than in other countries. MM.
Louise, Chomel, Forget, Guerin, and Piedagnel describe only
the oedema confined to the lower extremities. M. Martin is per-
haps the only French author who has given an account of the
anasarca and ascites following typhoid fever.

Partial oedema has been very well described by R. Virchow,
{Archiv fur pathologische Anatomie, tome ii. p. 401,) and by Mag-
nus Huss, {Statistique et traitement du typhus et de la fievre ty-
phoide, p. 205 ; Paris, 1855.)

Dr. Griesinger, of Tubingen, has given a very complete des-
cription of these dropsies (in Virchow's Handbuch der Pathologie,
etc., tome ii. p. 173, 1857.)

" There exists," says he, " a local dropsy consecutive to the
coagulation of the blood in the veins, the cause and signification
of which are evident. We meet, as a very rare complication of
typhoid fever, in its second stage, an extensive dropsy of the
cellular tissue and of the serous membranes. This dropsy is
more common in certain epidemics ; I have observed it, during
an epidemic which befell a population suffering from dearth, in
about one-fourth of the cases, the oedema supervened general-
ly at the end of the third week, more rarely at the end of the
second ; it commenced sometimes in the face, at other times in
the inferior extremities, spread rapidly over the whole body,
and was often accompanied by more or less ascites. A small
number of patients presented, in addition, a marked albuminu-
ria. In most cases it was not very decided, or had already

1859.] Physiological Researches on Dropsy. 635

ceased. During this time the skin was warm and dry ; a copious
eruption of miliaria accompanied the beginning of the dropsical
effusions, and persisted as long as they lasted ; sometimes the
pulse was at the same time slow and irregular. The internal
organs showed no symptoms of disease. This dropsy lasted
generally from six to ten days and disappeared mostly within a
few days. It exercised no favorable influence upon the termina*
tion of the disease ; in fact, only a small number of patients
succumbed. The dropsy aggravated the prognosis only by the
circumstance that it prolonged the period of convalescence."

M. Leudet had not seen a single case of this dropsy during
nearly ten years of observation made in the hospitals of Paris ;
but having had charge, for about four years, of a division of the
Hotel-Dieu of Rouen, he had the opportunity of observing a
certain number, and has reported seven cases of this kind in his
memoir.

A careful comparison of his observations with those publish*
ed by other authors enabled him to draw the following conclu-
sions :

The typhoid fever which is followed by dropsy is characterize
ed in Rouen, as in Paris, by ulceration of the intestinal follicles.
The serous infiltrations, whether confined to the lower extremi-
ties, or general, were of the nature principally described in Ger-
many. They are rarely limited to the superior extremities or
the face.

Sometimes the effusion takes place into the peritoneum ; M.
Leudet has observed no case of this kind ; in one instance he
met with a peritonitis.

The oedema is colorless and painless, and is, therefore, easily
distinguished from erysipelas. It supervenes mostly without
prodromic symptoms, and coincides often with some exacerba-
tion of the fever, with sweats, and abundant eruption ofsudami-
na, and an intense bronchitis. This latter coincident has been
particularly remarkable in Rouen, but it is not constant. In
the cases observed by M. Leudet, as well as in the epidemic
studied by M. Griesinger, the oedema showed itself, generally,
in the second or third week of the disease, and disappeared in
two or three weeks.

M. Leudet has been unable to discover albuminuria or lesions
of the kidneys in any of his cases. These two morbid states
have been observed, however, by Raver, Martin Solon, Finger,
Frerich, Begbie, Christison, Johnson, Griesinger, Barthez and
Rilliet.

The cause of this oedema, says M. Leudet, seems to be the
constitutional weakness of the the inhabitants of our city, and
the very nature of the typhoid fever, which is more frequently
accompanied by stomatitis, pleurisy, etc. than anywhere else.

H. 6. VOL. XV. NO. IX. 45

636 On (he Sulphate of Zinc, cc, as an Escharotic. [September.

Besides, the fevers and inflammations have generally an adyna-
mic character in Rouen. The anasarca is not a serious compli-
cation of the fever ; it prolongs, however the period of conval-
escence. The treatment consists of tonics exclusively.

[Archives Generate, and North Am. Med. Chur. Review.

On the Sulphate of Zinc and Sulphuric Acid as an Hkcharotic,
By Professor Simpson.

In a clinical lecture on carcinoma of the uterus and mamma
and its treatment by caustics, we find the following very im-
portant remarks;

" If you make use of the caustic made by saturating strong
sulphuric acid with a quantity of sulphate of zinc, dried and
powderedy you can manage by dipping an ordinary quill pen
in this mixture, as if you were going to write with it, to lay it
in a number of lines across the tumor, the number of lines cor-
responding to the size of the growth which you wish to destroy.
Very speedily the super-sulphate of zinc kills the skin in the
course of the lines which you have drawn ;. and if you will now
scratch assiduously with the filled pen along these lines, you
will cut through the skin in a few seconds. Leave for a day
the fissures filled with the caustic paster and then every day or
two by renewing the application of the scratching and caustic
you can cut down to a greater depth. In making the first ap-
plication I usually make a fissure of about a fourth or three-
eighths of an inch in depth, and then destroy the tumor more
deeply by successive applications. In this way five or six days
may suffice for the removal of a good-sized tumor. Let me
add, that in thus destroying and digging out, as it were, from its
very base, a cancerous tumor of the mamma, or other external
part neither of the two caustics applied by the quill would suf-
fice singly and individually. If you use the sulphuric acid
alone you will find that the acid so chars and hardens the spot
to which it is applied that you cannot next day cut or scratch
deeper through it with the pen ; while the super-sulphate of zinc
paste keeps the parts soft and pliable. Again, if you used sul-
phate of zinc alone you could not cut through the skin or pene-
trate deeply with it. For that purpose the aid of the sulphuric
acid is requiredy and the relatively slighter pain attendant upon;
this than upon most other caustics is perhaps explicable by the
fact that sulphuric acid acts almost instantaneouly in producing
its destructive effects upon living tissues. Usually the healthy
skin at the edge of the sloughing-out mass is granulating, con-
tracting, and partially cicatrizing before the dead tumor itself

1859.] Case of Pityriasis of the Eyelashes. 68?

separates. Dress the exposed tissues or ulcer before and after
the tumor is enucleated with black wash, chloride of zinc, sul*
phate of zinc, nitrate of silver, or any other appropriate surgical
lotion." [Mea\ Times and Gazette,

Case of Pityriasis of the Eyelashes. By Dr. James G. Heldige.

Case. A weak, scrofulous-looking child came to the Eye Dis-
pensary, Mecklenburg Street, complaining of inflammation of
the eyelids. The tarsal edges were slightly ulcerated and in-
flamed, and the cilia were very long, and appeared of a shiniDg
brownish color, and much thicker than natural. The itching
Was so intense that she was constantly rubbing the lids, which
aggravated her symptoms very much. The only previous treats
ment had been bathing the eyes with an infusion of chamomile,
which she did for four or five days, without deriving any benefit
from it. On examining the lashes with a lens, Dr. Heldige de-
tected an immense number of exceedingly small pediculi, about
the size of the point of a pin, which, together with their ova,
were exceedingly difficult to detach. They differed from the
ordinary pediculi in shape and size, the legs being very long in
proportion to the body, which Was small, and of a circular form.
The prescription was ointment composed of corrosive sublimate,
4 grs. ; tar, 9j ; and lard, 3 j ; about the size of a pea to be rub-
bed into the tarsal edges of the lids morning and evening. This
had the effect of completely removing the disease in about four
days, and no relapse occurred during a period of five days longer
that the case remained under observation.

This disease is not by any means of frequent occurrence.
Mackenzie, in the last edition of his work, mentions only one
case of it, and that not occurring in his own practice, but copied
from a notice published in the 'Lancet' by Mr. Lawrence.
Arlt, of Vienna, states that he has seen the disease occasionally ;
and Desmarres, of Paris, in his recent work, published in 1858,
does not even allude to it.

The species of pediculi peculiar to the body and head are also
sometimes found in the above situation ; but those described by
Mr. Lawrence, and observed in the above case by myself, are,
according to my own observation, peculiar to the eyelashes.

[Dublin Hospital Gaz.

Are Babies to be taught to Walk ? By (How to Manage

a Baby, A Tract ; also The Sanatary Review, Jan. 1859.)

" People talk about 'teaching babies to walk;' but babies do
not need teaching, for they will be sure to get up and walk

6BS Rules for the Dietetic Treatment of Asthma. [September,

when their legs are strong enough, and it does them harm to do
so before; in this, as in very many other things, babies would
be all the better for being left to themselves. But this does not
suit some mothers, who are in a hurry to see their children walk;:
such mothers cannot rest content without putting their children
into leading strings, or go-carts, or leading them with the hand.
All that they generally get for their pains is the sight of their
children's bandy legs and crooked ankles, caused by being
forced to walk before their time. Who would be a baby ?

" But, though baby should not be hurried in walking, it should
be allowed to keep moving all day long, while it is awake, for
the limbs cannot get strong unless they are used. The best
plan is, to put a piece of soft matting and a piece of carpet on
the floor, and put baby down upon them to stretch, roll, and
tumble about like other young creatures. If it has a ball or a
rag-doll to crawl about after, it will be ' as happy as the days
are long/ and will, besides, be very little trouble, and be ma-
king its limbs strong, ready to walk by-and-by. It is a great
pity to accustom a baby to be nursed, for it only does it harm,
and gives the mother a world of trouble in the bargain. In the
summer, it is a good plan to spread the matting and carpet on
the grass in the garden, and put baby down on them, to use its
limbs in the pure air and light. In short, wherever it is, and
whatever it does, it should keep moving all the time. The
birds, the beasts, the fish, and the creeping things are scarcely
ever still five minutes together in the daytime. Moving brings
life and health to all things, babies among the rest/*; [Rank-
ing* s Abstract

Rules for the Dietetic Treatment of Asthma. By Dr. Hyde Sai>
ter, Assistant Physician to Oharing Cross Hospital.

1. The tendency of food to produce asthma is greatly increas-
ed by the state of sleep; therefore, nothing should be taken
after such a time as digestion and absorption may be complete-
ly over in the stomach and small intestines, and even the lac-
teals quite empty, before bedtime.

2. This long fast before sleep involves a long period of inani-
tion ; therefore the asthmatic should break his fast early and
heartily.

3. The quantity of food the asthmatic takes should be small "f
therefore it should be highly nutritious.

4. As a rule, the tendency of food to produee asthma is in
direct proportion to its general indigestibility ; therefore the
asthmatic's diet should be of the simplest and plainest kind.

.5. But there are some articles of diet that have a special ten-
dency to produce asthma ; therefore from these the asthmatic
should exercise the strictest abstention. [Lancet.

1859.] Editorial. 639

EDITORIAL AND MISCELLANEOUS.

Dysmenorrhea.
[A recent paper, published originally in the Charleston Medical
Journal and Review, has been kindly sent us by the author, for exami-
nation. The ingenuity and utility of the new instrument therein des-
cribed, as well as the acknowledged difficulty ordinarily attending the
treatment of Dysmenorrhoea, induce us to spread the article in full, upon
our own pages. "We welcome the suggestion of a remedy, at once, so
plausible, expeditious, and easy of application.

Few Physicians, who have enjoyed much general practice, can re-
member with any satisfaction whatever, their cases of Dysmenorrhoea.
Occasionally here and there, as a green spot in the cheerless waste, a
case may be called to mind, in which, this or that remedy, nearly always
empirically applied, has effected full and satisfactory relief, but the ma-
jority have left no impression of pleasure ; remedy after remedy failing,
till at last, they have been either neglected 01 given over, in utter despair.
Much of this unsuccess has been, we agree with Dr. White, owing
mainly to there being no established theory as to the nature and origin
of the disease, and, while we are not prepared to admit, that, all cases
of Dysmenorrhoea depend upon mechanical obstruction at the os uteri,
both our observation and experience wTith cases, incline us to the opinion
that, such is the most frequent cause of this very painful disease. Ob-
struction any where along the course of the utero-vaginal passage, seems
competeni to give rise to all the symptoms peculiar to Dysmenorrhoea.
There is at present, a negro woman in Jackson Street Hospital, under
preparatory treatment, for the operation for Vesico-Vaginal Fistula. At
the time of her entrance into the hospital, the vagina was completely
occluded, the union of the anterior and posterior walls, having taken
place just behind the urinary fistula. Every month, this patient suffered
with all the symptoms of Dysmenorrhoea, in its most agonizing form, yet
we could find no indication by which we could hope safely to reach the
accumulation behind. A large tumor, the distended vagina, could be
felt per anum, but no pointing in any part of the vaginal surface.
The pain was kept down with morphine during the menstrual period
and subsided almost entirely in the intervals. The collection finally
pointing just behind the posterior lip of the urinary fistula, it was open-
ed, when the patient experienced immediate and inexpressible relief, on
the discharge of nearly a quart of retained menstrual fluid. The incis-
ion has been kept open with sponge tents and uterine bougies, and no
symptom of Dysmenorrhoea has appeared since. Precisely the same
result has ever followed our operations in every case of occluded vagina J

640 Editorial. [September,

indicating plainly that obstruction at other places, than at the uterine
orifice, is ever competent to produce all the symptoms of Dysmenorrhoea,
and that, on the removal of the obstruction, the function is performed
naturally and without pain. A large majority of cases of Dysmenor-
rhoea attended with engorgement of the neck, owe the pain and distress
experienced during menstruation, we are perfectly confindent, more to
the resulting occlusion of the cervical canal, than to the inflamed con-
dition of the cervix and when benefitted by local applications as cauteri-
zation and astringents, the relief is due more to the incidental enlarge-
ment of the canal, than directly to the reduction of the inflammation
which had been the chief object of treatment.

It is a notorious fact, that women suffering from Dysmenorrhoea, do
not bear children. This sterility is generally attributed to the distur-
bance of the system, consequent upon the painful periods. May not the
mechanical occlusion be an influential cause in preventing conception ?
These women do sometimes, as it were, by accident conceive ; and then,
we cannot say from our observation, that they are any more liable to
abort, but on the contrary, enjoy more excellent health during gestation,
than they ever did before. Then again, as our observation will fully bear
out the author, these women, after parturition, never again suffer from the
old distressing malady ; the distension consequent upon the act having en-
tirely broken up the obstruction upon which the distress chiefly depended.

If then, as would appear from the above considerations, mechanical
obstruction at the neck of the womb is a frequent, or even, an occasional
cause of painful menstruation, a disease so common, and at the same
time, attended with often, both bodily and mental distress, on account
of the barrenness it produces, some well-arranged and convenient means
of removing it, becomes a great desideratum in practice.

Dr. White's very ingenious Hysterotome is certainly a valuable
addition to the armamentaria of the Surgeon and Obstetrician, for it pos-
sesses all the advantages of safety, convenience and efficiency, so much
to be desired in an instrument of the kind. For his ingenuity and care
in bringing it to its present perfection, he certainly deserves the thanks
of our profession.] Editors Southern Med. and Sur. Journal.

Jl New Hysterotome. By Octavius A. White, M. D., of Charleston,

South Carolina.
Dysmenorrhea is certainly one of the most painful and intractable dis-
orders we can be called upon to treat. It is of very frequent occurrence,
and is the ftuitful source of much ill health to females. Commencing,
as it has often been known to do, even with menstrual life, it may pro-
ceed unchecked throughout successive years, and yield at last, only to

1359.] Editorial 641

time and the natural cessation of the discharge. If unrelieved, a trifling
case is liable to become worse and of longer duration, until finally, the
afflicted patient may be only beginning to recover from the shock of one
period, when the dreaded approach of the next is near at hand. It is,
therefore, not at all improbable, that many unfortunate women have fal-
len victims to consumption and other terrible maladies, in consequence
of these periodical sufferings.

Under such circumstances, the attention of accoucheurs must ever have
been directed to its relief. And such, indeed, has been the case, though
it is mortifying to reflect, that until a comparatively recent date, the
blindest empiricism appeared to direct the treatment. Incorrect views
respecting its pathology, inevitably led the way to notable errors in
practice, and the wretched applicant for relief, was too often subjected to
struggle not only with the original malady itself, but also against the
evil effects of injudicious means used to remove it. Thus, at one time, ob-
stetricians erroneously attributed all the phenomena of this disease to
plethora, when cups and lancets were indiscriminately applied. At anoth-
er, debility was the prevailing doctrine, and tonics became the fashion. At
another, spasm was obscurely hinted at as the cause, and opium was the
only specific. At a still later period, we hear of nothing but its nervous
and neuralgic origin ; this was the day of active temporising, main re-
liance being placed upon inunctions with belladonna, aconite, and the like ;
whilst, behold, at another, the very identity of the disease called in ques-
tion, and to ovarian irritation and inflammation, imputed the source and
origin of all the manifold suffering that was certainly uterine in its seat.

Such were many of the vague notions which prevailed respecting
Dysmenorrhoea, anterior to the year 1823. About this period, Dr.
Mackintosh of Edinburgh, first suggested the employment of mechani-
cal means for its relief. Being led to investigate this subject by acci-
dent, he forthwith commenced a series of examinations with experiments,
which resulted in convincing him that preternatural narrowing of the
uterine canal, was most commonly concerned in the production of this
complaint. This point being established, he proceeded to account for
the alarming symptoms so frequently met with, in the following man-
ner : " The menstrual discharge, after it is secreted in the uterus, cannot
readily escape, in consequence of the small size of its orifice ; distension
of the organ is the result, which, by exciting the contraction of its
fibres, produces uneasiness and pain in the pelvic region. When the os
uteri is very small and the secretion viscid, or mixed with coagulated
blood, shreds of membrane, or organized masses, then the distention
becomes more considerable, and stronger contractions are excited.
Sometimes the action of the abdominal muscles is called into play, and

642 Editorial, [September,

bearing down pains are produced, resembling in every particular, the
pains of labour, and continue until the expulsion takes place."

These observations, originally entertained and expressed so many-
years ago by Dr. Mackintosh, have since become generally adopted ;
and though improvements in the management of these cases are still
being made, no one can fail to observe that the doctrines promulgated
by that illustrious practitioner, continue to influence surgical opinions
and practice even to the present day.

Dysmenorrhea, therefore, being proved to result most commonly
from mechanical causes, surgical remedies for its control have largely
superceded the vaunted resources of the pharmacopoeia. But though
surgical appliances are oftenest available in the management of this dis-
ease, we must not lose sight of the fact, that there are also a certain
proportion of cases which require constitutional measures alone for
their cure. Let me not, therefore, be thought to accord to surgical in-
terference too great supremacy, experience having long since assured
me, that by far the largest number are amenable only to a careful and
judicious institution of both plans of treatment combined. If, therefore,
we adopt one of these modes of relief, and attempt to practice it to the ex-
clusion of the other, we shall too often be baffled in our best directed efforts,
and find the disorder liable to return, even after its apparent removal.

The method advocated by Dr. Mackintosh, consists, as will be remem-
bered, of careful and repeated dilatations of the os and cervix uteri, with
bougies of various sizes. But the same evil consequences which often
eventuate during the management of ordinary urethral stricture, by dila-
tation, were so liable to arise during this course of treatment here, that sur-
geons were soon compelled to abandon this procedure and look to measures
more expeditious, and against which no such objections could be alledged.

Accordingly, about twenty years after, Prof. Simpson announced to
the profession, another mode of treating this obstinate complaint, by an
expedient at once novel and brilliant. This was by incisions skillfully
made within the cervix uteri, with appropriate instruments, and keeping
the parts afterwards dilated with sponge tents until the cure was complete.

In behalf of this safe and simple operation, it is contended that it at
once places the parts in somewhat the same condition as subsequent to
parturition or a miscarriage. For it is a notable fact, that many cases
of otherwise intractable Dysmenorrhcea have been known to abate or
cease altogether after one or other of these occurrences have transpired.
As to the efficacy of this mode of operating, it would be needless
here to recount all the high testimony recently added in its favor.
Suffice it to remark the practice has since been adopted by many of the
most eminent accoucheurs and surgeons in this country and elsewhere

1859.]

Editorial.

643

Promising such certain and expeditious relief as this procedure

Fig. 1. tainly does, the facility with which the several steps

V of the operation may be performed, cannot fail to in-
terest surgeons. Already, therefore, have instruments
of different construction been suggested, each having
in view that important design. That invented by
Prof. Simpson, has. thus for, very justly commanded
the greatest favor. This, it will be remarked, how-
ever, is but a modification of the old Litkotome Cache,
which though a contribution of considerable value in
its proper place, to the armamenta of Surgery, is cer-
tainly liable here to objections which readily suggest
themselves to all who attempt its use.

Having been compelled, upon several occasions, to
resort to the practice and the instrument of this
eminent master, for the relief of obstructive Dysmen-
orrhea, the peculiar dangers which embarrass its
use, compelled me to lay it aside and employ one
invented by myself, of the following description.

Annexed is an engraving, which, though consid-
erably reduced from the original, will assist, I hope,
in giving an adequate idea of this instrument. It
consists, as will be seen, of a long and delicate staff or
stem affixed to a handle of unusual form. The staff
is about the calibre, and has somewhat the same
curve as a No. 3 small catheter. It is full nine
inches in length, and is so plainly notched and num-
bered off upon its posterior surface, from the point
to the handle, that these measurements may easily
be distinguished by the touch alone.

At a moderate distance from the point of the in-
strument, may be noticed two small blades, jutting
out from the staff on either side. Each of these
blades is capable of being thrust out about a quarter
of an inch, or concealed by being withdrawn again
within its sheath in the circumference of the staff, by
means of a certain manipulation at the handle, which
I shall take occasion presently to describe.
The standard depth of the womb from the os to the fundus uteri, has
already been ascertained to be just two inches and a half. To render,
therefore, the application of this instrument safe, and in order to bring
its utility within the range of possible cases of even smaller uterine di-

?

64:4 Editorial. [September,

mensions, a point about an inch and a half from the apex of the stem
has been selected, from which the knives are made to protrude when
needed.

The projection and closure of these blades is affected with great facili-
ty, by means of a female screw, (a) which plays upon a thread (6),
situated at the very butt of the handle. This screw is hexagonal in
shape, each side of which is made to bear a number, ranging from one
to six. The instrument being closed, No. 1 corresponds exactly to the
convex surface of the handle, but progressively, as the succeeding num-
bers are brought upwards, by turning the screw, the blades are forced
out to the extent desired ; No. 6, ol course, denoting the maximum.
The value of this little contrivance will be obvious, it being by this
means alone that the operator can learn at a glance, to what degree the
blades have been opened or shut, after that portion of the stem which
contains them has been introduced, to perform its duty within the uterine
orifice.

The second figure represents an anterior view of that section of the
stem which holds the blades, the upper surface being removed, in order
to display the mechanical principles upon which they act. The stem,
therefore, is seen to be hollow, and the two blades, lying back to back,
are held together, and fastened by means of a single pivot to a small
steel wire, which is made to pass quite through the centre of the instru-
ment, from c to b, fig. 1. When closed, the blades, of course, overlap
each other, to economise space, but obedient to the screw, (a) they are
forced to part, one on each side of the stem, in consequence of the
steady resistance opposed to the inclined plane of their backs, in the
shape of a wedge.

The handle made of some light material, is intentionally flattened
upon its posterior surface, and convex upon its anterior. The convexi-
ty of the handle, corresponds to the curvature of the stem, and by re-
ferring, therefore, to this distinction, the operator is constantly remind-
ed of the direction of the point of the instrument, even while hid to the
handle within the vaginal passage.

To incise the neck of the womb with this instrument, the patient is
made to lie upon her back, in a convenient position. The forefinger of
the right hand is inserted into the vagina, and its extremity held in con-
tact with the os tinea?, to act as a guide. The blades being closed, the
instrument is next held in the left hand, and its point carefully slipped

1859.] Editorial 645

along the palmer surface of the finger, until it is finally directed, in this
manner, through the cavity of the cervix and within the os internum.
It is then maintained in this position, until with the right hand, the
blades are forced out to the extent desired ; when, by simply withdraw-
ing the instrument, in the same direction as introduced, the operation is
fully accomplished. To complete the cure, all that remains now to be
done is to prevent re-union of the cut surfaces, and this is effected by
means of a sponge tent, or a permanent metallic bougie, similar to that
recommended by Prof. Simpson. "Whichever is selected should be worn
within the parts for several days, and only changed as often as cleanli-
ness requires.

My main object in communicating this paper, have been not merely
to record my approval of Prof. Simpson's mode of treating certain cases
of Dysmenorrhea by incision, but to introduce to the profession a new
surgical instrument for effecting this purpose. I trust that its credit
rests not so much upon its"originality and comparative cheapness, as
upon its especial adaptation to the relief of all classes of strictures in
which internal cutting would be admissible.

The instrument in my possession is one which was neatly and success-
fully fabricated at the factory of Mr. George Tiemann, No. 63 Chatham
St., New York. The skill of this veteran instrument-maker, is already
too well known to need encomium.

In conclusion, I would simply add, that this instrument needs but a
single application to effect in these cases, what it requires, at least, two
or more attempts with any other to perform. It offers, consequently,
an easier, more expeditious, safer, and, upon the whole, less painful mode
of operating than any other I know of. I therefore recommend its use
to my professional brethren, hoping that it may be found of as much
service in their hands as it has so far proved in my own.

American Medicine in* Great Britain. We are told that an intelli-
gent gentlewoman of England, not long since, was filled with astonishment
on beholding some of the inhabitants of the United States, exclaiming
" why their skins are iully as white as ours, and they wear doth
We are forcibly reminded of the above, (which we hope is an exagg
ation, or the result of a too implicit reliance on the romancings of " Boa
in America,") by a very just and most friendly article, in our valued
exchange, The Dublin Medical Press of July 20th. The able and liber-
al minded Editor, is, himself, entirely free from the false impressions he is
contending against, and magnanimously, in the very midst of a clamor
of complaint against him, for quoting American articles into his Jour-
nal, dares to raise his voice in vindication of American Practitioners,

64:6 Editorial. [September,

American writers, and the much despised American medicine gen-
erally.

Many of our readers will smile, while others will blush with indigna-
tion, when they learn the reason why American Medicine has not, as yet
gained a more important position in Great Britain. All will, at least,
experience surprise to read, that " The objection commonly made is,
that statements as to matters of fact, are not to be relied on, when made
by contributors to American Journals, in consequence of a habit of ex-
aggeration assumed to be prevalent there." Let them disbelieve we
shall adopt the wiser course of believing and proving, and " holding on
to the good wherever it may be found." We are free to admit that there
is a credulity which may often, render its subjects liable to imposition,
but on the other hand, it is well known, that there is an immuring scep-
ticism far more dangerous, which ever blocks up all the avenues to im-
provement, and binds down its unfortunate possessors, to the narrow
bounds of personal experience and immediate observation.

We cannot now enter fully into a consideration of the respective
merits of British and American Medical Literature, but we can assure
the Editor of the Medical Press, that his generous vindication of Ameri-
can Medicine, is not misplaced, and will be highly appreciated. Time
only is required, to convince his confreres that they would consult the
interest of their readers, by following his example in placing more re-
liance on, and quoting more extensively from, the reports of their Ameri-
can brethren.

We here present the article, in full :

4 Medicine in America.

Occupied by medical politics at this critical period of professional
revolution, we have been obliged to postpone the consideration of many
topics w^aich should otherwise have been the subject of discussion in
our columns, and amongst them one which should have been noticed.
We have often been asked, and sometimes not temperately, why we
quote and copy so much as we sometimes do from American journals,
meaning those of the United States, and to this question we have now
to reply, and perhaps after Irish fashion, we may begin by asking anoth-
er: Why should we not make our brethren here in Ireland, from time
to time, acquainted with the progress of professional improvement on the
other side of the Atlantic? for it must be admitted, that improvement is
taking place in a country so perfectly free to adopt any alteration which
experience justifies. Strange to say, the objection commonly made is,
that statements as to matters of fact, are not to be relied on when made
by contributors to American journals, in consequence of a habit of exag-
geration assumed to be prevalent there; an objection, we must say,
more discreditable to those who make it than to those to whom it lefers..
Such an assumption is, as regards American medical literature, alto-

1859.] Editorial 647

gether without foundation, whatever grounds may exist as to its adop-
tion with reference to literature of a different class, emanating from this
quarter, and could have arisen from prejudice only, or misconception,
amounting to what may be called vulgar error. To justify the opinion
we express, we have only to challenge a comparison between the medi-
cal journals of the United States and those of Europe, and to a*k any
candid man, whether the former exhibit less evidence of veracity than
the latter; in fact, we are convinced that there is no foundation what-
ever, for any such offensive supposition. On the contrary, we believe
that even a cursory examination of the American medical periodicals,
will at once refute any such error, for we venture to say that they afford
at least as much internal evidence of regard for truth, as their European
contemporaries. In the United States, the journalist and contributor
evidently address themselves to readers, of whose judgment and criticism
they entertain respect, while nearer home we find, from the nature of
many communications, writers must often consider their readers very
deficient in these qualifications. We do not mean to say, that in The
States there is no publication of worthless matter, or exaggeration of the
importance of communications, but we venture to say that there is
of writing for mere notoriety, or, as it is called, M keeping a man's name
before the public," and more of an honest conviction, that the informa-
tion offered is entitled to consideration. Hence our reliance on the
value of this source of professional knowledge, and our occasional use of
it for the benefit of our readers ; and hence, too, our regret that in con-
sequence of defective postal and agency arrangements, we cannot avail
ourselves of it as freely as we wish. That this vast country, with its
variety of climate, soil, and cultivation, and its peculiarities resulting
from civilization and political condition, must afford illustrations and ex-
amples highly important, both to practitioners and conductors of medi-
cal institutions cannot be denied, and therefore the advantage of appeal-
ing to facts recorded in its annals. Disease assumes characters in these
regions, not to be observed in our climate, and the habits of the people
have established customs and created institutions, so different from ours,
that the consequences cannot be unnoticed by the journalist or neglected
by the practitioner. We are at this moment here in Ireland, engaged in
warm controversies, as to the natnre of the qualification which should
entitle a medical man to practise, and as to the conditions under which
persons should be allowed to dispense nedicines, both of which points-
seem to be more or less settled in The states, by some means which we
cannot well comprehend. The Amercan Physician, as the general
practitioner there styles himself, seems to enjoy rights of practice, and
liberty to compound and dispense medicines which are denied to the
same class in this country, and it may be well to ascertain whether this
has been followed by consequences discreditable to the medical profes-
sion, or dangerous to the public. This free trade in physic, at the same
time, does not appear to lead either by law or practice, to any obstruc-
tion disabling the pure physician or surgeon from pursuing bis avoca-
tions as he does in this country, and so we have here again practical
proof that, however it has been done, much of what we are contending
for in this country, has been accomplished elsewhere. Believing, then,

648 Miscellaneous. [September,

that the study of disease may be promoted by observation of its effects
on black slaves in South Carolina, as well as on white free men in New
England, and that the operation of peculiar laws and customs on medi-
cal affairs throughout the Union may prove instructive, we propose to
make our readers from time to time, acquainted with what is passing in the
Western medical world. To fastidious friends at home, and considerate
contemporaries abroad, we therefore appeal to enable us to accomplish
this object, and we shall be grateful for any assistance afforded us, to carry
our views in this respect into effect. In fact, we begin to think that
the old medical world is growing older, and that a little transfusion of
new blood may give new life ; the journals of Europe are full as ever,
but their contents remind us more of the garrulity of age than the fresh-
ness of youth. At this side of the Atlantic, men are, in fact, so busy
praising themselves and endeavoring to prove that little was known
Until their time, that it may be well to learn how it is at the other, and
thus perhaps relieve us from the monotony of books and journals which
is, at present, rather oppressive.

[Dr. L. D. Ford of Augusta, has been using chloroform in cases of
Delirium Tremens for several years with the best effect. We are sur*
prized at the strangeness of the remedy in England.]

Delirium Tremens. A case of delirium tremens is recorded : the sub-
ject, a stout healthy man, in which laudanum and hyoscyamus having
completely failed in moderating the violence of the symptoms, chloro-
form was administered ; in five minutes he fell asleep, and continued
sleeping for six hours, when he awoke, and the symptoms of the dis-
ease had vanished. {Ed. of Lancet, p. 57.)

We apprehend that the indiscriminate use of chloroform in delirium
tremens would be highly dangerous. If a sly drinker, one who habitual-
ly gets nearly drunk, be compelled to leave off his stimulants suddenly,
he will probably be attacked with delirium tremens; but in this case the
"use of chloroform would be hazardous. You have an impoverished vital
energy, an exhausted nervine force. Small doses of brandy and constant
administration of small quantities of beef-tea are here called for. But
where, as in the case mentioned abo^e, the man is not an habitual drunk-
ard and the constitution is good, in fact, if we may use the term, when
the disease is more sthenic, chloroform will be found invaluable ; opium
and brandy injurious. [Braithwaite h Retrospect,

On Hemorrhagic Measles. By Dr. Otto Veit. The prevailing view
that the hemorrhagic or petechial form of measles is of a malignant or
septic character indicating great danger, is combatted by Dr. Veit upon
the strength of the experience which he has derived from the various
epidemics that have occurred in Berlin, from 1847 to 1857. After
quoting various authors from Huxham downwards, of whom Rilliet and
Barthez alone coincide with the views advocated by Dr. Veit, he details
his own observations. He met with the petechial form in 11 out of 160
cases ; and although 9 of them lived in needy cirsumstanees, they all

1859.] Miscellaneous. 649

passed through the disease without any peculiar disturbance or ill effects.
The author does not deny in toto the occurrence of a septic form of
measles, but is unwilling to admit that ihe petechia in the cases observed
by himself were due to decomposition of the blood, but that they must
be regarded as a proof of the greater intensity of the physiological pro-
cess in the same way as the catarrhal affection of the respiratory organs
may be converted into croup or bronchitis. In the hemorrhagic form
the eruption, after the usual prodromata of fever afid catarrh, on the
second, third, or fourth day, instead of becoming paler, suddenly assumes
a dark-red colour. These spots become still darker on the ensuing days,
and even black ; they are round or angular, but have a sharply-defined
margin ; they vary in size from a flea-bite to that of a pea or bean,
and more. They do not disappear on pressure, but behave exactly like
extravasations. These spots retain their intensity of colour for a day or
two, and then pass through the various changes of colour observed in
other extravasations, becoming purple, brown, and yellow before they
disappear all together. The desquamation of the epidermis is more
marked over these spots than elsewhere. Dr. Veit has not met with
cases in each epidemic of any intensity ; sex appears to exert some in-
fluence on the occurrence of the hemorrhagic form, seven having been
males and four females ; while of the 160 cases of measles, 80 were males
and 18 females, the sex of two children not having been noted. All the
epidemics observed by the author had a benignant character, only 3 of
his 160 patients having died. [Arckiv. fur Pathologische Anatomie
und Physiologic, and Brit, and For. Med. Chir. Rev.

Influence of Hunger on Poisoning. By the following extract from
article xv. of Virchow's Arckiv. Bd. xiv., (Hefte 5 and 6,) it is intended
to make known some of the results obtained by Dr. Th. Kbhler of Mar-
burg, who, among other interesting experiments, endeavored to deter-
mine the influence of hunger upon the activity of poisons i. e. the dif-
ference in the rapidity of their resorption in fed and unfed animals. It
appears that hunger retards resorption, and delays the occurrence of
poisoning and death, so that the generally prevailing idea that an ema-
ciated, weakened individual must sooner succumb to a dose of poison
than a well-fed and strong individual, is evidently incorrect. Kohler
explains that the rapidity of resorption bears the necessary relation of
effect to cause to the number of respirations and the corresponding fre-
quency of pulse. Abstinence of nutriment diminishes the absorption of
oxygen pretty steadily till death, corresponding to which the quantity
of excreted carbonic acid becomes less. During hunger, the blood,
therefore, cannot circulate with the usual velocity, and poisonous sub-
stances that must, directly or indirectly, be incorporated with the cur-
rent, are carried along less rapidly and consequently reach the central
parts of the nervous system later than when the usual food has been
taken. This action must necessarily also, therefore, occur later. The
earlier occurrence of death in well fed animals is also thus explained.
Circulation on which all processes depend being influenced by respiration,
and the state of the nervous system, becomes more rapid when the mus-
cles are violently contracted, and nourished animals distinguish them-

650 Miscellaneous*

selves generally from the unfed by their much more forcible and violent
muscular action, thus hasten their own destruction. [Med. and Surg,
Reporter.

On the Treatment of Croup. By M. Malgaigne. In a letter addressed
to the Academy of Medicine, apropos of a long discussion on the treat-
ment of croup, M. Malgaigne complains of the erroneous manner in which
his doctrines as to the employment of tracheotomy in this disease have
been represented, and sums up the views he entertains thus : he regards
the operation as a sad but imperative duty, justified only by the absence
of all other chance for the patient, and he distinctly opposes the doctrine
of M. Trousseau, who inculcates that the operation should be had' re-
course to as soon as false membranes make their appearance in the lar-
vnx. M. Malgaine considers that the time for the surgeon to interfere
Is when the physician states himself to be unable to do anything more*

[IS Union Medicate, and Ibid,

Translation of Medical Works into the Chinese Language. Some of
the standard medical authorities have recently been translated into the
Chinese language by Dr. Hobson. They include works on the following
subjects : Philosophy and General Anatomy, Surgery, Diseases of Wo-
men and Children, Medicine and Materia Medica, and on General Science,
Some of these works have created great interest in them and have been
republished by Chinese Mandarins, and widely circulated over China and
Japan. The medical works of the Chinese show them to be totally igno-
rant of medicine as a science. Anatomy has never been studied, and
they do not comprehend the circulation nor the functions of the viscera.
It is believed that this series of treatises will spread much useful infor-
mation among their practitioners, and induce attention to medical science,

[Med. and Surg. Reporter.

Light the only cause of Purulent Ophthalmia of Infants. Mr. Bal-
lard has written an original paper upon the above subject. The gener-
ally received opinion that the disease is the result of contact with vagi-
nal secretions is disputed, 1st, because the disease does not appear
until several days after birth ; 2d, extreme cases of leucorrhoea and yet
no ophthalmia if the room was kept dark ; 3d, no leucorrhcea and yet
ophthalmia, the room being kept light.

The proofs in favor of light being the cause of the disease are, 1st,
Expose an infant to bright light, and you can prognosticate the occur-
rence of the disease. 2d. It never prevails if the child is kept in the
dark. 3d. That many cases had been cured by obscuration only.

London Lancet

Prof. E. R. Peaslee has been transferred to the Chair of Obstetrics
and Diseases of Women in the New York Medical College, made vacant
by the resignation of Dr. B. F. Barker, and Prof. Austin Flint, Jr., late
of Buffalo, has been appointed to the Chair of Physiology and Micro-
scopy. Dr. Flint holds the same chair in the Buffalo Medical College.

[Med. and Surg. Reporter.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XV.] AUGUSTA, GEORGIA, OCTOBER, 1859. [No. 10.

ORIGINAL AND ECLECTIC.

ARTICLE XXII.

Aneurism of the Ischiatic Artery Ligature of this Vessel, and
subsequently of the Primitive Iliac Artery; with remarks, by
L. A. Dugas, M. D., Professor of Surgery in the Medical
College of Georgia. (Read before the Medical Society of
the State of Georgia, at its meeting in April, and ordered to
be printed.)

Axeurismal affections of the breech or gluteal region are so
rare, and their consequences so serious, that it becomes a duty
to place upon record such cases as we may see, together with
the result of the plan of treatment adopted, whether favorable
or otherwise. Were failures in the management of surgical or
other diseases, as freely published as successes, our means
for estimating the relative merit of different procedures, would
be greatly improved.

Although the branches of the internal iliac artery which pass
out of the pelvis, may become aneurismal without having suf-
fered any traumatic lesion, such cases are rather exceptional,
and the aneurism may in general be traced to some mechanical
injury. Of the small number of aneurisms of this region refer-
red to in systematic works, the majority implicate the gluteal
artery ; so that there are very few wrell defined instances of
aneurism of the ischiatic artery. Professor Bouisson, of Mont-

K. S. VOL. XV. KO. X. 46

652 DuGAS, on Aneurism of the Ischiatic Artery. [October,

pelier, is the first who has dwelt at any length upon these affec-
tions, and his memoir published in the Gazette Medicale de
Paris, for March, 1845, contains a better account of them than
can be found elsewhere. An abstract of this interesting contri-
bution, is contained in the first volume of Vidal's " Pathologie
Externe," and has also been incorporated in the American trans-
lation of Velpeau's Operative Surgery,

The symptomatology of these aneurisms does not differ mate-
rially from that of similar affections in other parts of the bodyr
and their diagnosis, although sometimes obscure, may usually
be made out with sufficient accuracy by careful examination.
Yet it is alleged, that " an eminent surgeon of London, Mr,
Guthrie, tied the primitive iliac in a patient who was supposed
to bave gluteal aneurism j but in whom death, which took place
eight months afterf disclosed the fact,, that it was an eneephaloid
tumor. n It is also stated, that a Parisian surgeon of large ex-
perience, mistook an aneurism of this kind for an abscess, and
punctured it. But it is much less difficult to diagnosticate the
mere existence of an aneurism of this region, than to determine
positively whether it be located in the gluteal or in the ischiatic
artery.

In a chapter upon Aneurisms, inserted by Dr. Mott, in the
translation of Velpeaurs Surgery, he says : " when an aneu-
rism exists in the gluteal region, we believe it utterly impossi-
ble for any surgeon to say whether the disease is seated in the
gluteal or ischiatic artery. These arteries emerge from the pel-
vis so near together, that, a priori, the identification of an
aneurism in one or the other is totally impossible." (Op. cit.
vol. 2, p 298y 1st ed.) The cases of which I am about to give an
account, establish conclusively that our distinguished country-
man has been rather hasty in the expression of his views so
dogmatically. In these cases, I think it wiH. be conceded that
there could have been no doubt as to which artery was the seat
of disease, even before its ligation made the demonstration com-
plete-
Several methods of treatment have been proposed and prac-
tised, in the treatment of aneurisms of the gluteal region. In
recent wounds opening the gluteal or ischiatic arteries, there
can be no doubt as to' the propriety of acting upon tl*e general

1859.] DuGAS, on Aneurism of the Isclriatic Artery. 653

principles which govern us with regard to wounds of arteries
in other localities ; that is to say, of cutting down to the vessel
and placing ligatures above and below the point injured. This
is advised even by the authority just quoted, notwithstanding
his manifest aversion to the ligature of these vessels under any
other circumstances.

In cases of a different character, other means have been used.
Systematic compression has failed to give more than temporary
relief, and surgeons are divided as to the point at which the
ligature shower, be placed within the pelvis; some advocating
its applicatiiunto the internal iliac, and others preferring to take
up the common or pvimitive trunk. Bouisson urges the liga*
tion of the - ^rected vessel >...tts emergence from the pelvis, as more
easily performed and less d;.b.gerous. Whether this will be
found more effectual, remains to be seen. It is unquestionably
easier to place a ligature upon the ischiatic artery outside of the
pelvis, than upon the internal iliac ; but by so doing, we oper-
ate nearer the seat of disease, where the coats of the artery-
are more apt to be in a pathological condition, and are con-
sequently more liable to be attended with secondary hemor-
rhage. On the other hand, the internal iliac is very difficult to
reach, and its numerous branches are apt to prevent its occlu-
sion for a sufficient length to obviate the dangers of* secondary
hemorrhage. Again, when we reflect upon the free anasto-
moses of the branches of the internal iliac with vessels derived
from the external iliac, or rather from the crural artery, we are
led to doubt the efficacy of ligatures placed upon any portion of
the internal iliac, or of its subdivisions. It would seem that the
only hope for success must be found in the possibility that by
retarding the force of the circulation in the aneurism, coagula-
tion may be induced within it. I must confess that such were
my expectations when I performed the operation I am about to
relate. Of the seven cases recorded in which the internal iliac
was tied for aneurisms of the breech, four terminated favorably
and three fatally. (Mott's Velpeau.)

As Prof. Bouisson's method of reaching the gluteal and the
'schiatic arteries, for the purpose of ligati ng them, appears to
floe the best, I may be permitted here to translate it, from
Lis essay.

654 DuGAS, on Aneurism of the IscMatic Artery. [October,

" The surgeon should recollect that the glutei artery emerges
from the pelvis, at the highest point of the sciatic notch, eleven
centimetres from the anterior superior spinous process of the
ilium, six centimetres from the posterior superior spinous process
of the ilium, and ten centimetres from the most elevated point
of the crest of the ilium. Having made the patient lie with
his back up, and ascertained by an examination of these
points, the precise seat of the gluteal artery, the surgeon should
make a transverse incision six or seven centimetres in length,
the middle of which should correspond with the* ^oint of emer-
gence of the vessel. This incision is carried thj pigh the skin,
cellular tissue and gluteus maximus, and exposes vie aponeurosis
in a line tangent with the curve of t>p sciatic notch. .The sides of
the wound will immediately ref act, and the aponeurosis may
then be cut upon a grooved director carried between it and the
artery, which may be felt pulsating beneath the edge of the
sciatic notch.

aWith a grooved director moderately bent, and having an eye
near the end with a ligature passed through it, he should care-
fully isolate the bundle of vessels from the cellular tissue, in
which they are imbedded, push aside the vein or veins as the
case may require, as well as the nerve on the inner margin, and
hook up the artery just below the bony edge of the sciatic notch.
It is important to carry the end of the director deeply enough
to be sure of elevating the arterial trunk itself, otherwise a
mere branch of the vessel might be mistaken for it. These
steps in the operation are materially facilitated by the natural
retraction and separation of the sides of the wound, as well as
by the direction of the incision. The threaded director may
readily be carried without difficulty in this transverse wound ;
whereas, when it is made parallel with the fibres of the gluteus
maximus, as advised by H. Harrison, it is not without some trou-
ble that the artery can be elevated by the grooved director, or
by Deschamp7s needle.

" The remainder of the operation presents nothing peculiar ;
the vessel is tied in the usual way ; and union by the first or
by the second intention will be sought according to circum-
stances.

" Ligature of the Ischiadic Artery. We know of no instance

1859.] Dug AS, on Aneurism of the Ischiatic Artery. 655

which this artery has been ligated in the living, although cases
have occurred which might have rendered this necessary, as
hemorrhages and aneurisms. The possibility of ligating this ves-
sel is admitted, and it is acknowledged to be less difficult than
a similar operation upon the gluteal artery.

" We have repeatedly tied the ischiatic artery without difficulty
in the dead subject by means of a transverse incision as in the
preceding case. The ischiatic artery emerges from beneath the
pyriform muscle, exactly at the centre of a line drawn from the
posterior superior spinous process of the ilium to the tuberosity
of the ischium. A transverse incision of six centimetres in
length, should pass over the point just indicated, and penetrate
through the skin, cellular tissue and gluteus maximus. The
artery is found on the inside of the sciatic nerve, with the vein
on its posterior and internal aspect. The vessel is to be isolated
and elevated with a threaded grooved director, care being taken
to avoid including the vein in the ligature, and the operation is
to be completed as in ordinary cases.

" A similar incision would answer for tying the internal pudic
which lies a few millimetres from the inner side of the ischi-
atic." {Gazette Medicate de Paris, March, 1845, p. 200.)

I will now present the history of a case which came under
my charge in 1857, as taken from my note-book.

Wesley M. Johnson, of Gilmer Co., Georgia, aged twenty-
four years, directed to me by my friends Drs. Setze and Connel,
of Marietta, placed himself under my care in March, 1857. He
states that when four years old, he fell from a tree and struck
with his seat upon a rocky surface ; but has no recollection of
any contusion or injury to the part at that time. He was told
that he was so badly stunned, that he was carried home insensi-
ble. About five years after this, he first felt a little tumor in
the region of the tuberosity of the ischium, which has been
steadily increasing ever since. He does not know when it began
to pulsate, but thinks it has done so for several years. About
a year ago a " Cancer Doctor" said, " he could cure him with
plasters that would eat out the tumor." A plaster was
accordingly applied, which gave him such intense pain, and
caused so much inflammation and tumefaction, that he refused
to have it repeated.

656 Dugas, on Aneurism of the Ischiatic Artery. [October,

His condition when I examined him was noted as follows :
[see Fig. 1,] General health apparently very good ; has a tumor

as large as a goose's egg upon the inner cheek of the nates, near
the tuberosity of the ischium, and extending upward and in-
ward in the direction of the well known course of the ischiatio
artery. It is easy to grasp the whole tumor in the hand, and
no distinct neck can be felt extending up beneath the gluteus
maximus.

Its lower extremity protrudes about two inches beyond the
general surface, is somewhat conical, soft to the touch, and feels
as though there was no more than" the thickness of the skin be-
tween its contents and the finger. The skin is also here of a red
or dark hue, not unlike that presented by an acute abscess on
the point of bursting. The tumor evidently contains- a fluid
which may be forced out of it by pressure, and which returns
immediately when this is discontinued, the current of egress
and of ingress being distinctly felt by the finger. The tumor
pulsates visibly to the eye and sensibly to the hand ; a distinct
aneurismal thrill or whiz, with beats synchronous with the action
of the heart, may be easily detected with the naked ear or with!
the stethoscope over the entire tumor, and along the course ofthf*-

1859.] Dugas, on Aneurism of the IscMatic Artery.

657

ischiatic artery up to the sciatic notch, where it is most audible. Firm
pressure upon the seat of the ischiatic artery at its exit from the
pelvis, arrests both the pulsation and the whiz, and these return
when the pressure is omitted.

The tumor never gives him any pain, except when he rides
on horse-back, or sits long upon it. It then feels heavy and
sore. It is evidently an aneurism of the ischiatic artery, proba-
bly induced by the traumatic cause above mentioned.

The following operation [see Fig. 2,] was performed on

Monday, the 16th of March, in presence of a number of phy-
sicians and students : concentrated chloric ether was inhaled to
intoxication, but not to coma ; an incision five inches long was
made in the middle of a line drawn from the posterior superior
spinous process of the ilium, to the tuberosity of the ischium, and
carried through the gluteus maximus which was unusually thick;
ligated one small artery ; exposed the inferior margin of the
pyriformis, and found the ischiatic artery beating strongly and
with a distinct thrill to the finger. When this was compressed,
the pulsation in the tumor ceased, but would return upon re-
moving the pressure. The vessel was now ligated with silk

658 Dugas, on Aneurism of the Iscliiatic Artery. [October,

and the tumor ceased to pulsate and became pale and flabby.
The edges of the wound were brought together with quill
sutures, and a firm compressing bandage applied to the
tumor. Two hours after the operation, a freezing mixture of
ice and salt was applied for ten minutes to the tumor, over the
bandage, and 40 drops tr. opii. administered.

17th March. Passed a bad night in consequence of febrile
excitement and confined position ; is still feverish and feels
" sore all over ;" no pulsation nor whiz in the tumor. Re-ap-
plied freezing mixture to tumor.

18th. More comfortable ; no febrile excitement.
19th. Yery comfortable ; no pain ; no pulsation in the tumor ;
removed the bandages and found that the tumor resumed par-
tially its former fullness, but no pulse nor thrill detected by
applying the ear. Some sanious pus discharged from wound
upon pressure ; did not disturb the sutures, but re-applied the
compressing bandage. Bowels to be kept quiet with opiates.

20th. Feels very well ; compresses got off during the night ;
the ligature upon the muscular branch came away ; slight pul-
sation and sound detected in the tumor ; compresses re-applied.
22d. Has had hemorrhage from the nose to-day ; pulsation
still perceptible slightly ; adhesion of wound nearly complete,
but suspecting pus beneath, I removed the quill sutures and
found suppuration pretty free from deep-seated parts.

24th. This morning at 8 o'clock, the patient got out of
bed, and on seating himself for an alvine evacuation, felt some-
thing suddenly " give way," and was immediately deluged with
blood flowing from the wound. He was at once assisted to the
bed and placed upon his abdomen, while pressure was exerted
upon the wound. The bleeding ceased at once. On reaching
him, about half an hour after the accident, and removing the
dressing, no blood issued ; the wound did not gape open, nor
could I see from what point the blood escaped, although the
quantity lost was estimated by his room-mates at from a pint to
a quart. The ligature still in place, with the projecting end
covered with adhesive plaster. Tumor still pulsates feebly.
Covered the wound with a thick compress, firmly bound down
by a many-tailed bandage carried around the pelvis. Bled
again from the nose to-day, showing the hemorrhagic diathesis

1859.] DuGAS, on Aneurism of the Ischiatic Artery. 659

25th. At 4 o'clock P. M.} the wound bled a little. I re-
moved the dressing, but no blood issued. Re-applied compresses.
26th. Finding early in the morning that blood had* been
oozing from the wound all night, I invited several professional
friends to meet me at 9 o'clock A. M., when, on removing
the dressings, the blood gushed out in a torrent. I at once
tore asunder the adherent surfaces, washed out the wound with
a solution of sulphate of zinc, and brought the ischiatic artery
fairly into view. The blood flowed from just above the seat of
ligature. Bits of lint were applied to the bleeding point, and
the wound well packed with them after the manner suggest-
ed by Dr. Mott, so as effectually to arrest the hemorrhage.
The patient being very much exhausted, was then turned upon
the back, and brandy given him. In consultation with the physi-
cians present, it was determined to proceed at once to take up the
common iliac artery. Being indisposed at the time, I requested
my friend Dr. Wm. J. Holt, late Surgeon in the Crimean war,
to perform the operation, which he did. The patient's feeble
state deterred us from using any anaesthetic. He was on the
verge of syncope during the whole time of the operation, and
vomited several times before its completion, although he lost no
blood. The peritoneum was wounded in consequence of his
movements. The artery having been tied, the wound was
closed by quill sutures ; compresses dipped in cold water ap-
plied over the abdomen and ordered to be. kept cool ; brandy
and laudanum was administered ; and the patient allowed to rest.
27th. Passed a comfortless night; took one gr. opium every
five or six hours, with a sufficient quantity of brandy ; but
gulped up continually whatever he took of broth or other drink ;
pulse bad ; temperature of limb normal ; no hemorrhage ; some
tenderness of abdomen ; ordered opium pills, toddy, broth,
iced water, and cold cloths to the abdomen to be continued.

28th. Evidently sinking; pulse feeble and frequent; still
gulps up every thing ; limb warm ; feels relieved of all soreness
and thinks himself better.

29th. Died at 4 o'clock A. M. No post-mortem examination
made.

Since these notes were taken, I have found only one case of
the kind, and it resembles my own so closely, that I cannot re-

660 Dug-AS, on Aneurism of the Ischiatic Artery. [October,

frain from appending it to this report, in the author's own
words. It is contained in the Revue- Clinique) published in
Paris in 1850, under the following caption :

li Aneurism of the Ischiatic Artery Ligation of this Artery. By
M. C. Sappey, Agrege of the Faculty of Medicine of Paris.

u Paul Dudire, mechanic, about fifty -five years of age, and of
good constitution, says that when twelve years of age, he fell
upon the left breech. Moderate pain and little inconvenience
in walking, were all that followed the rccident at first; but
fifteen days later, the patient discovered a tumor about the size
of a small nut, below and internally to the painful region.
The tumor, perfectly indolent, round and without pulsation,
remained so for ten years, without increase. After this, the
tumor grew gradually, and during the interval between twenty-
two and twenty-five years, it attained the size of a hen's egg ;
during this period of growth, pulsation developed itself by de-
grees. At twenty -five years the pulsations were very distinct ;
il very often," says the patient, " I amused myself by feeling
them." Notwithstanding its progress, it remained indolent ;
and if at times it gave pain, it was because the sitting posture
had been too much prolonged.

" Ten years more passed without the tumor making any pro-
gress, or presenting any other phenomena ; the patient continu-
ed 10 walk as before and to work at his trade without difficulty.
At thirty-five years of age, on the 27th of August, 1829, after
being seated for a very long time, he felt a sharp and sudden
pain in the left breech ; the next day the tumor was found to
have doubled in size, and to be about as large as a fist. He
presented himself at the hospital of la Pitie, and was admitted
into the wards of Prof. Laugier, whose duties devolved upon me
during the months of September and October. After having ob-
tained the above history, I made a careful examination of the tumor.

"It was situated upon the inferior border of the gluteus maxi-
mus, on a level with the tuberosity of the ischium, thus render-
ing the sitting posture uncomfortable.*

"Its volume, which was a little less than the fist, could be

* Yet as the tumor was easily pressed to one side, he could, by so doing, be
seated for some length of time without pain.

1859.] DuGAS, on Aneurism of the Ischiatic Artery. G61

partially reduced by a gradual compression. The integraents
over it were red, painful and analogous to those covering a
phlegmonous abscess. The fingers applied to the surface, de-
tected fluctuation, and consequently the existence of a liquid,
which might have led to the belief that it was an acute abscess,
had not the examination revealed at the same time another im^
portant phenomenon, the existence of pulsations synchronous to
those of the arteries.

" These pulsations existed not only at the surface of the tumor,
but also over the whole course of the ischiatic artery. By com-
pressing this vessel immediately below the pyramidalis muscle,
all pulsation ceased in the tumor, but returned as soon as the
pressure was removed.

" By means of the stethoscope, applied immediately to the
tumor, or along the course of the ischiatic artery, an intermit-
tent blowing sound, synchronous with the contractions of the
ventricles, was detected.

"All the phenomena clearlj- indicated the nature of the disease;
it was an aneurism and this aneurism had its origin in the ischi-
atic artery. The latter point of diagnosis might alone be sub-
ject to doubt, yet the seat of the tumor on a level with the tuber-
osity of the ischium, its pulsations extending along the whole
course of the ischiatic and being suspended and reproduced al-
ternately as this artery was compressed, or not, appeared to me
to offer such unequivocal signs that I could not hesitate in de-
termining, which vessel was aneurismal.

" As this aneurism rested upon the tuberosity of the ischium, and
involved an artery of the fourth class, I thought at first of treat-
ing it by compression. With this view, I used the spica band-
age firmly applied, and in order to make this more effectual, I
modified it by carrying the upper half of the figure of eight
over the right shoulder, instead of around the abdomen. This
reduced the size of the tumor but the pulsations persisted, and
at the end of a fortnight no farther improvement being percepti-
ble, I suggested to the patient the more decisive measure of
ligating the aneurismal trunk which was done on the 21st Sep-
tember.

" In order to make the ligature, the patient lying upon the ab-
domen was subjected to the influence of chloroform, and I mada

662 Du GAS, on Aneurism of the IscMatic Artery. [October,

an incision fourteen centimetres in length, parallel with the me-
dian line, and at equal distances from the trochanter major and
the tuberosity of the ischium over the course of the ischiatic
artery. This incision extended successively through the skin,
the subcutaneous cellular and adipose tissues, and the lower
two-thirds of the gluteus maximus, dividing nine or ten mus-
cular arteries, which had to be tied. Beneath the gluteus
maximus, the ischiatic artery was detected by the finger,
which was a great help to me inasmuch as the blood oozed
abundantly from the whole surface of the wound, and con-
cealed the parts from my eye notwithstanding the free use
of the sponge. The artery was tortuous and scarcely larger
than usual. A grooved director being passed beneath the lower
edge of the muscle, parallel with its course, I exposed the ves-
sel so as to be able to compress it between the thumb and index
finger of the left hand. This compression immediately suspend-
ed the pulsations in the tumor, which returned as the compres-
sion was omitted. This experiment repeated several times with
like results, effectually removed every doubt that might have
been entertained as to the real vessel implicated. I then de-
nuded the ischiatic artery and applied to it a silk ligature which
suspended all pulsations.

"In order to unite this long and deep wound, I resorted to the
quill sutures, which could alone approximate the edges in their
entire thickness. Four stitches at equal distances sufficed.
A single dressing was applied, retained by means of the spica
bandage, and the patient put to bed.

uThe night following the operation, the patient had a pretty
smart fever ; was restless, slept but little, perspired freely, but
suffered very little pain. The next day the pulse was not so
strong and less frequent. I deemed it prudent to leave the
dressing undisturbed. On the second day, I proceeded to re-
move the dressing. The pulsations had not returned, the aneu-
rism was notably diminished in size, and the wound seemed
disposed to heal by the first intention. On the third day, I re-
gretted to find that the tumor was the seat of feeble pulsations,
and in order to prevent their return, I added to the force of
compression. The lips of the wound had healed by the first
intention, except at the outlet of the ligatures from which some

1859.] Dugas, on Aneurism of the Ischiatic Artery. 663

pus issued. On the fourth and subsequent days, notwithstand-
ing the strong compression made upon the tumor, its pulsations
became more and more decided and union by the first intention
complete. All the threads came away except that upon the
aneurismal artery, which remained until the eleventh day, at
which time cicatrization was nearly complete, but the tumor
still pulsated, though with less force, and is not so large as it was
before the operation. Compression was continued until the
22d October, but without success. I then abandoned it, and
dreading the progress that this aneurism would unquestionably
make if left to itself, I thought of treating it by the old methodr
that is to say by opening the sac. I communicated this to the
patient, who seemed at first disposed to consent, but business
calling him into the country he left Paris and did not return to
the hospital. Two months after he left I saw him, and learned
from him that the tumor was in the same state, that it gave him
neither pain nor inconvenience, and that he would defer any
farther operation.

"Remarks. No instance of the ligature of the iscliiatic artery
for an aneurism of this vessel, has so far as I know, been re
corded. Experience has therefore furnished us no indications
for the treatment of such a case. On considering the two meth-
ods, that of Anel's ligature and that of opening the sac, I gave
the preference to the former, in accordance with the general
opinion which is in favor of ligating the internal iliac for aneu-
rism of the breech, but this opinion, although perhaps correct,
with regard to aneurisms of the gluteal arteryy now appears to
me altogether erroneous, with regard to those of the ischiatic.
For in as much as the gluteal artery anastomoses with other
vessels of the same class only by capillary ramifications, we
may very well suppose that by obliterating its trunk, the blood
will coagulate in the aneurism and thus effect a cure ; but the
ischiatic artery communicates with several branches of the femo-
ral, and particularly with the internal circumflex and the first
perforating artery by large vessels. In ligating this, therefore,
we should not expect to arrest the ingress of blood in the tumor j
we can only lessen the force of the current within it, but this
will gradually increase until it becomes as great as ever, and
thus render the operation unavailing. The reasons in favor of

664 t)UGAS, on Aneurism of the Iscliiatic Artery. [October,

the method of Anel, although perfectly applicable to the gluteal
artery, are little or not at all so to the ischiatic artery. In order
to ligate this artery by the method of Anel, we have to make
an extensive and deep wound. Is it not more simple at once
to lay open the sac ? We need not apprehend here a great
effusion of blood, as the vessel is small. The incision need
not be more extensive, but would rather be smaller. The dan-
ger of this method would not be greater, and theory indicates
that this operation will be more effectual.

" Conclusion. In aneurisms of the ischiatic artery* we should
prefer opening the sack to operating by the method of Anel."

We have already stated that authorities differ with regard to the
point at which the vessel should be ligated in aneurisms of the
breech ; some advocating the ligature within the pelvis, and others
preferring to place it upon the vessel outside of this cavity.
Within the pelvis we may tie either the primitive or the internal
iliac ; externally, the affected vessel may be reached through the
aneurismal sac, or be tied above this, as advocated by Bouis-
son. In cases in which it is optional with the surgeon to
operate, either within or without the pelvis, it would be diffi-
cult to understand why he should prefer the former locality.
There can assuredly be no comparison as to the relative difficul-
ty and danger of the two methods of treatment. And yet we
find the greatest discrepancy on this question between the
highest French and American authorities. Telpeau thus ex-
presses himself :

" If the obliteration of the hypogastric artery has the advan-
tage of curing irrespectively all aneurisms of the breech, what-
ever may be the artery wounded, its manipulation is, in fact,
so fearful, that we should be fortunate were we enabled to sub-
stitute for it the ligature upon the diseased artery itself. Now
this appears to me practicable where we are treating a diffused
or a circumscribed aneurism, or a traumatic, or a spontaneous
aneurism, so often as the diseased portion of the artery is in the
breech. In fact, the gluteal artery on leaving the pelvis, lies
naked upon the anterior and superior border of the great ischiatic
notch, so that were we obliged to open the tumor before reach-
ing the origin (racine) of the vessel, it would still be a thousand

1859.] DuGAS, on Aneurism of the ischiatic Artery. 6&?

times preferable to the ligature upon the internal iliac artery,
There it would be easy to compress it and to cauterize it, and
close it with the end of the finger. Nothing would prevent us
at first from introducing a conical gum-elastic bougie into the
wounded artery, to arrest the blood and raise up the vessel until
we should pass a ligature around it,"

Dr. Mott thus summarily disposes of the subject :

" Those persons who have suggested the practicability of tying
the trunk of either of those arteries on the cardiac principle,
can never have seen an aneurism in this situation. Like many
other great operators upon paper, they have formed their ideas
in favor of, or against, an operation, merely by the dissection of
the dead body. These are generally the most vindictive and
censorious critics, and the most ignorant and dangerous sur-
geons. It must always be recollected that they predicate their
conclusions as to the practicability of surgical operations on the
living body, by the beautiful delineations of normal structure.
Those who choose to retrograde to the ancient practice of open-
ing the aneurismal sac by an incision a joot or two long, and
reach for the artery at arm's lerigth, in the midst of a gallon or
two of coagulated blood and the gushing and roaring of the vital
torrent, are at liberty to do so if they please.

" For our part, we prefer the more genteel method of tying the
primitive trunk itself v/ithin the pelvis. It is only in all recent
wounds of the region of the trunk of the gluteal or ischiatic
arteries, that we should use all commendable industry and care
in endeavoring to secure and tie the bleeding vessel, or to com-
mand the hemorrhage by the mode we have already pointed
out, with small pieces of sponge and pressure."

With due deference to the very distinguished author, we
must regard Joh-n Bell's celebrated case, to which the italicized
allusion refers, as a striking illustration of the advantage of the
external operation even under the most unpromising circum-
stances. His example has moreover been followed by many
others since, and with very general success.-

With the lights before me, I think the question narrowed
down to the two modes of reaching the artery after its emergence
from the pelvis. In all cases of aneurism of the breech, wheth-
er of the gluteal or the ischiatic artery, consequent upon a me-

668 HOWARD. Cases of Placenta Prazvia, [October,

the relative expansion of the cervix uteri and growth of pla-
centa. Indeed, I have not so observed it ; but even if it be the
fact, yet I doubt not the placenta grows proportionately with
the uterine expansion. Is not the absence of a support at the
os uteri more probably the cause ? the placenta laying over a
foramen. True, uterine contractions will effect detachments}
but I speak of hemorrhage without such contractions.

Sept. 26th. Called to see a negress, aged 30- borne several
children. Found that she had three hours previous to my ar-
rival, been delivered of a dead foetus ; and was shown foetus
and placenta in the relation they were expelled, as a reliable
old negress stated. The placenta was on and around the left
shoulder. Two thirds of the mass had evidently been very
much compressed, and I doubted not that this had been done
by the head in its passage, and the shoulder following, had
brought it with it. No hemorrhage during the labor, or for
months previous. But in the first few months of this pregnancy r
I had repeatedly prescribed on account of hemorrhage. Suspect-
ing the nature of the case, and by my advice, her owner, who re-
sides in this village, brought her here to have her nearer at hand;
but getting, weary of her, sent her back to his plantation. Anoth-
er peculiarity of this case, consisted in the insertion of the cord
into the chorion, nearly equidistant from the placenta. The ves-
sels of the cord bifurcated several times before reaching the placen-
tal mass. I have never observed this distribution of the cord,
but once besides the above, and that was on the fourth day of
same month.

Arriving at the bedside of a negress who had near an hour
previously, been delivered of a dead child, and seeing no cause
for its death ; and finding that in pulling on the cord in re-
moving the placenta, the membranes followed the cord, I ex-
amined it enough to induce me to take it home when, with
Drs. D. and 0., found the insertion in the chorion, nearly equi-
distant from the placenta. There was but one artery. It did
not bifurcate before reaching the placenta ; but the vein did
once or twice. The perforations of the membranes by the foetus
was at considerable distance from the placenta, though the ves-
sels did not appear to be injured from that cause. In the other
case, some of the vessels were thus lacerated. In this- case I
douited not that the death of the child was owing to the com-

1859.] Howard. Cases of Placenta Prazvia. 669

pression of the vessels ; for their relation must have been equi-
valent to a presentation of the cord.

Here I desire to dissent from those who consider the perfora-
tion in the membranes made by the foetus, as any reliable index
whatever to the distance the placenta was placed from the os
uteri. For it is evident that the point of perforation will de-
pend very much upon the period in the labor, at which the
membranes are ruptured.

November. Galled in consultation to see Mrs. , aged

about twenty -six good form and size had borne two children.
She was thought to be within a few weeks of her full time, had
had hemorrhage some days previously, and at different times.
But little weakened however, by loss of blood. We gave opi-
ates, astringents, &c, and thus the case progressed two or three
days. Finally the hemorrhage became alarming from its con-
tinuance, amount and effect. The pulse preternaturally fre-
quent and feeble surface cool and blanched sighing and it
became evident that delivery must be accomplished speedily.
Passed the right hand up, on the left side of the uterus, by the pla-
centa ruptured the membranes seized a foot, the breech being
in apposition with the placenta, brought it down, and without
any increase of hemorrhage whatever, accomplished delivery in
twenty or thirty minutes. In such a case as this last was, the
position of the child might be fully ascertained before rupturing
the membranes.

From what I have seen or know of placenta praevia, I would
not entertain the thought of passing the hand through the pla-
centa. I would prefer, as in the above case, to pass up by it
deliver the child, and then the placenta. But in central cases, or
those in which the hand had been passed on that side on which
the placenta chiefly lay, I can conceive that the delivery of the
placenta first, would be unavoidable. Still my effort should be
to secure the promptest expulsion of the child.

It will be observed in four of these cases, the breech was in
apposition with the placenta. Did the location of the placenta
contribute in determining the position of the fcetus ?

Medical men do not snatch their patients out of the jaws of
death, as frequently as many persons suppose, "by upwards of
a good deal." Yet I fear I have lost cases when others could

670 Farell. Tannin in Large Doses. [October,

have saved them ; for no medical man should raise for himself
a lower standard than the accomplishment of the best that
could be done. And if he be an idler, let him not soothe his
conscience with the " flattering emotion" that he has done the
best which he could do, under the existing circumstances. But
while I do not reflect upon the first case reported, with much
complacency, this last elevates our noble profession in my esti-
mation. And as we cannot tell when such cases may fall into
our hands, I trust this report will, at least, induce the reader
whether long or recently in the profession, to propound to his
mind and conscience the question of preparation for them.

ARTICLE XXIV.

Tannin in Large Doses in Albuminous Anasarca. (Translated
from the Journal de Medecine et de Chirurgie Pratiques,
for the Southern Medical and SurgicalJournal,) by William
Farell, M. D., of Eome, Georgia.

Pure tannin, tannic, or gallic acid, such as is obtained by the
process of M. Pelouze, has been but little employed in France,
in large doses ; but in Germany, England and Portugal,
MM. Liebert, Lees, Frerichs, Scott, Allison, Burns, of Glascow,
W. Bayes, and Barral, have prescribed it with success in doses
of two to six grammes, (30 to 90 grains nearly,) in the treat-
ment of albuminuria, diabetes, haemoptysis, hemorrhage, chloro-
sis, certain cases of morbid secretions, general debility, &c.

These facts prompted Dr. P. Gamier, a practitioner of Paris,
to experiment with this agent in the treatment of albuminous
anasarca, so frequently met with, and so often rebellious to the
ordinary means. M. Gamier has published some of his obser-
vations in the Archives General de Medecine, from which it
would appear, that the morbid phenomena, having the common
character of more or less general infiltration of the cellular tis-
sue, with albuminous urine, have rapidly and simultaneously
disappeared, under the influence of tannin in large doses.

The first of these observations relates to a little boy of
three years, who, during the desquamating period of an attack

1859.] Farell. Tannin in Larye Doses. 671

of scarlatina, suddenly presented an enormously bloated condi-
tion of the face, hands and feet, with tumid abdomen, and ab-
sence of urine during the night. Calomel, jalap, mall pellitory,
nitrate of potassa, &c, were successively and repeatedly given,
while the general infiltration increased until the patient could
not rest on his seat. The skin became tense, shining, translu-
ent, and apparently ready to burst ; the penis was twisted upon
itself and hid in the scrotum, and urine was charged with albu-
men. Convulsions soon supervened, which caused the dropsi-
cal effusion to yield slightly under their violent action ; but it
soon augmented anew, notwithstanding the use of the decoction
of horse-radish, Dover's powder, tartrate of potassa, &c. M.
Gamier, in despair, thought of tannin, and prescribed the fol-
lowing solution :

Tannin " 2 grms. " (About grs. xxxj.)

Distilled water

Syrup of cinchona " aa 30 grms. " (Say aa f I j.)

The patient took a spoonful of this solution three times per
day, continuing the tonic regimen, pursued for the last eight
days.

This treatment was commenced on the 12th of January,
(1859.) On the 14th, the most abundant diuresis came on ; the
urine flowed so frequently and copiously, that the constant use
of a urinal became necessary. The tumidness greatly diminish-
ed. The solution was regularly continued up to the 18th of
February ; the child having taken as much as five grammes
(77 grains nearly) of tannin in six days.

Under this treatment the appetite was developed, constipation
relieved, and diuresis and transpiration well established, with-
out other medical interference. On the 20th of February, the
cure was complete.

After these important facts in his own practice, M. Gamier
alludes to similar ones in the practice of foreign physicians.

He cites the case of a young woman, treated by M. Sampson
for anasarca, complicated with " chloro-anemie." Her urine
contained albumen and sanguineous globules.

This patient took three doses of fifty centigrammes of gallic
acid per day, (7 J grains nearly per dose, or about 23 grains per

672 Gaston, on Counter- Extension, [October,

day,) and at the end of a week after, she was entirely relieved
of the oedema, and not a trace of the abnormal modification of
the urine remained.

We also notice, in this memoir, the case of a man, who la-
bored under anasarca and albuminuria, for which diuretics and
purgatives were freely used without effect. Professor Barral
prescribed the following pills for him:

Tannin " 30 centigr. " (About 4| grains.)

Gum Arabic " 4 grms. " (Say i drachm.)
Syrup " q. s.

Make one dozen pills.

The patient took three of these pills the first day, six the
second, and nine the third, and so on. On the fourth day, the
oedema was sensibly diminished and the urine flowed copiously.
On the tenth day the cure was nearly complete. A few days
later, Bland's pills were substituted for those of tannin. In
this case, six grammes (about 92 \ grains) of this acid proved
sufficient to relieve the infiltration.

Tannin affords more advantages in draught, than in pills, but
as the tannic solution becomes decomposed and altered after a
few days, M. Bayes prefers the pillular form. It is necessary,
however, when the pills are used, to administer them at meal-
time, unless the patient be allowed to drink freely immediately
after taking them. M. Gamier usually prescribes it in solution,
in his practice, using mucilage as a vehicle to mask its disa-
greeable taste.

Counter- Extension with Adhesive Plaster. By J. McF. GASTON,
M. D., Columbia, S. C.

The use of adhesive plaster for the purpose of extension, is
generally and favorably known to the profession, but its appli-
cation as a measure of counter-extension requires to be brought
more fully to the attention of practitioners, and a case of frac-
ture of the femur, which has been treated chiefly by this pro-
cess, may serve to illustrate this procedure.

Rufus, a servant of Mr. John Davis, was placed under our
care on June 16th, and upon a special examination with my
partner, Dr. A. N. Talley, a comminuted fracture of the lower

1859.] Gaston, on Counter- Extension. 67#

third of the shaft of the femur was discovered. With the assist-,
ance of two of our studentsf extension was effected, and after co-
aptation of the fragments, the roller bandage was applied to the
entire limb. Three splints were next fitted to the thigh, and
Welch's long extension apparatus was then adjusted by a gai-
ter, to secure the ankle to the foot-board beneath, and a sTlk
handkerchief wrapped around a roll of cotton as a perineal
bandage, tied firmly to the upper end of the long splint above
the crest of the ilium. By means of a screw connected with the
apparatus, extension was now made, until the measurement
from the anterior spinous process of the ilium to the internal
malleolus was found to correspond to that of the sound limb.

The muscular development of the thigh afforded great resist-
ance, yet the extension was steadily maintained for a week,,
when there was such excoriation from the perineal bandage, as
to induce a discontinuance of this mode of counter-extension,
for the application of adhesive plaster, on the principle, but not
precisely in the form, suggested by Dr. Gilbert of Philadel-
phia.

A strip of strong linen plaster, two inches wide,- and two feet
in length, was doubled upon itself at an angle, so as to make a
loop, and yet both of the extremities having their adhering sur-
faces in the same direction. One of the free ends was pasted
closely over the spinous process of the ileum, and extended
down towards the inguinal region ; while the other end was
carried down and pasted over the trochanter, so that both
pieces had firm attachments, by the closeness of the integument to
these bony prominences, and thus presented resistance to traction
upon the loop above. Transverse strips were placed from one
piece to the other, to secure their adhesion. A piece of home-
spun was now passed through this loop and made fast to the'
upper end of the long splint, thus effecting counter-extension.
When the apparatus was tightened by the screw, it was found
that all the indications were met satisfactorily, while the excori-
ated hip and the perineum were left entirely free for such appli-
cations as the ulceration required. The strips adhered closely
for three weeks without interference, and have proven an effi-
cient means of counter-extension.

Those who may be interested in this subject, will find a well
written article on the adaptation of adhesive plasters to counter-
extension, by Dr. D. Gilbert, in the April number of the
American Journal of Medical Sciences, in which he details his
mode of application and the principles involved in their use ;
while other articles from his pen may be found in the numbers
for January 1851 and 1858, in the same journal.

The only particular in which my proceeding is entitled to any
superiorty over the process of Dr Gilbert is, that it makes the

674 Gaston, on Counter -Extension. [October,

attachment of the strips extend over the firm unyielding points
of bone, and thus serve, perhaps, to give a more fixed resistance
to the force of extension. But while this is original with me, I
prefer no claim which shall lessen the appreciation of the emi-
nent service which has been rendered to the profession by the
elaborate articles above referred to, and I trust that all may
profit by their perusal, and cease to punish the subject of frac-
ture with the excoriations of a perineal bandage.

In connection with this application of adhesive plaster, I
would notice its use also in a case of fracture of the patella,
which occurred in our practice recently. Being called on Feb.
7th, of this year, to a servant of Mr. Robert Bryce, Dr. Talley
and I went together, and found a transverse fracture of the pa-
tella, with the upper fragment drawn up considerably by the
contraction of the muscles. Bringing the fragments in apposi-
tion, a figure of eight bandage was first applied, but subse-
quently, at the suggestion of my brother, Dr. J. B. Gaston, of
Montgomery, Alabama, we resorted to the use of adhesive
strips, to keep the fragments in apposition. Three pieces of
plaster, an inch wide and twelve inches long, were carried from
above the knee round the inner side of the patella to the upper
and inner part of the leg ; while three other similar pieces were
carried from above the knee around the outer side of the patel-
la, to the upper and outer portions of the leg, thus keeping
down the upper fragment of bone securely. Another set of
strips were attached in a semi-circular arrangement around the
lower fragment, by which accurate apposition of the fragments
was effectually maintained. This plan of treatment is attribut-
ed to Dr. Neill, and Erichson makes reference to it in his work
on Surgery. Our case progressed favorably, and though the
union is not osseous, the connecting layer of cartilage is perhaps
shorter and firmer than is usual in this accident, and does not
interfere at all with locomotion.

In a fracture of a similar kind, which I treated some years
ago, the case was managed throughout by the figure of eight
bandages, with a good result as to the union of the fragments ;
but I had to keep the entire leg and thigh encircled with a
roller, the latter to control the action of the muscles, and the
former to suppress the swelling which would have ensued from
the obstruction to blood vessels and absorbents at the knee.
This difficulty is entirely obviated in using the adhesive plaster,
as it extends only partially around the limb, and leaving that
region free where most of the vessels are located. And the
same views hold in reference to their application to the upper
arid outer part of the thigh, instead of extending round the
inner part, where the vessels and nerves are located.

Enough has been said to indicate the advantages of the ad-

1859.] Treatment of Puerperal Convulsions. 675

hesive strips in this class of cases, but at a future day I propose
to give my personal experience in the treatment of inflamma-
tion by the compression of adhesive plasters. [Charleston Med.
Journal and Review.

Puerperal Convulsions Successfully Treated by Croton Oil Suppo-
sitories. Letter from Mr. Overton.

Puerperal convulsions are usually so alarmingly dangerous, and
cause so much anxiety, both to relatives and friends ay, and to
the medical attendant, at the same time and are often so rebel-
lious to all treatment, that I trust you will deem the two following
cases, extracted from my note-book, worthy of insertion in your
columns.

Case 1. Mrs. R., aged twenty-four, married about two years.
A miscarriage took place six months after marriage, when she
suffered considerably from nervous excitement, which, however,
soon yielded to appropriate treatment. She was again pregnant
in September, 1858, and enjoyed good health till February, 1859,
when I received a summons to visit her immediately. J found
her suffering from general anasarca, with excruciating pain in the
head, restlessness, vomiting, and febrile symptoms. Upon the
whole, I did not like the appearance of those symptoms. I pre-
scribed saline aperients, with alteratives, etc. ; cold applications to
the head. The symptoms did not yield to this treatment : con-
stipation gave some trouble.

March 15. I was again sent for in great haste; the husband
stating that his wife was in a fit, and all feared she was dying.
I was soon with her, and found her suffering from epileptiform
puerperal convulsions, frothy blood issuing from her mouth, and
there were clonic spasms present. I at once abstracted blood
from the arm, to about thirty ounces, put six to eight grains of
calomel on her tongue, administered an enema of senna, etc., and
applied a blister to the nape of the neck. These, combined with
cold applications, produced little or no other effect than that of
mitigating the acute pain in the head, between the convulsive
paroxysms, which paroxysms became frequent. The patient
having had no relief from the bowels, I deemed it advisable to
mix six drops of croton oil with lard, in the form of a suppository,
and so use it. This produced tenesmus, with a sense of smarting,
burning heat in the lower bowel ; but relief followed, and a copi-
ous watery evacuation almost immediately ensued. The patient
had no more convulsions. Upon examination, I found no signs
of on-coming labor, nor did the slightest chance of producing it
present itself.

16th. On my visit this morning, I found Mrs. E. calm, and

n. s. vol. xv. no. x. 48

676 Treatment of Puerperal Convulsions. [October,

free from convulsive symptoms ; the anasarca had disappeared ;
micturition normal ; bowels relieved (largely) four times ; os uteri
in the same state as before,

17th. I found her dressed, and sitting by the fire in a lower room.,
24th. J was again sent for; and this time I found her in labor,
the os uteri fully dilated, and the head presenting. Fearing a re-
currence of the convulsions, I turned the child, and delivered her
of a still-born, putrid child.

25th. I found her quiet and comfortable, she had passed a
good night, and from that period she went on well without one
unfavorable symptom.

Case 2. Puerperal Convulsions ; recovery ; subsequent death
from swallowing a row of front false teeth. February 18. Anna F.,
aged twenty-two, a country servant, primipara, unmarried, six
months advanced in pregnancy. The man to whom she was en-
gaged to be married left the neighborhood, and married another
woman. This event produced great despondency, and on her
way home to see her mother, she was seized with convulsions
about every ten minutes. At this time she lost four front teeth,
fixed on a silver plate ; they could not be found. She had swal-
lowed them. I was sent for, and found her suffering from puerpe-
ral convulsions. Blood issued from her mouth ; the tongue bitten
severely ; clonic spasms ; head cool ; pulse small and compressi-
ble ; micturition scanty ; bowels not open. Upon examination
I found the os uteri high up in the pelvis contracted. I introdu-
ced the catheter, and some urine came away. I then administer-
ed an enema of castor oil and ol. terebinth, and put 10 grs. of
calomel on her tongue. I waited two hours ; but no amendment
was perceptible. I now ordered 8 drops of croton oil to be rub-
bed into some cerate, and so passed into the rectum. In a few
minutes, she complained of great tenesmus and smarting pain in
the bowels. Twelve large watery evacuations followed. No
more convulsions. I enjoined perfect quiet, and left her.

19th. Found her better in every respect. No return of con-
vulsions ; she complained only of some soreness in the throat ;
but there was no dyspnoea.

20th. I was sent for in the night ; natural labor was going
rapidly on ; a large quantity of liq. amnii was discharged, and in
a short time she gave birth to a dead child.

21st. A good night ; no pain in the head ; lochia natural ;
urine had been passed ; pulse good ; tongue moist, but injured
during the convulsions. All went on remarkably well till the tenth
day, when, as she was sitting up in the bed drinking a cup of tea,
and talking cheerfully with her mother, she suddenly called for a
basin ; vomited a large quantity of blood, sank back on her pillow,
and expired.

1859.] Anthelmintics u nto/Ten

The cause of death was evidently from the false teeth, or some
portion of the metallic fastening, having penetrated some 1
vessel. No post-mortem inspection could be obtained. [Med.
Times and Gazette.

Relative Value of Different - rhe Treatment of T

Bv Dr. Peacock, Assistant Physician to St. Thomas's Hospi-
tal.

The following is a brief summary of a series of cases in which
different anthelmintics had been employed against tapeworm.
The patients were all treated by Dr. Peacock, in the out-patients'
department at St. Thomas's Hospital, and we are indebted to
him for access to the detailed notes upon which the statements
are founded :

As a general result of his experience both in public and private,
Dr. Peacock states that he gives preference to the oil of male fern
before all other remedies, and that he holds the kousso in very
light estimation indeed. It appears that of the hospital cases re-
specting which notes have been preserved, the fern oil was given in
thirty-five. Ofthese, in sixteen no other remedy had been previous-
ly tried, and in this <iroup the result was always satisfactory, the
animal being expelled in a dead or dyincr state. In seven cases the
oil was given after the partially successful use of kousso, and in
all these more of the worm was brought away. In three, after
partial success by pomegranate bark, the oil brought away other
portions of the parasite, and in one a like result was obtained
after the use of the turpentine draught. In six cases in which
the oil was used, either the result was not satisfactory, or the
patient did not attend again. The dose of the oil given was from
half a drachm to a drachm and a half to children, and from a
drachm to three drachms to adults

The cases in which the kameela was driven are seven. In five of
these no other remedy has been previously tried, and in all these
portions of worm (generally quite alive) were expelled. In one
the expulsion of worm was caused after kousso had been tried
without effect, and in the fifth, which was under similar circum-
stances, a like negative result followed its use also. In t
after the successful employment of the kameela. the oil of fern was
employed without procuring the expulsion of any more of the

* We are informed that great care
in order to avoid disappointment in tl I solu-

tion, which is by far
ciple. A prolonged shaki: _

r pay more than usu
get a dose which is but little more than etl

678 Anthelmintics in the Treatment of Tenia. [October,

worm. The dose of kameela prescribed was from half a drachm
to a drachm for children, and from one to three drachms to adults.

It would from the above facts appear that kameela is more
efficient than kousso, but that it must rank as a vermifuge rather
than a true vermicide. After the fern oil the animal is usual-
ly voided dead. An important statement with regard to the com-
parative value of kameela, is made by Mr. Henry Callaway for-
merly of Finsbury Circus, but now a medical missionary amongst
the Zulus, The kameela is the native remedy among the abori-
gines ; but, in a letter to the ' Pharmaceutical Journal,' Mr. Cal-
laway states, that from experience they have learned already to
put much more confidence in " the white man's dose." The
latter consisted of turpentine and castor oil, the time-honored
remedy among ourselves. We are not able, from Dr. Peacock's
cases, to institute any comparison between turpentine and fern
oil, and can only state that we believe he is supported by several
other hospital physicians who have given much attention to this
matter, in maintaining that the latter ought to stand facial prin-
ceps among our anthelmintic drugs.

As regards the economics of the question, which are important
in hospital and union practice, it will, of course, be easily granted
that, all things considered, the most efficient remedy will probably
in the end prove the cheapest. A dose of castor oil and turpen-
tine, undoubtedly, costs far less than any of the others. Next to
it comes the kousso, which has as rapidly fallen in price as it has
in general estimation. The kameela is, as yet, rather expensive,
though not nearly so much so as the fern oil. A full dose of the
last costs eightpence, of the kameela about fourpence, of the kousso
threepence, and of the turpentine and castor oil not more than
three-halfpence.

Kuchenmeister, in his 'Manual on Parasites,' (Sydenham So-
ciety's edition,) writes of the oil of turpentine as follows : " As has-
already been remarked, the touchstone of a remedy for tapeworm
is not whether it expels bothriocephalus latus or taenia solium, but
whether it is also capable of effecting this with t. medio-canellata*
That oil of turpentine is efficacious in the latter case I can prove
at any time ; for the finest specimen of taenia med. that I ever saw
was expelled by it. In general also it acts pretty rapidly. Lastly,
it has also the advantage that it expels the worm entire." Of the
kousso he writes, " For my part I have always been more or less
unlucky with this remedy. , . . I have generally seen the
worm expelled in innumerable fragments. ... I have never
found the head. In one case I detected fragments in the evacua-
tions for three months." Professor Martins, of Erlangen, who
also has used kousso largely, never saw the head brought away.
Of the male fern, Kuchenmeister states ; " This remedy, which
will always maintain its renown against the hothriocephalir appears

1859.] South American Arrow Poison. 679

hardly to maintain its reputation with regard to taenia. The
kameela he had not tried.

Of the desirability of having: the intestinal canal as empty as
maybe before giving anthelmintics, nrtost practitioners are aware.
To administer them fasting in the morning is usually thought
sufficient ; but in cases where difficulty has been encountered in
destroying the animal it may be well, as an introductory measure,
to give a sharp purgative. [Ibid.

South American Arrow Poison. Bv Wm. D. Hammond, M. D.,
U. S. A., and S. W. Mitchell, M. D.

The following is a brief resume of a long paper which appeared
in the American Journal of the Medical Sciences for July, 1859,
upon carroval and vao, two new varieties of woorara, or curare,
as it is termed in France. The authors preface their own obser-
vations with an elaborate history of woorara, and of the chemical
and physiological labors already bestowed upon it by Rolliker,
Bernard, Pelikan, Velpeau, Brodie, etc. They then proceed
to describe the physical characters, chemistry, physiological re-
lations, and toxic peculiarities of the two new, or hitherto un-
known varieties of woorara which have fallen into their hands.
They thus examine separately the two substances carroval and
vao, and state in detail the reasons which induced them to consid-
er vao as but a weaker carroval : or else, if we comprehend them
aright, as bearing to carroval some such relation as brucia bears
to strychnia, or cinchonia to quinia.

Both poisons yielded, to appearance, one and the same essen-
tial principle, a new alkaloid, which the authors have termed car-
rovalia. This substance, whether from vao or carroval, was of a
deadly potency; since, however, the authors explain that their
supply of the poison was not sufficient to enable them to complete
the chemistry of the subject, we shall await some further develop-
ments in regard to the tests for the new alkaloid. Although the
two poisons were studied separately, it is unnecessary here to
view them apart, since it has been shown that the chief dissimi-
larity is one of degree, and not of kind.

The new woorara, then, according to Drs. Hammond and
Mitchell differs remarkab.; from that long known to the toxicolo-
gists of Europe. Thus the woorara of our authors kills by par-
alyzing the heart ; while the other, or European woorara, des-
troys by paralyzing the nerves of motion throughout the body.
This singular difference completely isolates the carroval and vao
poisons from all other woorara hitherto examined, and approxi-
mates them in character to the upas poison, so ably investigated

680 South American Arrow Poison. [October,

by Professor Rolliker, whose toxicological labors are as yet little
known or appreciated in this country.

We refer to the following " conclusions," as setting forth what
the authors conceive themselves to have proved in regard to these
poisons, premising that as they seem to have been finally of opin-
ion that carroval and vao are nearly allied, if not identical, we
have thought it unnecessary to copy both sets of conclusions.
We have appended to each conclusion, in brief form, a statement
of the proofs in favor of the proposition set forth.

1. Carroval and vao are capable of being absorbed from the
areolar tissues, and from the stomach of warm and cold-blooded
animals. When given by the stomach, both poisons are more
apt to cause convulsions than under other circumstances. The
larger part of the absorption experiments were made with vao
only. From these it was ascertained, say our authors, that it(vao)
is also absorbed by the stomach, oesophageal canal, rectum, and
skin of cold-blooded animals, (frogs,) with a degree of rapidity
which varies ; and is rapid or slow as the animal is ill or well sup-
plied with water.

Warm-blooded animals absorb vao from the stomach and in-
testines when they are fasting, but suffer no ill effects when the
vao is given during digestion. That this protection is not due
to a mere mixture of the vao with the food of the full stomach,
is shown by the fact that rabbits, whose stomachs are always
more or less distended with food, are protected only when, owing
to the entry of fresh food, digestion becomes active.

Both carroval and vao arrested the heart's action. This was
shown by exposing the hearts of frogs, and then inserting the
poisons under the skin, when the heart began to beat more
strongly, then became paralyzed in parts, and finally stopped,
and was found to be so dead, that in most cases no galvanic or
other stimulus could induce a single pulsation. After this, the
frogs thus poisoned leapt about until the cessation of the circula-
tion produced its usual effect, in paralyzing first the sensitive and
then the motor nerves. These secondary effects our authors have
shown to follow any arrest of circulation in the frog. Thus,
when the heart was tied, sensation and motion disappeared in an
hour, even when no poison was given. Both carroval and vao
were found to arrest very early the motion of the lymph hearts,
and both of them undoubtedly lessened the duration of muscular
irritability ; while the ordinary woorara either does not effect it,
or, according to Bernard, lengthens its duration.

When these poisons are administered to warm-blooded animals,
death usually occurs without convulsions, except in the cat,
where they nearly always are seen. In animals of this class, the
arrested circulation stops the aeration of the blood, so that the
checked respiration is to be looked upon as a consequence and

1859.] A New Poison from Ote Interior of China. 681

not a cause of the injury to the cardiac functions. This was also
illustrated in the case of the alligator, whose respiration contin-
ued long after the heart had ceased to move. It was also found
that artificial respiration was of no value as a means of relief, as
might have been suspected from the fact that the poisons destroy-
ed the muscular irritability of the heart.

The authors were unable to discover that these poisons altered
the blood, or affected the ciliary movements. They are of the
opinion that the varieties of arrow-poison examined by them are
of a purely vegetable origin, and contains no trace of the venom
of serpents. [North American Med. Chir. Review.

On a New Poison from the Interior of China. By Robert Chris-
tisox, M. D., Professor of Materia Medica in the University
of Edinburg.

About eighteen months ago I received from China a copy of a
newspaper printed at Shanghai, giving an account of a formida-
ble poison, said to be used far west in the interior of the country,
for killing game and in warfare.

According to this account, springs had been invented for using
it against the British invaders ; and as these had been found to
answer against goats, much was expected from its aid at Canton.
But, unluckily, the sudden peace nipped the scheme in the bud.
That the poison might have been employed with deadly effect is
very probable, if only one-half of what was said of it be true ; for
the account in the Northern China Journal, (April 4, 1857,) re-
presents it to be so virulent that " instant death is inevitable from
the slightest abrasion" by an arrow tipped with it. The opera-
tor, who prepares it in the shape of an extract, goes on concen-
trating and strengthening it until a small animal, whose skin is
punctured with it, dies instantaneously : not until then, it seems,
does he cease to boil down his extract. In the mountainous re-
gions of Chihkiang large game is killed by means of arrows whose
neck is encircled by the poison. Even tigers are killed in this
way by the Funghwa hunters. Should a limb be struck, the
beast writhes awhile before expiring ; but should the arrow " hit
the body, he leaps forward, staggers, and immediately falls down
dead."

This is marvelous enough. But it is also said to be of a singu-
larly volatile or progressing nature. For if the poison " be ap-
plied to blood trickling from a little wound, even though only to
the lower end of the stream, the blood is rapidly blackened along
its whole length ; and if the stream be continuous with the wound,
the subtile poison will enter, and occasion death."

This poison is the extract of a root called Tsau-wu ; and the

682 A New Poison from the Interior of China. [October,

plant is represented to be a perennial creeper inhabiting the cen-
tral provinces of the Chinese Empire. It is added that the extract,
is sometimes applied, as a practical joke, to the tongue of the un.
wary, " in whom it excites a keen sense of formication."

In the beginning of January last, I received specimens relative
to this extraordinary poison from Dr. D. J. Macgowan, an Ameri-
can physician, residing at Ningpo. The specimens included not
only the poison itself, but likewise some leaves and roots of the
plant which yields it. The materials are scanty ; yet they are
sufficient to enable me to ascertain the source of the poison pretty
nearly.

The leaves present characters common to several plants of the
Ranuculaceous family. Only one of the roots, which are but
four in number, is entire ; but even the structure of this alone,
taken along with its singular impression on the organs of taste, is
sufficient to prove that the plant is a species of Aconitum, or
Monkshood. All the species of Aconitum that I have examined
spread by roots in the following manner, of which the A. Napellus
may be taken for an example. During winter there is nothing
to be seen but an under-ground tuber, tap-shaped in all the poison-
ous species, with rootlets from the lower extremity, and an inci-
pient leafy bud at the crown. Early in the spring bud begins
to shoot out into the future stem, which attains its full stature
toward the close of summer, or a little later. During its progress,
early in summer, a little knot forms near where the crown and
stem meet ; and from this is gradually produced a new tuber
exactly like the primary one, parallel to it and connected with it
by a small band. Near the close of autumn, when the seeds of
the plant are mostly ripe, both tubers seem equally vigorous, and
of equal size ; but the new one is firm, and continues plump on
being dried, while the old one is more watery, shrivels much in
drying, and, in fact, soon rots and disappears in the ground, leav-
ing the new tuber to perpetuate the plant next season. Now, one
of the Chinese roots shows a portion of the stem, with its tap-
shaped, somewhat shriveled tuber at the bottom ; and, attached
to the crown of this tuber, a plump, firm, tough tap-shaped tuber
of the same size. No one familiar with the Aconites can fail to re-
cognize in this Chinese specimen a miniature representation of the
root of the A. Napellus of Europe, and A. Ferox of the Himalayas.

The likeness is maintained in the very singular impression pro-
duced by this root upon the organs of taste. A little bit, no big-
ger than a pin's head, carefully chewed, while it is held in one
spot between the tip of the tongue and the lips, produces intense-
ly that strange combination of numbness and tingling which char-
acterizes so remarkably all tbe poisonous species of the known
Aconites. It is an impression so peculiar, that I do not know any
plant, not an Aconite, which produces a sensation like it, except

1859.] A Xew Poison from the Interior of China. 683

the Delphinium Staphysagria, or Stavesacre, another plant of
the Banunculacece, which, with its whole genus, presents close
natural resemblances to the Monkshoods.

I have no doubt, therefore, that the Tsau-wii. or Wii-tsau, for
the name is variously given by my informant in his letters and in
the labels, is the root of a Monkshood. It is probably a new
species; for, though like a diminutive A. Napellus, it is much
whiter and more amylaceous in its interior, and yet evidently,
from its taste, much more active. It is by much the smallest
aconite root of the poisonous species; for the whole tuber is scarce-
ly an inch long, and delicate in its structure.

It only remains to be seen whether the poison is really prepar-
ed from this root. The extract sent to me is still soft, and evi-
dently made with great care and skill. The most minute portion
causes in the tongue and lips precisely the same impression as
the Wu-tsau root, but with extraordinary intensity. The Wu-
tsau is in it therefore ; and nothing more is wanted to make a
most virulent and efficacious arrow-poison.

I must here enter my protest, however, against some of the
statements which have been made to Dr. Macgowan by his Chi-
nese informants, as to the action of this extraordinary poison and,
indeed, against the facility of belief among travellers generally
respecting the effects of arrow-poisons used by barbarous and
semi-barbarous tribes of men. The Wu-tsau cannot by any pos-
sibility travel up a stream of blood, against the current, and into
a blood-vessel. It cannot cause instant death in any animal.
No arrow-poison can cause instant death. All poisons which act
through a wound must take a little time to act*, because they act
through absorption into the blood upon distant parts the brain,
the spine, or the heart ; and a solid poison cannot thus reach its
destination in snfficient quantity all in a moment, even though
the arrow pierce a blood-vessel.

It is possible to account for the frequent error of travellers as
to the alleged instantaneousness of the action of arrow-poisons.
The lapse of time is, in the first instance, apt to be overlooked or
understated. But, further, if such formidable poisoned arrows as
those used by the negroes of the Upper Gambia, or the Macusi
tribe at the sources of the Essequebo, be struck into the trunk of
even a large animal by means of their strong bows, the arrow may
quite well reach a vital part, and thus arrest motion at least, if
not occasion very speedy death, merely as an arrow, by mechani-
cal violence. Small animals and birds may be thus brought down
suddenly even by the little wooden darts shot through blowing-
tubes by the Macusi natives of the Essequebo, as well as other
wild tribes. The Macusis use the deadly Uraii* poison. But

* Generally corrupted by English writers into WburalL and by the French
into Curare. Schomburgk, the best authority, saya that the Macusis who make
it call it invariably Urari.

681 Sulphate of Copper and Opium in Diarrhoea. [October,

the dart may kill as an arrow quite as well as through means of
the poison, should it hit the trunk of a small animal ; for its force
is surprisingly great. With very little practice, I can blow the
little light, wooden dart 180 feet; strike it at 60 feet so firm-
ly into a board that it cannot be removed unbroken ; and trans-
fix with it, at a short distance, a fir board a fourth of an inch in
thickness, or thirty folds of cartridge-paper.

I will also venture to take exception to the frequent propensity
of travellers and others to magnify savage skill in the manufacture
of such poisons, at the expense of civilized ingenuity. The Urari
of the Essequebo, the Upo or Upas of Java and Borneo, the Wu-
tsau of China, are potent poisons, no doubt. But in potency they
never will stand comparison with several of the pure principles
which the chemistry of civilized nations has detached from poison-
ous vegetables. Any tribe of men, compelled by circumstances
to obtain their food by shooting game with poisoned arrows,
would profit greatly could they substitute digitaline, aconitina,
conia, strychnia, and other pure principles of plants, for their own
cruder extractiform poisons. These principles, indeed, might be
so used as to deal destruction to the very largest animals on the
face of the globe. [Edinburgh Med. Journal, and North Amer.
Med. Chir. Review.

Use of Sulphate of Copper and Opium in Diarrhaza, occasioned by
Dentition. By Dr. Eisenmann, of Wurzburg.

During first dentition children are frequently affected with diar-
rhoea. It is often so slight that parents do not regard it as a dis-
ease, and leave it to the action of nature only ; at other times,
however, especially when dentition coincides with weaning, the
evacuations are copious, and the diarrhoea passes into the chronic
state. Then the patient becomes remarkably thin, and nervous
symptoms of all kinds arise ; sometimes that morbid condition is
developed which has been confounded with acute hydrocephalus,
but which Marshall Hall has designated by the name of hydro-
cephaloid. When it has passed into the chronic state this diar-
rhoea is frequently fatal, the little patients dying in marasmus.

I have found a medicament, the use of which has been attend-
ed by extremely favorable results in a great number of cases of
these diarrhoeas.

In the autumn of 1838 Dr. Roessel, Bavarian Aide-Major, then
in garrison at the fort of Oberhaus, consulted me about a child in
a low state from a diarrhoea of dentition. Sophie Krick was of
delicate health ; she commenced to cut her teeth with her second
year. After the appearance of the first teeth she was taken with
a diarrhoea, to which the parents at first paid no attention ; but

1859.] Treatment of Purpura Utemorrhagica. 685

soon afterwards the evacuations became serious, persisted for
three months, and so reduced the child that only skin and bones
remained. She was continually in a state of coma vigil ; pulse
very frequent, and hardly perceptible ; no appetite, and constant
thirst ; in a word, her condition appeared desperate. Upon my
proposition, Dr. Roessel prescribed the sulphate of copper, asso-
ciated with opium, in the following proportions :

Sulphate of copper, gr. .

Opium, yV

Sugar, q. s.

Recommending three powders a day to be given.

The first four days there was a marked amendment, the evacua-
tions became less frequent and less serious, and three daj-s after
the little patient commenced to convalesce. The diarrhoea ceas-
ed, the appetite returned, and digestion was re-established ; the
strength and the normal size of the body sensibly increased, and
four weeks after the cure was completed. This case created a
considerable sensation in the neighborhood, and soon after Dr.
Roessel had two similar cases to treat. He called me in consulta-
tion, and we agreed to employ the same means, and the results
were equally favorable in the two cases.

In 1840, I had an opportunity to observe a fourth case of this
diarrhoea at the fort of Oberhaus. The little patient presented
the same symptoms as those I have just mentioned, with this dif-
ference, that vomiting still persisted, and that the disease had only
continued for fifteen days. The emaciation, however, was very
marked, the abdomen tumid, and sensitive to pressure ; appetite
bad, and great thirst ; the respiration was accelerated, and there
were mucous rales, without any other symptom of a pulmonary
lesion ; countenance pale, and a little tumefied, the expression in-
dicating apathy, I prescribed the sulphate of copper with opium,
according to the formula given above, and twelve of these pow-
ders brought about in four days convalescence, which was very
short. [Bulletin Generate de Therapeutique, and American Med.
Monthly.

On the Treatment of Purpura Hemorrhagica by Tincture of Larch
Bark. By Dr. S. L. Hardy, Physician to the Hospital for
Diseases of Children, Dublin.

Dr. Hardy tells us that he has been long in the habit of using
larch bark as a stypic and carminative tonic. The tincture is of
a dark carmine color, with an agreeable " pinic" smell. In taste
it partakes of that of the oleo-resins. " It is," says Dr. Moore,
" one of the most elegant forms at our disposal of prescribing a
terebinthinate."

Treatment of Purpura Hemorrhagica. . [October,

Case 1. A boy, set. 16 years, who had frequently been a
patient at the Hospital for the Diseases of Children, was present-
ed for treatment on September Gth. His appearance was that of
extreme debility; he could scarcely walk; his pulse was exceed-
ingly feeble, and his countenance pale and dejected. He was
ordered the Liquor Pernitratis Ferri, with good nourishing diet.
Having continued this treatment until the 15th, it was perceived
that his symptoms were much aggravated ; and there now exist-
ed a very extensive crop of spots of purpura over his entire body ;
his skin was harsh, dry, and contracted ; his spirits greatly de-
pressed ; and altogether his general appearance was most un-
promising. There had not been hemorrhage from the gums or
by stool. Tincture of larch bark was now substituted for the iron,
in fifteen drop doses, to be taken every two hours.

The immediate improvement which resulted from this medi-
cine was most remarkable ; all traces of purpura disappeared, and
his strength became so perfectly restored, that on the 23d instant
he ceased to require further treatment.

Case 2. E. C , a female child, aet. 7 years, residing in a
small and badly- ventilated house, was brought to the Hospital for
the Diseases of Children, on the 10th of August, having been a
week ill. The account given by her mother was, that she had
bleeding of the nose and gums, with discharges of blood from the
bowels, and had lost all her strength. Her appearance agreed
most truly with this statement. There was great debility, with
a look of general distress in her countenance, sometimes more
forcibly expressed by a knitting of the brows. Her body and ex-
tremities were covered with a very extensive and well-marked
orop of purpura ; the gums were spongy, and easily made to
bleed ; and her tongue was coated with a thick fur.

Tincture of larch bark was now commenced, in doses of ten
drops, three times daily ; after two days increased to fifteen drops,
and given more frequently. On the 21st it is reported "All
bleeding has ceased ; the tongue is cleansing ; the bowels regular ;
and strength greatly improved."

From this date, under the same treatment, this child's recovery
progressed rapidly and most favorably.

For the following cases, in further illustration of this subject,
I am indebted to my colleague, Dr. Moore.

Case 3. July 1st, 1858. John M . set 2 years, was brought
to the Institution for Diseases of Children. He looked a soft,
flabby child, and has had a cough for the last six months. On
examination, I found a thick crop of purpura studded over his -
chest, arms, and abdomen ; he was languid, with total loss of ap-
petite, and was greatly annoyed with a soft rattling cough. He
never passed blood by his bowels. As the child lived in a com-
paratively unhealthy part of the city, I directed that he should

1859.] On Injection in Gonorrhoea, 687

be at once removed to the country ; or, if that was not conveni-
ent, that he should be kept as much as possible in the park during
the day. I prescribed tincture of larch bark, eight drops to be
given three times a day, in lemonade ; which latter beverage,
well sweetened, he was allowed ad libitum during the day and night.

July 3d. The spots fading; cough still troublesome.

5th. Purpura scarcely perceptible ; the child to leave for the
country. Larch bark discontinued.

I have seen this boy frequently since; he has had no return of
the purpura, and the cough has entirely ceaged. His general
appearance is much improved.

Case 4. Co^e of Bleeding from the Gums, and general Cachex-
ia. Matilda M , aet. 5 years, was brought to the Hospital for
Diseases of Children, 15th September last. She looked anaemic
and puny, and for the last few days free bleeding from her gums
had occurred, two or three times, during the day and night. On
examining the state of her mouth, I found the tongue " too red,"
and gums spongy. I prescribed ten drops of the tincture of larch
bark, to be taken in cold lemonade four times during the day ;
the girl to have cold lemonade to drink freely ; her food to con-
sist of vegetables and fruit.

September 18th. The bleeding has only occurred once during
the last two days. Continue the larch bark, ten drops three times
a day. Lemonade and vegetable diet as before.

21st. General improvement in the patient ; state of the mouth
and gums much healthier. There has been no return of the
bleeding; however, I thought it advisable to continue the larch
bark a little longer, and prescribed gutt. viij. twice daily, in a
mixture of chlorate of potash. This treatment sufficed to con-
firm the previous amendment.

I looked carefully for petechias in this case, but could not dis-
cover any. [Dublin Hospital Gazette.

On Injection in Gonorrhoea. By Professor Sigmund.

Professor Sigmund, of Vienna, as the result of his extensive ob-
servation in this class of diseases, is decidedly in favor of the em-
ployment of injections in the treatment of gonorrhoea. He be-
lieves that those who have derived no benefit from their use, or
who have observed mischievous consequences from this, have in
the great majority of cases, employed them improperly. He has
tried injections with balsam of copaiba, and with chloroform, but
has given them up as unpractical, and those made with the
patient's own urine, while taking balsam copaiba, were found to
be as inert as water. From among a large number of substances
tried, he confines himself now almost enlirelv to sulphate and
acetate of zinc or lead, alum, and tannin ; and of these he pre-

688 On the Shortness of the Duration of Labor. [October,

fers the sulphate of zinc to all others, because the great majority
of patients are cured by it; it acts mildly, neither soiling the
linen nor changing the color of the urine, and it is very cheap.

For injections to succeed, they must be used at the proper
time, in a suitable dose and manner, and they must be continued
sufficiently long. The period for their employment has arrived
as soon as the inflammation of the mucous membrane of the
urethra has become subdued ; but they should not be used as
long as there is present considerable swelling, great, or even slight,
if continuous, pain, spasms, or frequent calls to pass urine. The
dose of the material should be small, as five grains to the ounce
of extract of lead, one quarter of a grain of nitrate of silver, one
grain of sulphate or acetate of zinc, &c. It is seldom necessary
to increase the original dose. The addition of anodynes, as opium,
hyoscyamus, &c, has no advantageous effect. We should care-
fully teach the patient how to use the injection ; and a small tin
syringe, with a conical tube, is to be preferred. It should hold
at least two drachms. The patient should be placed in the up-
right position, and should pass urine prior to the injection being
thrown in. The tube must be so passed into the urethra, that no
fluid can flow out between the canal and the tube. The fluid is
now to be slowly thrown in, and then the mouth of the urethra
is to be kept closed by two fingers, so that nothing can pass out
during two or three minutes. Two injections are to be thrown
in, one after the other, and they are to be repeated three or four
times daily. The injections should not be thrown in just before
going to sleep, as they then sometimes give rise to seminal dis-
charges. They must be persevered in for eight or ten days, after
all traces of diseased secretion have ceased to be visible, even in
the morning. The average time required will be from twenty-
one to twenty-eight days. Internal means may also, if desired,
be employed, and balsamic medicines in many cases hasten the
cure.

Dr. Sigmund rarely has recourse to caustic injections, as the
nitrate of silver, sulphate of copper, chloride of zinc, &c, because
generally the experiment is dangerous. He limits their use to
simple, uncomplicated gleet, which has resisted the usual means,
as also to recent gonorrhoea without inflammation occurring to
persons who have already employed the treatment with advan-
tage. [Schmidt's Jahrbuch, and Banking's Abstract

On the Shortness of the Duration of Labor. By Dr. J. Gray.

In order to increase the action of the uterus, and thereby hasten
delivery. Dr. J. Gray advises us to excite the nipple as labor-pain
comes on, and continue the stimulation so long as it lasts. This

1859.] Formation of an Artificial Pupil by Tying the Iris. 689

is accomplished by passing the left hand gently but continuously
upwards and downwards over one or other of the nipples ; or by
stimulating with the fingers the act of sucking of the infant. By
such manipulation, he says, the nipple erects, and in virtue of re-
flex action, the uterine contractions increase in force ; while at the
same time the os dilates, and the external parts become relax-
ed. Besides shortening the duration of labor, he finds it has also
the effect of preventing hemorrhage. The second stage of labor
completed, if the placenta be not in the passage, he still maintains
at short intervals the friction over the nipple, in order that the
uterus may expel its contents ; and also resorts to it in cases
where he has occasion to fear M flooding."

" Reasoning," Dr. Gray remarks, " from the practice of ancient
and modern times, and influenced especially by the theory of reflex
action, as recently discovered and propounded by Marshall Hall,
I have lately been led to adopt this mode of irritating the nipple,
in order to increase the action of the uterus, with a view to the
abridgement of labor. If, I inquired, the application of the child
to the breast causes the womb forcibly to contract, and thus pre-
vents ' flooding,' may not a similar operation, artificially perform-
ed, have the same effect in promoting the contractile efforts of
the uterus, and hastening the delivery ? That it does so, very
ample trial has fully convinced me. In difficult cases, indeedT
which require instrumental aid for their termination, it will most
probably prove useless failure depending upon malformation
either on the part of mother or child. But where the child is in
the normal position and of average size, and should no deformity
exist in the pelvis or soft parts of the mother, I have found it gen-
erally successful. I never, however, be it remembered, interfere
in those cases where there is already active uterine contraction.

[Glasgow Med. Jour, and Ibid.

Formation of an Artificial Pupil by Tying the Iris. By Mr.
Critchett.

The object of this operation (which Mr. Critchett terms iridde-
sis, from Ipic;, and Ssotg, a binding) is to prevent the receding of the
portion of the iris drawn through the cornea in the operation for
artificial pupil. This operation is performed in the following
manner: The patient, if at all restless, being placed under the in-
fluence of chloroform, the wire speculum is inserted, and, with a
pair of forceps, a small fold of the conjunctiva close to the cor-
nea, is held so as to fix the eye. An opening is then made with
a broad needle through the margin of the cornea, close to the scle-
rotic, and just of sufficient size to admit the canula forceps ; with
it a small portion of the iris, near, but not close to, its ciliary

690 On Laryngoscopy. [October,

attachment, is seized and drawn out to the extent considered
necessary to enlarge the pupil; a piece of fine floss silk, previous-
ly tied in a small loop round the canula forceps, is slipped down
and carefully tightened around the portion of iris made to prolapse,
so as to include and strangulate it. This manoeuvre requires a
little practice and dexterity, and is best accomplished by holding
each end of the silk with a pair of small forceps with broad ex-
tremities, bringing them exactly to the place where the knot is to
be tied, and then drawing it moderately tight. A single tie is suf-
ficient ; the ends are then cut off, and the operation is complete.
Little or no irritation usually follows. The small portion of iris
included in the ligature speedily shrinks, leaving the little loop of
silk, which may be removed from the eye about the second day.
This operation has been performed many times by Mr. Critchett,
and by his colleagues, Mr. Bowman and Mr. Poland, and the re-
sult has been in every respect most satisfactory ; the size, form,
and direction of the pupil can be regulated to a nicety ; its mo-
bility is preserved, and the eye speedily recovers from the effects
of the operation. It is applicable to numerous groups of cases,
including all those in which the natural pupil, or even a part of
the natural pupil, is moveable, and has a free edge. \_Opihalmic
Hospital Reports, and Hid.

On Laryngoscopy. By Dr. Czermak, of Pest.

Under the head of " a contribution to laryngoscopy," Dr. Czermak
relates a case of chronic loss of voice, of supposed nervous origin,
chiefly because it was often suddenly aggravated by emotional
causes ; in which, by means of a small laryngeal mirror and an
ordinary study lamp, he was enabled distinctly to make out a
small dark-colored tumor, of the size of a small green pea, resting,
by a tolerably broad base, on the right true vocal chord. The
growth bad a somewhat uneven surface, and seemed of soft con-
sistence, inasmuch as each vibration of the chord caused its whole
substance to tremble, and when closed on by the glottis, it seem-
ed somewhat elastic ; the sudden exacerbations of hoarseness,
from emotional causes, depended, no doubt, on the more or less
erectile character of the growth. Dr.- Czermak only saw the
patient once in passing, but suggested the propriety of operative
interference in such cases, and relates this case chiefly as an
encouragement to others to prosecute this method of diagnosis
by means of Garcia's laryngeal speculum, recalling, however, the
fact that this method of diagnosis dates long previous to Garcia,
and referring for proof thereof to Liston's ' Practical Surgery,'
London, 1840, p. 417. [Winer Wochenschr., and Ibid.

1859.] Effects of Ligature of the (Esophagus in Animals. 691

Effects of Ligature of the (Esophagus in Animals. Report of M,
Trousseau.

The question here proposed assumes a vast importance, from
the fact that in a large number of the experiments upon the in-
gestion of poisons, made by Orfila and others, the oesophagus
was tied to prevent the rejection of the substance employed.
Until a recent period, no one seems to have suspected that the
mere ligation of the oesophagus could give rise to formidable
symptoms and to fatal results, which might be wrongly referred
to poisons previously placed in the stomach. In June, 1856,
MM. Bouley and Reynal sent to the Academy of Medicine a
communication, in which they believed themselves to have de*
monstrated that ligature of the oesophagus was not the innocu-
ous operation which Orfila believed it to be ; that in most cases
it was followed by grave symptoms, and that when permanent-
ly applied, it was inevitably fatal. The bearing of these state-
ments is clearly this : Orfila left on record a large number of
experiments in which he had placed various substances in the
stomachs of dogs, and then tied the oesophagus. If, now, the
latter observers are right, and this operation is alone competent
to destroy life, nearly all of Orfila's experiments will demand a
new and more rigorous scrutiny.

The paper of MM. Bouley and Beynal was referred to a com-
mission, composed of MM. Begin, Bouley, Jobert, Larrey, Ren-
ault, and Trousseau, the latter of whom acted as reporter. To
the same commission were also referred additional communica-
tions on the same subject by M. Orfila, a nephew of the toxico-
logist, Follin, Sedillot, C olin, Szumowski, and Jobert.

After a patient, experimental criticism of the views of these
several observers, the commission arrived at the following, con-
clusions :

1. Ligature of the oesophagus causes symptoms of a serious
nature, which should not be neglected in toxicological studies.

2. These symptoms are more or less grave as the ligature is
more or less rightly applied.

3. Permanent ligature of this canal causes death in nine-tentha
of the cases.

4. The maximum duration of life, under these circumstances,
having been six days, doubt is cast upon the supposed toxicolo-
gical characters of substances tested by ingestion and subsequent
ligature of the oesophagus, when death follows their administra-
tion only after the lapse of two, three, four, five, or six days,
and with still more reason when it is yet longer delayed.

5. The symptoms which follow the permanent application of
a ligature to the oesophagus, are profound prostration, super*
vening at the close of twenty- four hours.

K. 8. VOL. XV. NO. X. 49

692 Arnica Montana. [October,

6. The consecutive leisons are inflammation of the nerves
which accompany the oesophagus, with or without purulent
formations in the track of the wound, so that where these com-
plications attend the administration of poisons retained in
the stomach by ligature of the oesophagus, their supposed
effects are to be regarded with suspicion, owing to the impossi-
bility of referring the accidents in question to the supposed poi-
son, or to the means used to retain it in the intestinal cavities.

7. The temporary ligature of the canal is fatal but in three of
one hundred cases.

8. It is hence inferred, that when the ligature is to be used,
it should be applied without great pressure, and should be re-
moved within six hours.

In commenting upon the report here analyzed, M. Brown-
Sequard states that two experiments are needed to make the
matter complete First, to irritate the nerves of the oesophagus,
without obstructing that canal ; and second, to tie it after cut-
ting the said nerves. To try the first of these, he divided the
canal longitudinally, and fixed it in a tube by the aid of two
ligatures, so that deglutition and vomiting were still possible.
The accident observed by MM. Bouley and Beynal showed
themselves in this case, but to a less extent than when the canal
was tied without the use of a tube.

In the second experiment, the two recurrent nerves were di-
vided and a ligature placed about the canal near the thorax. In
this case, the phenomena recorded by Bouley and Eeynal failed
to appear ! The symptoms observed by these gentlemen were
therefore due in all probability to reflex impressions affecting the
buccal, pharyngeal, salivary, bronchial, and gastric secretions,
and analogous to the flow of tears which follows irritation of
the cornea. [Jour, de Physiologie, and N. Amer. Med. Ghir. Rev.

Arnica Montana.

The therapeutical properties of the Leopard's bane is made the
subject of an article in the College Journal by Dr. T. C. Millerr
and we abstract as follows the observations he has made with it
in his own practice. He says :

I have been accustomed to use it for twenty- eight years. In
nervous fevers characterized by torpor, this remedy is very valu-
able to rouse the sinking energy of the nerves, particularly the
nerves of the abdominal viscera, while at the same time it in-
creases the contractile power of the muscular fibres, and espe-
cially the fibres of the unstriated muscles of the walls of tubes
and ducts. It is a very valuable remedy in enteric fever, and
where there is colliquative hemorrhages, passive sweatings, and
exanthemata of the abdomen. It will not take the place of vale-

1859.] On the Healthy Urine of Man. 693

rian, quinia, camphor or the acids, for its action on the system
is unlike that of either and all of these. These four great reme-
dies have each its own distinctive influence, and each is a valua-
ble aid to the others, when needed.

In inflammations combined with torpidity, as in typhoid
pneumonia ; in inflammation of the brain and its coverings, in
gangrene, and other similar affections, it requires oftimes, camphor,
quinia, and perhaps opium, to be given in conjunction with it.

In obstinate maltreated intermittents, with torpidity of the
abdominal viscera, and engorgement and enlargement of the
spleen and liver, and perhaps abdominal dropsy, and in the so-
called typhoid cholera, arnica is of great value. My brother,
Lewis E. Miller, uses it in conjunction with ether in those cases.

In old, atonic gout and rheumatism, especially locally ap-
plied, it always is of value. In dysentery, where the disease is
complicated with torpidity of the bowels, or constipation, ex-
haustion, or colliquative dysentery, it is peculiarly indicated.
In these cases I consider the root preferable to the flowers'.

In passive hemorrhage, of a scorbutic character ; in discharges
from the respiratory or the reproductive organs ; in bloody or
serous extravasations caused by contusions and hurts, it is the
main remedy I depend upon. It is also very valuable in atonic
dropsies.

The external use of the flowers, in tincture or infusion, is the
best agent I have tried in acute hydrocephalus.

In paralysis, particularly where the paralysis has been caused
by mechanical influence upon the brain or spinal marrow, but
the nerve structure remains in-tact not by congestion or soft-
ening of the nerve structure and in the commencement of
amaurosis, it has always proved of utility. Theilmann, in treat-
ing amaurosis, made use of an infusion of three drachms of the
flowers to eight ounces of water, and gave a large spoonful at
a dose, once in three hours.

In enlargement, torpidity, or engorgement of any of the ab-
dominal viscera; and also in suppression of the menstrual,
lochial, or hemorrhoidal discharges in consequence of torpidity,
its use is of great value. Leidbeck speaks very favorably of it in
varicose veins of pregnant women. I have derived great bene-
fit from it in such cases. [Pe?iinsular Independent.

On the Natural Constants of the Healthy Urine of Man. By the
Kev. Samuel Haughton, F. K. S., F. T. C. D.

Having already given an abstract of that portion of the above
paper which treats of urea, we now proceed to do the same with
respect to parts two and three, relating to uric and phosphoric acids:

694 On the Healthy Urine of Man. [October,

11 1 believe that both uric and hippuric acids are accidental in
healthy urine, though the former is always found in small quan-
tity ; the latter, hippuric acid, occurred to me only once, though
it was carefully sought in each case. "When I say that uric acid
is accidental in healthy urine, I do not mean to say that it
occurs like chlorine and sulphuric acid, the quantity of which
depends directly on the chloride of sodium, and sulphate of alu-
mina and potash consumed with the food ; but I do mean, that
no uric acid whatever, should occur in the urine of a man in
perfect health, but that all the nitrogen of the urine should pass
off in the form of urea, a more highly oxidated product than
uric acid.'7

The quantities of uric acid excreted daily, according to the
varying statements of eminent chemists, amount to from five to
eighteen grains. In Mr. Haughton's tables, the quantity differs
greatly in different individuals, ranging from 0.71 to 11.88
grains in "beef-eaters/' and from 0.50 to 2.48 grains in vegeta-
rians ; the mean in the former class is 4.55 grains, in the latter
1.48 grains daily.

" When we consider that the quantity of urea passed by the per-
sons considered in these tables per day, is 5.76 grains, and 8.94
grains, respectively, we may fairly consider the uric acid dis-
charged simply in the light of a minute fraction of nitrogen,
which has escaped complete oxidation, and as a matter rather of
chemical than physiological interest."

Liebig sets down the average daily discharge of hippuric acid
at 7.5 grains a statement quite at variance with that of Mr,
Haughton, who found it only in one case, that of a vegetarian,
whose urine had " a remarkable smell, compounded of that of
sweet hay and apple-juice."

" There is no subject respecting which more difference of
pinion exists, than with reference to phosphoric acid elimina-
ted by the kidneys ; some investigators considering that it is as
accidental in its character, and as dependent on food, as chlorine
or sulphuric acid \ while others regard it as the direct product
of the disintegration of nervous tissue, and, as such, entitled to
our regard as the measure of nervous work done by the system.
In whatever point of view it is to be considered, it is obviously
important to determine its daily amount in the case of healthy
men, under different conditions as to food and work of mind
and body."

The average quantity of phosphoric acid discharged per day
was found to be, in beef-eaters (6 in number,) 87.07 grains ; in
vegetarians (5 in number,) 26.70 grains and in the former
probably, and certainly in the latter, the proportion of the acid
combined with alkalies was to that combined with earths in
the ratio of 4 to 1. [Dublin Medical Press.

1859.] A A ding Dyspepsia, &c. 695

On a new mode of treating severe Dyspepsia and Chronic inflam-
mation of the Stomach. By Alexander Fleming, M. D., Se-
nior Physician to the Queen's Hospital, Birmingham.

"In the medicinal treatment of affections of the stomach, I have
long been convinced of the great importance of acting directly
on the gastric mucous membrane. That, in fact, local treatment
is here nearly as valuable as it is in affections of other mucous
surfaces, as the eye, pharynx, vagina, and urethra. Hygienic
rules and the management of the food are, for obvious reasons,
very important in affections of the stomach, and will often cure
mild cases without the help of medicine; but I am satisfied that,
in the more severe and obstinate forms of chronic gastritis, the
local medicinal treatment of the diseased mucous membrane has
been unduly neglected and that it contributes very powerfully
to promote the cure.

"Of the several medicines which I have employd with a view
to their local action on the stomach, my experience gives the
first place to nitrate of silver; and the observations I have now
to make apply to this remedy. It is often given in pill. If this
be made with bread-crumb, the chloride of sodium in the bread
converts the nitrate into the insoluble and comparatively inert
chloride of silver. If made with gum or starch, the pill, on
reaching the stomach, causes quickly the secretion of gastric
juice, the chloride of sodium and muriatic acid of which again
render the nitrate inert. It can have very little local action in
the form of pill. I have for many years, therefore, given the
crystalized nitrate dissolved in distilled water, in the proportion
of from half a grain to four grains to the half ounce. The dose
is taken at bedtime on an empty stomach, and is repeated every
night, every second, third, or fourth night, according to the
severity of the disease. The stomaeh should be strictly empty
the patient recumbent and he should be made to roll about
immediately after taking the medicine. It is thus, before it suf-
fers decomposition, brought into contact pretty freely with the
mucous membrane, and gives, at the time and subsequently,
evidence of its local action. In many cases, this mode of using
the remedy suffices, in conjunction with other means, to effect a
cure.

" But this method of exhibiting the medicine is not equal to
the cure of some of the severer forms of dyspepsia and chronic
gastritis ; and in these I have, for the last four years, endeavor-
ed to act more generally and efficiently on the mucous surface
by injecting the solution into the stomach. I employ a strong
brass syringe and flexible tube, one-eighth of an inch in bore,
the grastic end of which has a number of holes so directed that

696 Affinity between /Scarlet Fever and Measles. [October,

the fluid is thrown in a circular shower outwards and upwards
on the walls of the stomach. The injection is made by dissolv-
ing from one to four grains of the nitrate in three ounces of dis-
tilled water. The operation is for the most part managed easily.
Sometimes it causes nausea and retching often er not. It ex-
cites at first an enduring and grateful sense of coolness in the
stomach, and subsequently there are felt pricking and sharp
painful sensations, but of a different nature from the pains of
the disease. Sometimes one injection is enough, but I have
more frequently had to repeat it two, three, or more times.

" During the employment of the injections the patient takes,
three times a day and before food, a little morphia or chloric
ether, or Indian hemp, in plain or cinnamon water. He is con-
fined to small and frequent meals of milk, and as he gets better
this is thickened with arrowroot or tapioca, and he is very grad-
ually introduced to a nourishing and easily digestible diet.
Counter-irritation to the epigastrium, nitrate of bismuth, oxide
of silver, gentle tonics, &c, are employed when indicated.

" Of the thorough efficiency of this mode of acting on the mu-
cous surface of the stomach, and of its power in promoting the
cure, my experience, so far as it goes, is very decided. Although
it is now four years since I first tried injection, I have not used
it in more than ten cases. I have always in the first instance,
employed the simpler method already described, and resorted
to injection only as a last resource ; but its greater efficiency would,
I feel certain, justify its employment in many of the less severe
cases, and give more thorough and speedy cures. It is not my
purpose, at present, to consider the intimate nature of the mode
of cure, or the manner in which the nitrate of silver substitutes
healthy for diseased action in the inflamed gastric membrane.
I must reserve that interesting question, and the detailed narra-
tive of cases, for another opportunity. [Med. Times and Gaz.

On the Question of the Affinity between Scarlet Fever and Measles.
By Dr. Kuttner, of Dresden.

That measles and scarlatina, in their symptoms and in their
essence, present two well-defined states of disease, is one of the
most indisputable facts in pathology. Schonlein, making use of
an analogy derived from botanical science, looks on measles as
a peculiar exanthematic form of catarrh, and accordingly places
it in the family of the catarrhs; whereas scarlatina is placed by
him in the group of erysipelatous diseases. Admitting that, in
the regular course, such sharply defined examples of the diseases
exist, Dr. Kuttner observes, that experience furnishes us with
androgynous cases calculated to embarrass even the expe-

1859.] Affinity between Scarlet Fever and Measles. 697

rienced " diagnostiker." If the diseases were always so well
marked as we find them in the handbooks, there would
be no difficulty. Sometimes the exanthem bears the charac-
ter of scarlatina, while the catarrhal irritation of the bron-
chial membrane, and of the mucous membrane of the nose
and of the eyes, indicate the morbillous process ; or, on the other
hand, the rash of measles is accompanied by vomiting, by a
sharp attack of angina, and by the characteristic scarlatina
tongue.

We see occasionally, in the same individual, parts of the skin
presenting the scarlet-red eruption, while in others the rosy rash
of measles exists. We have, then, not merely examples of
transition, but we see cases which may be termed hybridous.
If we were even disinclined to assign any relationship to the
two diseases, arising from the fact of their passing into each
other, there is still another observation which shows it in a
higher degree namely, that the same contagious matter appears
capable of producing, in different individuals, different diseases ;
in some measles, in others scarlatina. Many reliable proofs of
this are to be found in medical literature, to which the following
may by added, as affording good examples : During an epi-
demic of measles, a boy of sixteen years of age became affected
with the disease, which ran a favorable course, and at the end
of three weeks he was sent from Dresden to his father's country
house, at some distance from the city. A little sister, two years
of age, who visited the brother on the day of the appearance of
the rash, although immediately sent away, sickened on the tenth
day, presenting the ordinary symptoms of the eruptive fever;
in her, too, the disease passed over mildly. A second sister,
one of the older members of the family, who had before repeat-
edly attended upon persons in measles without taking the
disease, did not now escape. There yet remained a third sister,
who was married, and who had been for fourteen days on a
visit to her father's house, but who, from never having had
measles, carefully avoided intercourse with the sick and the con-
valescent, not, however, guarding against the possibility of
transmission through a third person. Without any previous
indisposition, sharp febrile symptoms appeared in this case,
leading to the belief of the invasion of measles. An intense
scarlatinal eruption, however, manifested itself, with the charac-
teristic affection of the throat, and with the red- tongue. The
exanthematic period passed over without any remarkable symp-
toms, ending in the second week with an extensive exfoliation
of the epidermis. No second case of measles or scarlatina oc-
curred in the house.

Although observations such as these have been made by
practical physicians, and recorded, still this is worthy of notice,

698 Physiology and Pathology of the Nervous System. [October,

from the concurrent circumstances, and because the course of
the disease was so characteristic as to leave no doubt as to the
correctness of the diagnosis.

In what relation scarlatina and measles stand to each other,
and whether the same contagion can, in reality, produce both
forms of disease, we are scarcely in a position to determine. A
sceptic will naturally say that the scarlatina of the last named
case was not the product of the contagion of measles, but was
developed independently.

Admitting, however, that a direct proof to the contrary can-
not be given, the fact nevertheless remains, and no communica-
tion from without, capable of conveying scarlatina, took place.
Is it in reality so preposterous a notion, that the matter of the
exanthematic contagion may act like a ferment, without any
specific character, and according to individual disposition, may
produce measles in one case, and scarlatina in another, as, under
similar conditions, the impression of cold may cause in one in-
dividual catarrh, and in another rheumatism? [Jour, fiir Kin-
derkranhhj and Banking's Abstract.

On the Physiology and Pathology of the Nervous System. By Dr.
Brown- Sequakd.

The principal points which Dr. Brown-Sequard endeavors to
establish in connection with the physiology and pathology of
the central nervous system are these :

1st. Excitations of the anterior roots of the spinal nerves may
be a cause of pain, because these roots, being motor, produce a
cramp. The pain due to this cramp is what has been errone-
ously called recurring sensibility. Cramps, and several other
kinds of painful spasms (of the uterus during parturition, of the
sphincter ani in certain cases, &c.,) are painful on account of a
galvanic irritation of sensitive nerves accompanying muscular
contractions.

2d. Our movements seem to be guided by the peculiar sensa-
tions we derive from the galvanic irritation of certain sensitive
nerves of muscles, while they contract.

3d. The power of transmitting sensitive impressions exists in
many parts, which are not able to give pain or any other sensa-
tion, when they are excited by our usual means of irritation ;
so it is with the gray matter of the spinal cord, and with many
parts of nerves, which, however, are conductors of sensitive im-
pressions.

4th. Hyperesthesia is a constant result of certain injuries
upon, or alterations of, the posterior parts of the cerebro-spinal
axis, from the tubercula quadrigemina down to the lower end
of the spinal cord.

1859] Physiology and Pathology of the Nervous System,. 699

5th. The transmission of sensitive impressions, in the spinal
cord, takes place chiefly through the gray matter, and partly
through the anterior columns ; but, before reaching the gray
matter, the impressions/ in a certain measure, pass through the
posterior columns.

6th, The conductors of sensitive impressions from the trunk
and limbs, decussate in the spinal cord, and not in the encepha-
lon, as was universally admitted.

7th. Although the spinal cord is greatly altered or injured,
sensibility, more or less diminished, may persist everywhere,
on account of a peculiar arrangement of the conductors of sensi-
tive impressions.

8th. The various kinds of sensitive impressions seem to be
conducted by quite distinct nerve-fibres, in the nerves and in
the nervous centres, and the place of passage of some of these
conductors in the spinal cord, seems not to be the same as that
of the others, but none of them go up to the sensorium along
the posterior columns.

9th. In the upper part of the cervical region of the spinal
cord, near the medulla oblongata, most of the conductors of the
orders of the will to muscles are in the lateral columns, and in
the gray matter between these and the anterior columns.

10th. The voluntary motor conductors decussate at the lower
part of the oblong medulla, and not all along the median line of
the base of the encephalon.

11th. The posterior columns of the spinal cord have a great
share in reflex movements, and this is the principal cause of the
peculiar kind of paralysis so often observed in cases of altera-
tion of these columns.

12th. The effects of excitation of the vaso-motor nerves, con-
sist essentially in a contraction of bloodvessels, which is follow-
ed by a diminution in the quantity of blood, in the temperature,
and in the activity of nutrition. The effects of interruption of
continuity of the vaso-motor nerves, (i. e. their paralysis) con-
sist essentially in a paralytic dilatation of bloodvessels, which is
followed by a greater afflux of blood, an increase of tempera-
ture, and a greater activity of nutrition.

13th. As a great many vaso-motor nerve-fibres go up to the
brain, and to the cerebellum along the spinal cord, the medulla
oblongata and the pons Varolii, the diseases or injuries of the
various parts of the cerebro-spinal axis, besides symptoms con-
cerning sensibility and movement, present symptoms depending
upon irritation, or paralysis of vaso-motor nerves ; contraction
or relaxation of bloodvessels, diminution or augmentation in
the quantity of blood, increase or diminution of temperature,
alterations of nutrition, of secretions, &c.

14th, Besides the influence of the nervous system upon nutri-

700 Physiology and Pathology of the Nervous System. [October,

tion, absorption, and secretion, through the vaso-motor nerves,
there is another which seems to consist in changes in the ele-
ments of the tissues changes producing various modifications
in the quantity of blood attracted, and in the interchange of
materials between the blood and the tissues.

15th. The absence of the influence of the nervous system on
any part of the body, is hardly a cause of other alterations of
nutrition than atrophy, while the irritation of the nervous sys-
tem, is a most powerful direct or reflx cause of a great many
morbid changes in nutrition, secretion, &c.

16th. The sympathetic normal and morbid changes of nutri-
tion, secretion, &c, are reflex phenomena, the study of which
shows how many diseases are produced by a reflex action, and
how a rational mode of treatment might be arrived at.

17th. The loss of conciousness in simple vertigo or in com-
plete attacks of epilepsy does not depend upon a disease of the
brain, but upon a contraction of the bloodvessels of the cerebral
lobes contraction due to some irritation of the vaso-motor
nerves of these vessels, either by some direct cause irritating
them in the base of the encephalon or the spinal cord, or by
a reflex influence.

18th. Much more frequently than has been imagined, all the
following affections may be produced by a peculiar kind of
irritation starting from almost any centripetal part of the nerv-
ous system : epilepsy, the various forms of insanity, chorea,
catalepsy, hysteria, tetanus, hydrophobia, &c.

19th. The medulla oblongata is neither the only nor an
essential nervous centre for the respiratory movements.

20th. There are a great many nerve-fibres and nerve-cells in
the medulla oblongata, the pons Yarolii, and the other parts of
the base of the encephalon, which are not employed in the trans-
mission of sensitive impressions or of the orders of the will to mus-
cles, and are endowed with the singular property of producing,
after even a slight irritation, & persistent spasm in certain muscles,
and especially in the neck. Eotatory convulsions very often
depend chiefly upon the production of such spasms, and of
changes in the bloodvessels of certain parts of the encephalon.

21st. The irritation of the auditory nerve may cause rotary
or simple clonic convulsions.

22d. The conductors of the orders of the will to muscles, of
the sensitive impressions, and of the nervous influences to blood-
vessels, decussating at different places in the cerebro-spinal axis,
various symptoms are to be observed, depending upon either
the irritation or the paralysis of these three kinds of conductors,
according to the part of a lateral half of the cerebro-spinal axis
where an alteration exists. [London Lancet.

1859.] Hysteria, and Menial and Bodily Diseases. 701

Hysteria considered as a connecting link beticeen Mental and Bodily
Disease. By Dr. W. Camps.

Dr. Camps's object is to draw attention to such forms of hyste-
ria as present marked evidence of psychical, in addition to, or
complication with, somatic affection. Until within a compara-
tively recent date it has been the custom to consider mental
disease as unconnected with or independent of bodily disease.
But insanity is far more a bodily disease than has hitherto been
considered ; and in cases of this malady there is mostly, if not
always, impairment of the proper healthy cerebral structure.

Dr. Camps gives a brief account of the hysterical paroxysm,
which is almost, though not exclusively, confined to the female
sex. It is, however, in the moral state and motives, which not
unfrequently attend or accompany the severer forms of hysteria,
that we may recognise without difficulty the approximation of
this disease to some of the forms of mental disease. In severe
cases of hysteria, amidst considerable general disorder, the nerv-
ous system being chiefly involved, the proper functions of the
brain often become deeply affected. There is observed in such
an increased susceptibility to impressions, a great rapidity of
movements, together with a capriciousness of motives ; the coun-
tenance indicates the alterations that take place in the feelings
of the patient; and in the worst cases, the most amiable senti
ments are observed to be converted into the most un amiable and
repulsive. In some, there appears to be, at times, a complete
metamorphosis of the whole moral character. This state of the
disease becomes a subject of the deepest importance, more espe-
cially in regard to its moral treatment, so far as regards the im-
position of personal restraint, or confinement of the patient; for
nothing would be more injurious to a hysterical patient in this
condition than undue interference with personal liberty. The
functional activity of the spinal chord, as well as of the brain,
may be morbidly diminished, or augmented, or perverted ; and
this latter state is especially the condition in hysteria. The per-
version of the functional activity of the spinal cord is most mark-
ed in some cases, in which there is an extreme irritability of the
cord at least, if not of the entire cerebro-spinal axis ; and in the
severer forms of the disease there doubtless exists an excess
irritability of the whole nervous centres ; and it may be, of the
entire nervous system, including even the nerves themse]
It might be assumed that the irregular, convulsive, and impul-
sive actions of hysterical patients, depend rather upon some state
of the blood, which alters its healthy relation to the nervous tis-
sue, than upon, any structural alteration of the proper nervous
tissue itself.

During the last nine months, Dr. Camps has had under his

702 Hysteria, and Mental and Bodily Diseases. [October,

care a somewhat severe and remarkable case of hysteria, which,
he thinks is one that afforded him good reasons to conclude that
it, and similar cases, present phenomena that clearly show a
connection between mental and bodily disease. The subject
of this affection was a lady, above fifty years of age, of a highly
nervous temperament, who first came under his notice, present-
ing many of the ordinary characters of hysteria ; but as the
disease gradually developed itself, this patient presented, in ad-
dition, many of the characters of a very protracted and aggra-
vated case of this disease. There were paroxysms of choreic
movements; at first chiefly confined to the lower extremities,
and to the left side of the trunk ; these gradually affected, in a
slighter degree, the upper extremities ; being attended then with
considerable paroxysmic palpitation of the heart, and heavy,
labored respiration. Then supervened excessive restlessness of
the body generally, so that when out of bed, the patient was
almost always in bodily action, seldom or never sitting, fre-
quently not even when at meals ; in motion whilst standing,
and very frequently walking hurriedly about in various apart-
ments of the house. This was followed by, and accompanied
with, excessive talkativeness, so as to fatigue her companions.
When remonstrated with, and requested to be silent, her reply
was, "I must talk, fori cannot help it." The subject of her
conversation was, almost invariably, herself, and her peculiar
ailment and condition, and this ultimately assumed the form of
intense selfishness or egotism. There was no derangement of
the special senses, nor of the general cuticular sensation. The
disease appeared to ascend gradually higher along the cerebro-
spinal axis, and at length to reach the sensory ganglia, and the
cerebrum itself; for certain psychical phenomena presented
themselves at times, bearing the closest affinity to those exhibit-
ed in some forms of mental disease. Commonly, the patient
slept well during the earlier part of the night, and seldom or
never complained of pain in any part of the frame. The facul-
ties of perception and memory were unimpaired, as was the judg-
ment also in relation to all matters of business demanding close
attention ; the imagination was in too lively exercise at times,
but the will appeared to have lost its controlling power over the
current of the thoughts. The patient would frequently remark,
" My thoughts master me ; I cannot help thinking about myself:
I seem at times to have lost the power to think of anything, or
of anybody, beside myself." Frequently, but not always, there
was great irritability of temper ; and this would sometimes be
expressed in words, and sometimes in actions. The will having
lost its controlling power, the impulses arising from this state of
excessive emotional sensibility were occasionally expressed in
very irregular and extraordinary phrases and actions of the body.

1859.] On the Delivery of the Child by Taming. 703

The view the author takes of this case was, that it is mainly
connected with the cessation of the menstrual function. More-
over, in this case, there was excessive irritation, possibly conges-
tion, of the greater part of the cerebro-spinal axis, including at
least the sensory ganglia at the base of the brain a condition of
parts sufficient to account for most if not for all the symptoms con-
nected with the nervous system.

Dr. Camps concludesby a brief reference to the treatment of hys-
teria. The measures recommended are : 1. The use of such agents
as improve the general health, and especially the general state of
nutrition of the nervous tissue ; 2. Of such agents as remove the
exciting causes of the paroxysms ; and lastly, of all such agents
as are likely to act beneficially upon the mental state and con-
dition of the patient. [British Med. Jour., and Banking's Ab-
stract.

On the Delivery of the Child by Turning as a general ride in La-
bor. By Mr. E. Garland Figg, of Borrowstowness.

In this paper Mr. Figg attempts to show, not only that delive-
ry by turning is preferable to delivery by the forcepts in cases
requiring operative interference, but that turning is the rule to
be adopted in general cases. He tells us that he has attended
sixty labors since writing these papersy that only three of these
were conducted as head presentations, and that of the remainder,
two were breech presentations, and fifty-five deliveries by turning.
As the results *of this astonishing practice we leave Mr. Figg
to speak for himself:

"With regard to the children, they are generally still from
two to five minutes, and in some cases half an hour's duration.
In many instances the first arm brought down is a little painful
when moved for a day or two. I confess with humility that I
have even broken four arms, which, though they occurred in
cases of great pelvic contraction, were attributable to my own
mismanagement in pressing over the shaft of the os humeri in-
stead of following its line to the elbow. Should you commit
the same error, with similar result, be not too candid to the re-
latives, but at once by your own dictum transubstantiate the in-
jury into a slight sprain received by the infant striking its should-
er against the backbone of the mother while actively prosecu-
ting his uterine gambols. It will pass current, more especially
if you appeal to her experience, when it is sure to be corroborat-
ed by a quotation of the day and hour of the occurrence. Two
slips of pasteboard applied, with a 'strip of calico a yard longr
remedies the evil in ten days.

" In establishing a comparison between the advantages deri-

704 On the Delivery of the Child by Turning. [October}

vable from turning in primiparoe and multiparas, I believe there
is a preponderance of argument in favor of the former. In a
primipara the os uteri is more in the axis of the pelvic brim, the
body of the organ being more inclined to the perpendicular,
and not projecting anteriorly, as in the frequent parturient;
hence, in the former case, the uterine efforts of the last month
previously to labor lodge the os and cervix inclusive of the head
low in the cavity of the pelvis, not only assuring the practition-
er by tangible proof of the perfect capacity of the brim, but also
presenting the best arrangement for the co-operation of the
uterus with his extractive efforts. In the latter case, from the
yielding of the abdominal muscles in former labors, the fundus
bearing forwards, throws the os in the direction of the spine,
rather than the pelvic cavity. Hence until the contraction of
these muscles in some measure restore the proper axis, no ad-
vance can take place.

" The advantage in the second particular is briefly explained,
by stating that in a primipara the antagonistic force is directly
in line with the extractive. In a multipara it is entrenched
round a corner.

" Again, in a primiparal case you have good grounds for the
conviction that, in obviating the perineal stage, you limit the
labor considerably ; while in the latter patient an hours suffering
might conclude the case.

"Be they right or wrong, these are the sentiments which
have guided my conduct in a large majority of my cases latterly,
experience appearing to justify in happy results what theory
dictated on sound reasoning. I hope I shall sooii lose all men-
tal impressions of a head lingering on the perineum, or stationa-
ry from failing pains for hours. My primiparal patients are up
in four day, without swelling of the vaginal muscles, nymphas,
or labia ; and what to me is perfectly unaccountable, with very
slight laceration of the perinium. ^

" I have had but one maternal death where the infant was
turned, and that occurred five days after the event, by inflam-
mation of the peritoneum of a patient, who with contracted
pelvis, had submitted to the ordeal to produce her sixth full-
timed dead child.

"If I be entitled to any credit at all, it is for the candid
avowal of a practice, that some, under fear of professional cen-
sure, would have adhered to but concealed.

" The operation was ancient, but nearly obsolete, and its re-
vival by Dr. Simpson in particular circumstances led to my
adoption of it in general cases."

In a latter communication, written chiefly as an answer to
the strong objections of Drs. Eobt. Lee, Kamsbotham, and Old-
ham, are the following passages : "Permit me," says Mr. Figg,

1859.] Antagonism of Ague and Consumption. 705

" with humility to observe, that while physiology, anatomy,
and analogy enables me to concoct as rational a theory for the
operation as they can against it, I bring forward a formidable
ally to my cause in nearly eighty-seven consecutive cases of per-
fect convalescence in mother and child, without adverting to a
still greater number of successful instances effected at various
intervals antecedently. Do these gentlemen impugn rny vera-
citv ? Let them depute any member of the profession resident
either in Edinburgh, Glasgow, or London, to visit the locality
of my residence, and by impartial inquiry of my patients prove
its immunity from danger and their satisfaction as to its adop-
tion." And again : " While my deliveries average two per
week, I have had but one death during the year the second
child of a woman aged 45, born to a second husband after a
widowhood of fourteen years." [Med. Times and Gaz.

On the Supposed Antagonism of Ague and Consumption. By Dr.
Peacock, Assistant Physician to St. Thomas's Hospital.

After a careful statistical investigation, Dr. Peacock concludes
that the information elicited in this manner is only negative.
He then inquires whether clinical observation is capable of
yielding more positive results, and after relating six cases, he
proceeds to say :

11 The facts which I have now detailed, conclusively show that
neither does the existence of consumption prevent the occur-
rence of ague, nor the occurrence of ague preclude the subse-
quent development of consumption ; but they do not prove that
the supposed antagonism may not, in some degree, exist. For,
on the one hand, phthisical patients, subjected to the influence
of malaria, may take ague in less proportion than healthy per-
sons similarly exposed ; and on the other hand, persons who
have had ague may be less liable to consumption than those
who have not had the disease. These objections I have no
means of meeting; but when it is considered that, within a
period of two years, five cases of the co-existence of the two
diseases have fallen under my owu notice, at one public institu-
tion, where the majority of phthisical patients do not come from
malarious districts, the coincidence cannot be regarded as excep-
tional or rare.* I cannot, then, but conclude, that it is not pro-
bable any material antagonism exists between phthisis and in-

* During the two years in which these five cases occurred, Dr. Peacock treat-
ed, at St Thomas's Hospital, among the in and out patients, 236 cases of ague,
and at least 262 cases of phthisis. The precise number of cases of the latter
disease he cannot give, as some cases of phthisis are entered in the out-patients'
book as " affections of the chest." He has also met with several other cases in
which there was reason to suspect tendency to phthisis in aguish patients.

706 Oil of Turpentine and Opium in Large Doses. [October,

termittent fever. The facts do not, however, warrant the denial
of the supposition altogether, and there are probably few popu-
lar ideas which have not some foundation in truth.

" The correct inference would appear to be, that the influence,
if any, exerted on the prevalence of consumption, by a malari-
ous atmosphere or by ague, is far less important than that of
various other causes which affect the development of that dis-
ease. The practical conclusion also to be arrived at is, that as
phthisical patients may take ague, and as such complication
materially aggravates the original disease, we should, in select-
ing residences for consumptive patients, avoid those situations
which are marshy, or in which aguish affections are known to
prevail." [Med, Chir. Review.

On the employment of Oil of Turpentine and Opium in large doses)
in severe Puerperal Diseases. By Dr. E. Bonfils.

M. Trousseau has lately employed, with considerable success,
a method of treatment proposed originally by Dr. Graves, in
puerperal diseases. This treatment consists in giving opium and
oil of turpentine in large doses to women in child-bed who are
attacked with metro-ovaritis, peritonitis, uterine phlebitis, &c.
Among other cases, M. Trousseau has treated in this manner,
and with success, a woman attacked with peritonitis and double
pleuro-pneumonia. He also employed this plan in another case
of a woman attacked with general and very severe peritonitis,
which was very rapidly checked and afterwards cured ; but
although the cure appeared to be permanent, the patient was un-
fortunately seized with hectic symptoms of an insidious character,
and sunk under what appeared to be a putrid infection. In the
first case the opium was prescribed in pills and the turpentine in
injections. At first five centigrammes (about one grain) of opium
were given in five pills, to be taken daily ; then the dose was
gradually augmented till it reached about two grains a day. The
opium was continued for thirteen days. The turpentine was ad-
ministered at first in the dose often grammes (about two drachms
and a half,) in two clysters, one in the morning and the other in
the evening ; then the quantity was progressively augmented to
thirty grammes (about seven drachms and a half.) In the second
case the opium was also given in pills, in the dose of five centi-
grammes (about one grain) for three days. The oil of turpentine
was administered by the mouth in capsules, each containing one
gramme (about the fourth of a drachm) of turpentine ; six of these
capsules were taken every day, and they were continued for six
days. [Bull. Gen. de Therap, and Banking's Abstract.

1859.] On the Accidents Produced by Catheterism. 707

On the Accidents Produced by Catheterism. By M. Charles
Phillips.

These not unfrequently occur, however carefully and adroitly
catheterism may have been performed. Usually, they are not
to be predicted, although they are more frequently met with
in certain diatheses, and during old chronic affections, which
also add much to their gravity and importance. The size of
the instrument or nature of the operation do not seem to exert
any effect in their production ; nor do nervous and pusillani-
mous subjects seem to be more liable to them ; but the seat
of the affection appears to have considerable influence, as they
much more frequently occur when this is near the neck of
the bladder or beyond the bulb. The explanation of the ex-
emption of women from these accidents by the ease with which
catheterism is performed on them, seems contradicted by the
fact that they sometimes, in men, follow catheterism when per-
formed with the greatest ease, and at others are not produced
by the most violent manoeuvres.

Passing by those of the accidents which are of a local charac-
ter, such as hemorrhage, retention, etc., M. Phillips confines his
attention to the general accidents, which may be divided into
three categories : 1. They are manifested under the form of sim-
ple febrile paroxysms, unattended with complications. 2. The
febrile accident is complicated by some disease, especially of the
urinary organs, and particularly of the kidney. From simple
intermittent it becomes a remittent affection, and only tempo-
rarily yields to quinine. In the 3rd, the febrile paroxysms are
more or less rapidly followed by the production of plegmonous
inflammations and suppurative arthrites. In the simplest form,
the febrile paroxysm much resembles that of ague, except that
it is determined by the catheterism, and is less regular in its re-
currence. Whether confined to the simple febrile paroxysm
complicated with disease of the urinary organs, or accompanied
by abscess, the paroxysms may assume the quotidian or double
tertian type. The continued remittent type is oftenest met with
when there is prior disease or abscess. Under these circum-
stances, too, the pernicious condition may ensue, or it may at
once arise in the aged or enfeebled.

Simple Febrile Paroxysms. Sometimes these disappear prompt-
ly of their own accord ; but at others, they are more persistent,
or may even assume the pernicious form. Under all circum-
stances, however, they yield to the action of quinine.

Febrile Paroxysms Complicated with Diseases of the Urinary
Organs. When disease of these exists, febrile paroysms are
easily induced, although in the case of their being slight, they
may sometimes yield, like the simple ones, to quinine. In

k. s. vol. xv. no. x. 50

708 On the Accidents Produced hy Catheterism. [October,

other cases the fever is converted into an obstinate continued
remittent. "When the disease of the urinary organs is more
serious, this type, or the pernicious form of fever, may be at
once developed.

Production of Pus in the Joints. M. Yelpeau first described
this as one of the accidents supervening upon catheterism. In
certain of the patients suffering from disease of the urinary or-
gans, a considerable effusion takes place in one or more of the
joints. They rapidly increase in size, and become red, hot, and
very painful ; and the*, danger is then very great. The pus
which forms is very fluid and very fetid, resembling that of
urinary abscess.

Diagnosis and Prognosis. The really important question to
decide is, whether the febrile paroxysm supervening upon
catheterism have aroused or revived a nephritis, of all compli-
cations in these cases the one to be most dreaded. Determined
in the affirmative, we have then to ascertain how far this com-
plication may have placed the case beyond our aid. If after
one or two paroxj^sms, there being constant renal pain, the skin
is found harsh and dry, the pulse rapid and full, and above all,
if the tongue which is always dry and sometimes cold, becomes
covered with a blackish coating, the worst issue is to be expect-
ed. When the fever is followed by plegmonous inflammation
or arthritis, we may at first confound the disease with an attack
of rheumatism, gout, or gonorrhoeal arthritis. The rapid pro-
gress of the disease to suppuration helps to elucidate its nature.

Nature of the Disease. Yelpeau advanced the hypothesis that
admission of some of the principles of the urine into the blood,
owing to defective elimination of these, was the origin of the
symptoms witnessed : and the researches of Claude Bernard
upon the varying colour of the renal blood, seem to confirm this
view. The urinary odour of the abscesses, even when remote
from the possibility of infiltration, has often been remarked.
Phlebitis may also give rise to these accidents \ but then either
a purulent collection existed already, or the passage of the in-
strument has given rise to the formation of one, and then the
patient dies in consequence of purulent resorption.

Treatment. Experience has shown that preventive treatment
is often quite efficacious, and even when not so, remarkably
diminishes the severity of the subsequent attack. It consists in
administering quinine for four or five days prior to the cathe-
terism, giving six grains per diem in the young and robust,
and double the quantity in the aged and enfeebled. When the
intermittent paroxysms are quite simple, expectative treatment
usually suffices ; but when they persist or assume worse types,
large doses of quinine, as fifteen to thirty grains, should be
given daily. In the case of disease of the kidney, it must be

1859.] On the Employment of Extract of Belladonna, 709

remembered that the quinine is only a palliative, and that the
nephritis calls for our greatest attention. Bulletin de Therapeu-
tique, tome lv. pp. 203 216.

[Dr. Wolff, in the Berlin Med. Zeitung, 1858, No. 42, relates
an interesting case, in which the patient was carried off amidst
febrile symptoms sixty hours after the introduction of the cathe-
ter. Dr. Heyfelder, of St. Petersburg, also reports two cases in
the Deutsche Klinik, 1857, No. 35, in one of which the patient
died in twenty -four, and in the other in forty hours afterwards.]

[Medical Times and Gazette.

On the Employment of Extract of Belladonna in the Treatment of
Irritable Bladder. By Henry Behrexd, Esq., L. R. C. P.,
Edin.

The efficacy of the extract of belladonna in the treatment of
that hitherto most intractable disorder, incontinence of urine,
has been so abundantly proved by the concurrent testimony of
numerous authors during the past two years, that it may now
be considered as one of the established facts of medical science.
It has already led to an investigation into the action of this
remedy in several kindred affections, and induced me some time
ago to give it a fair trial in a most severe and protracted case
of irritable bladder. The causes of this painful disorder have
met with so clear an exposition at the hands of my friend, Mr.
Gant, in his recent able volume upon the subject, as to render
any further inquiry upon the present occasion unnecessary ;
but I may be permitted to add my testimony to that of all other
physicians who have directed their attention to the subject, to
the increasing frequency of the malad}r, especially amongst the
wealthier classes of society. Indeed it seems to advance pari
passu, with the spread of refinement and civilization, and their
too frequent attendants enervating and luxurions habits. The
success of the treatment in the case referred to was so striking
as to induce me to put it on record, that its efficacy may be test-
ed by other experimenters ; especially as, since its discontinuance,
now more than six months ago, there has not been any tenden-
cy to relapse.

The patient was a married lady, without family, about thirty
years of age. Some five or six years ago she had suffered from
acute dyspepsia, but shower-baths and horse exercise had com-
pletely cured her, and she had enjoyed uninterrupted good health
until about two years ago, when she was suddenly, and without
any assignable cause, attacked by the complaint for which she
first consulted me in August, 1858. Previously to its com-
mencement, which was in May, 1857, she had always slept

710 On the Employment of Extract of Belladonna. [October,

remarkably well, and had seldom or never been disturbed during
the night; but during the last fifteen months, the irritability of
the bladder had been so great as to render the immediate evacua-
tion of its contents imperative at least three or four times during
the night, and often as frequently as seven or eight times, or
even more. During the day there was little or no irritability,
and the quantity of urine passed was normal, or nearly so ; but
in the course of the night, two or three times the natural amount
was passed, pale, insipid, and when tested, free from sugar, albu-
men or other abnormal constituents. The combined effects of
the loss of rest and the drain of fluid from the system had mate-
rially affected her general health. She had lost flesh, and suf-
fered much from thirst, headache, and nausea, especially upon
rising in the morning. She was much depressed in spirits, and
took a desponding view as to the ultimate result of the malady.
I prescribed successively the tincture of the sesquichloride of
iron, compound tincture of valerian, tincture of hyoscyamus,
liquor potassas, diluted mineral acids, sea-bathing, and change
of air and scene, without the least amelioration of the symptoms ;
and upon her return to town at the commencement of October,
I decided upon giving the extract of belladonna a trial. She
began taking it in doses of the twelfth of a grain three times a
day, in the form of a pill, and was at this period always dis-
turbed four or five times in the course of the night, and often
much more frequently. The belladona was at once increased
to a third of a grain three times a day, or a grain in all, as soon
as I found that its use was not forbidden by any peculiarity of
constitution. These doses were continued for about six weeks,
(with the occasional intermission of a day or two.) at the expi-
ration of which period its toxical effects began to manifest them-
selves; for though the pupils were not dilated, yet vision was
not normal ; black spectra appeared; the mouth and fauces
were parched and dry, and there was occasional nausea. Al-
ready the improvement in the symptoms was decided ; my
patient slept better, and was never disturbed more than three
times in the night.

As it is a recognised fact, that in order to obtain the full
amount of benefit from the belladonna, it must be pushed until
its specific symptoms are quite established, I now increased the
daily amount taken to a grain and a half, in the proportions of
half a grain in the morning, and one grain at nine P. M. In the
couse of three or four days, the pupils became dilated, the nausea
extreme, and there were repeated efforts to vomit, for the most
part ineffectual, but occasionally followed by a little glairy mu-
cus. The irritability of the bladder became almost entirely sub-
dued ; she was disturbed once only, or at most twice, through-
out the night, and the quantity of urine passed was normal, or

1859.] Different Modes of Pa fanning Lithotomy. 711

only occasionally slightly increased. The belladonna was at
once discontinued, the general health rapidly improved, and
during the past six months the cure has been permanent, and
my patient has continued perfectly free from any recurrence of
her distressing complaint, except that a slight tendency to irri-
tability of the bladder manifests itself now and then, for one or
at most two nights in succession, but passes away of itself, and
is not of sufficient consequence to require any treatment. [iVoi*
folk Crescent, and London Lancet.

Different Modes of Performing Lithotomy in the English Hospitals.

A large majority of English Surgeons employ trie ordinary
lateral method of lithotomy on a curved staff'. There has been,
however, a considerable disposition to endeavor to improve on
it of late years. The median plan, so strongly recommended
by Mr. Allarton, has been tried by not a few London Surgeons,
and amongst provincial ones has found a warm advocate in Mr.
Teale, of Leeds. At the London Hospital it was first adopted,
by Mr. Ward about two years ago, and since then has been em-
ployed by his colleagues, Mr. Cntchett and Mr. Gowlland, each
in a single instance. All the three patients were children, alb
recovered well, and in all it was considered that much less than
the usual amount of bleeding took place. At Guy's Hospital,
Mr. Cock has performed median lithotomy several times, and
Mr. Erichsen has done the same at University College Hospital,
both Surgeons being, we believe, well satisfied with its results.
On all hands it was considered to be the best adapted for chil-
dren and for small stones. At St. Bartholomew's, Mr. Lloyd
still continues to operate in all cases by his recto-urethral (me-
dian) method, which was described in detail when he first adopt-
ed it in 1853. He informs us that he has not yet lost a case
after it, and considers it decidedly preferable to the lateral
operation. His colleagues, however, without exception, we be-
lieve, always employ the latter. At the Metropolitan Free,
Mr. Hutchinson always employs his rectangular catheter-stafl^
and considers that he obtains great advantage from it. Tire
same instrument has been employed at King's College, by Mr.
Lee, but it is not, as far as we observe, in use at any other Hos-
pitals. In a recent instance in which the calculus was of large
size, Mr. Hutchinson injected the bladder with oil instead of
water, in the hope of facilitating the dilatation of the pa

With regard to the ration as advised by Mr. Al-

larton, it is universally admitted to be :i dap ted only for small
calculi. Now Mr. Lloyd's experience during the last few
has quite proved, that when the anterior coniniissure of the

712 On Different Forms of Syphilitic Inoculation. [October,

sphincter ani is cut clean through from the perineal wound,
there is no danger of the parts not healing. Might it not be
well, therefore, to adopt this measure whenever, after the usual
median incisions, the stone has been reached and is found too
large for removal ? Mr. Lloyd's operation gives abundance of
room. [Med. Times and Gazette.

On Different Forms of Syphilitic Inoculation.

The object of this paper was to show that primary syphilis does
not always commence in the same way. The " specific pus-
tule," in which all syphilitic diseases were formerly said to ori-
ginate, is produced by one kind of syphilitic inoculation only,
and that form is one which does not give rise to constitution-
al or secondary symptoms. As nearly all the experiments on
syphilization had been performed so as to produce this pustular
variety of the disease, it follws that no fresh constitional syphi-
litic disease can be engendered by syphilization so practised.
The kind of syphilitic sore which infects the system, commences
in a different way, and when not artificially irritated, it gives
rather to the adhesive than to the suppurative form of inflam-
mation. This form of disease Mr. Lee has shown, in 1856, to
be, as a rule, not inoculable upon the person who had it. This
view had more recently been confirmed by the researches of
French Surgeons. But although not ordinarily inoculable like
the suppurating form of the disease, yet it was capable of being
rendered inoculable by artificial irritation. The results of the
inoculation were, however, then uncertain in their results, pro-
ducing little local irritation, and capable of being transmitted
by successive inoculations a very limited number of times.
These observations applied only to inoculations performed upon
the individuals who had at the time, or had previously had,
infecting sores. The author described one kind of suppurating
sore which was surrounded by induration, which could n6t al-
ways be distinguished from the induration of the infecting sore.
The induration could not, therefore, always be taken as the
diagnostic mark of a sore which would infect the patient's sys-
tem. The character of the secretion, however, gave the infor-
mation which the induration did not always give. If care were
taken to prevent any accidental cause of irritation, the secretion
from an infecting sore, would soon cease to be purulent, where-
as, in the suppurating sore surrounded by induration, (the phleg-
monoid variety of suppurating sore,) the secretions would con-
tinue, as in other forms of suppurating sores, puriform to the
last. The number of cases of indurated sores which had been
said to have been inoculated by Dr. Sperino and others, led to

1859.] Supporting Stumps after Amputation. 713

the cod elusion that the two forms of disease now described, had
not been distinguished from each other. It was now ascertain-
ed that the infecting sore could not, as a rule, be inoculated upon
the patient having it, whereas the plegmonoid variety of the
suppurating sore, was of all kinds the most readily inoculated.
When inoculated artificially, it produced a pustule containing
well-formed pus within forty-eight hours, and it was occasion-
ally followed by an eruption of a brick red colour, confined to
one part of the body,, disappearing spontaneously, and not re-
curring. This eruption was, therefore, certainly not syphilitic.
The various points in the paper were illustrated by experi-
ments, drawings, and tables of cases. [London Lancet.

Useful Plan of Supporting Stumps After Amputation.

At Guy's Hospital for the last two years, Mr. Hilton has been
in the habit of supporting the stumps of amputated thighs in a
manner which is worth}- of notice, from its cleanliness and con-
venience, together, with the comfort accruing to the patient.
It consists in applying a short and broad splint under the stump,
which is elevated at an angle of forty degrees ; beneath the
splint is a small cushion, and a light bandage is applied over all.
This permits of examination and dressing without the slightest
disturbance to the patient, the stump always looks clean and
healthy. The cases in which it is at the present moment em-
ployed, are the following :

A. young man, twenty-two years of age, was admitted on the
23rd March, for extensive pulpy degeneration of the synovial
membrane of the left knee, with incipient disease of the lungs.
The former had existed for twelve months, and was making
rapid inroads upon his health. The thigh was removed at its
upper third on the 23d ultimo ; and when we examined the
stump on the 5th instant, it had almost entirely healed, and
looked remarkably clean and healthy from the way in which it
was put up. The phthistical symptoms have completely sub-
sided.

A second case was that of a man, aged forty-eight years, who,
as we gather from the notes of Mr. Tuck, his dresser, was kick-
ed by a horse on the knee, twenty-one years ago, causing, at
that time, a wound over the patella. He has been subject to
frequent attacks of pain and swelling ever since. Three v
ago the symptoms generally increased. Seven weeks back an
abscess was opened at the side of the knee, and subsequently
two openings had to be made to let out pus from the joint.
The bones were much diseased, and he had suffered most acute
pain. Considering his age and other circumstances, Mr. Hilton

714 Editorial [October,

thought the most prudent course was amputation through the
thigh, which be performed on the 5th instant, under chloroform.
When placed in bed, the stump of this patient was carefully
put up by Mr. Tuck in the manner already described, and we
learn he is going on extremely well. [Ibid.

EDITORIAL AND MISCELLANEOUS.

Medical College of Georgia. It will be seen by the Twenty-
eighth Announcement, published under cover of our July number, that
the Annual Lectures in this Institution " will commence on the first
Monday in November next, with a general Introductory by Professor
Joseph Jones." The prospects of the College for a large and intelli-
gent Class are most encouraging. Students arriving in the city, will find
the Registrar, Dr. Charles Palmedo, in the College Library, who will
introduce them to the several members of the Faculty, and assist them
in procuring desirable board. Important improvements have been made
in the College edifice, and the comfort and convenience of the Class have
had a large consideration by the Trustees, in their new arrangements.

Prizes to Medical Students Their Value. There is a charm in
emulation, and the hope of winning honorable distinction, though not the
highest, is yet a very potent, stimulus to our best exertions. " Emulation
and the love of Honor," says one of great experience in teaching,* " con-
stitute the appropriate stimulus in Education." 'In learning,' says the
wisdom of Bacon, ' the flight will be low and slow without some feathers
of ostentation." Mental exercise is ever sure of its reward. "The
Gods," says Epicharmis, " sell us every thing for toil." "We may enter
the lists and contend vigorously for the prize straining every nerve,
we may reach the goal, barely in time to see another hand grasp the
treasure which was so nearly our own in disappointment we turn away,
but seldom are we disheartened at the contest; instead of being tired
and weary, and weakened, we have been strengthened by the energy put
forth ; we have measured arms, may be, with a giant, and though we
did not conquer, we feel that, but another trial, is the condition of suc-
cess. The sure rewards of labor are first the pleasure which comes in
energizing, and next, and far more important, the increased power and
desire to energize again. " The intellect is perfected, not by knowledge,
but by activivity," is the dictum of one no less than Aristotle himself.

We find in the last Annual Announcement of the Medical College
of Georgia, that encouragement is offered their Class at the approaching
session, in the following terms :

* Sir William Hamilton. Lectures, p. 636.

1859.] Editorial 715

"The Faculty of the Medical College of Georgia, ever desirous of cul-
tivating a high degree of Scientific and Literary excellence among their
Graduates, have established prizes for the competition of the Class.

At a meeting of the Faculty, held February 2Gth, 18.59, it was

Resolved, "That at all future Commencements, a gold medal, of the
value of Fifty Dollars, ($50,) be awarded to the writer of the best Thesis,
and one of Twenty-five Dollars, ($25,) to the second best." [Extract
from Minutes."

We highly approve the measure, and confidently predict a marked
improvement in the style and value of the Theses of the approaching
session in November.

Origin of Plants. A Hint to those whom it may Concern. The
following list of Indigenosities, (everybody has a right to coin words we
believe these days,) reminds us of the student-experience of one, who,
though now a distinguished Professor, was once, it appears, often at a
loss when questioned as to the origin of Medicinal Plants. He finally says,
that he fell upon an expedient in which guessing was the basis-element.
He found that most of the potent vegetables of the Materia Medica, at
that time, say, near thirty years ago, came from a particular region ;
and therefore, whenever asked by his Professor where such, or such is
indigenous, his invariable and confident answer was, " From the South
of Europe, Sir !" He seldom failed to give satisfaction, nor did the
wisdom of his Philadelphia Professor ever even suspect the ruse.

He is himself now, as we have said, a Professor, and, we believe Ma-
teria Medica is his department. Would it not be curious if some of his
own pupils should in their turn, gain his commendation by a similar
device ? Remember then, " The South of Europe," more physic comes
from there " than is dreamed of in the philosophy " of most students.
Verbum sat.

Origin of Plants
Madder came from the East.
Cellery originated in Germany.
The chesnut came from Italy.
The onion originated in Egypt.
Tobacco is a native of Virginia.
The nettle is a native of Europe.
The citron is a native of Greece.
The pine is a native of America.
Oats originated in North Africa.
The poppy originated in the East.

Rye came, originally, from Sardinia. |

Parsly was first known in Sardinia.
The pear and apple are from Europe.
Spinach was first cultivated in Arabia.

716 Miscellaneous. [October,

The Sunflower was brought from Peru.

The Mulberry tree originated in Persia.

The Gourd is probably an Eastern plant.

The Walnut and Peach came from Persia.

The Horse Chesnut is a native of Thibet.

The Cucumber came from the East Indies.

The Quince came from the Island of Crete.

The Radish is a native of China and Japan.

Peas are supposed to be of an Egyptian origin.

The Garden Cress is from Egypt and the East.

Horse-radish came from the south of Europe. [Exchange.

Ingenious Device. We notice in a New York newspaper, an adver-
tisement, half a column long, headed ' Health of American Women,"
setting forth the virtues of the " Graefenberg Medicines." The proprie-
tor of these medicines, or the " Graefenburg Company," represented by
Dr. Bridge, a " regular physician of fine attainments and of great judg-
ment and discrimination in the treatment of disease," offers testimoni-
als " from the Governors of two States, the Chairman of the Board of
Health of New York, one of the Surgeons-in-chief of the Bellevue Hos-
pital, many clergymen including the Rev. N. Bangs, D. D., the head
of ihe Methodist Church ; the State Chemist and Assay er of the State
of Massachusetts ; the Mayor of New York City ; the United States
Commissioner to Great Britain ; the proprietor of Barnum's Museum,
arid many other public men," &c. There is nothing surprising in all
this, for many of the above names are attached to other quack medi-
cines, and there is a frankness in placing the proprietor of Barnum's
Museum" on the list, which is quite refreshing. We confess, however,
we were not a little surprised to see the names of several of the most
eminent New York medical men appended to the advertisement.
While we were wondering how these names could possibly have been
procured, a closer examination showed that though they are printed in
a conspicuous manner, so as to appear at first sight, as if endorsing the
wonderful virtues of the Graefenberg medicines, there is in reality no
fraud, since it is only stated that " convincing and unanswerable argu-
ments have been addressed to the leading physicians and surgeons of
the day, prominent among whom were Dr. Valentine Mott, President
and Professor of Surgery," and half a dozen others. We do not know
what reply these gentlemen made to the convincing and unanswerable
arguments, but the Graefenberg Company has not seen fit to publish
them, perhaps with a view of persuading the public that " silence gives
consent." [Boston Med. and Sur. Journal.

Dr. S. D. Gross, Professor of Surgery in the Jefferson Medical College,
has been elected to the Surgical Department of the Howard Hospital, to
fill the vacancy caused by the resignation of Dr. R. L. Madison. The duties
of this position are divided between Dr. D. D. Clark and Dr. Gross. [Ibid.

The Reportoire de Chimie says that the Ailanthus Glandulosa, or Ja-
pan varnish tree, yields a fixed oil, which is a powerful vermifuge.

1859.] Miscellaneous. 717

Alcoholic Extract 0/ Mezereum. By treating with alcohol the fresh
bark of Daphne mezereum, a dark green extract is obtained, of a burning
acrid, bitter, and at the same time sweetish taste. Water extracts from
it a brown red fluid, consisting mainly of sugar, daphnin, malate of po-
tassa, salts of lime, and magnesia, but still retaining some acrid taste.
By dissolving the residual green resinous matter in some alcohol, so that
it becomes of the consistency of honey, by evaporation in the air, a
strong preparation is formed, possessing the rubefacient property in a
high degree, and which may be used as a salve or spread upon silk or
other material.

By treating such an alcoholic resinous solution with an alcoholic solu-
tion of potassa, a milky green fluid is formed upon the addition of
water, and on adding to this dilute hydrochloric acid, light green floccu-
li precipitate, perfectly soluble in alcohol when washed, and possessing
the same acrimony. This shows that the resinous matter particularly
possesses the rubefacient property, and that it is not destroyed by the
process of saponification. [Wittsteirts Vierteljahresschrift, and Penin.
Independent.

Syrup of Coffee for Whooping Cough. When whooping cough has
resisted the agents most ordinarily used, the following syrup, which is the
formula given by M. Delahaye, slightly modified, will be used with full
success. We have experimented very often, says Dr. Courbassier, in the
localities where whooping cough appears each year with an epidemic
character, and it has rarely failed us. Here is the mode of its preparation :

Take eight ounces of Mocha or Martinique coffee, slightly browned, in
powder ; treat by displacement with boiling water, so as to obtain six-
teen ounces of infusion.

Dissolve in this liquid, alcoholic extract of belladonna, alcoholic ex-
tract of ipecac, of each 3 1 1-4 ; alcoholic extract of chinchona, gr. xxxvj ;
add sugar gxvj. Digest on a water bath, and filter.

The dose for children of three or four years is a tablespoonful repeat-
ed three times a day. Under this age, the dose should be reduced one
half. [Revue de Therapeutique, and Ibid.

Atropine in Epilepsy. Dr. Maresch, of Vienna, administers atropine
to epileptic patients in the following manner : he dissolves a grain in five
hundred drops of rectified alcohol, and of this solution he gives from five
to ten drops, (from one hundredth to one thirtieth of a grain). This
dose is administered every day from sixty to ninety days, without inter-
mission, and then is to be resumed after an interval of from thirty to
forty five days. Coffee, tea, and chocolate must be excluded. It favors
menstruation, rarely induces constipation, more frequently diarrhoea,
during which it must be suspended. (Translated from L'Union Med.,
by Dr. S. E. Chaille.) [N. Y. Med. Press.

Formula for Mentagra. Administer the usual general medidines,
and when the scabs have fallen away, use the following solution :
ft Zinci Sulph. ss. Cupri Sulph. 3j.

Aquse Distillat. Oj. Aquae lauro-cerasi gss. M. [Ibid.

718 Miscellaneous. [October,

Artificial Pupil Iriddesis. The usual way of operating for artificial
pupil is often clumsy ; the pupil is too large and irregular, and often too
near the cornea. You cannot regulate the size and place by the old
method. Try a new way by tying the prolapsed iris in the following
way: The patient, if at all restless, being placed under the influence of
chloroform, the wire speculum is inserted, and with a pair of forceps, a
small fold of the conjunctiva close to the cornea is held, so as to fix the
eye. An opening is then made with a broad needle through the mar-
gin of the cornea, close to the sclerotic, and just of sufficient size to ad-
mit the canula forceps ; with it a small portion of the iris, near, but not
close to, its ciliary attachment, is seized and drawn out to the extent
considered necessary to enlarge the pupil ; a piece of fine floss silk, pre-
viously tied in a small loop round the canula forceps is slipped down
and carefully tightened around the portion of iris made to prolapse, so
as to include and strangulate it. This manoeuvre requires a little prac-
tice and dexterity, and is best accomplished by holding each end of the
silk writh a pair ot small forceps with broad extremities, bringing them
exactly to the place where the knot is to be tied, and then drawing it
moderately tight. A single tie is sufficient ; the ends are then cut off,
and the operation is complete. Little or no irritation usually follows.
The small portion of iris included in the ligature, speedily shrinks, leav-
ing the little loop of silk, which may be removed from the eye about the
second day. By this method, the size, form, and direction of the pupil
can be regulated to a nicety. (Mr. Critchett, p. 242). Braith. Retro.

Premonitary Symptoms and Treatment of Diphtheria. Symptoms
are a deposit of white putty-form membrane about the isthmus faucium,
or between the anterior pillar and the tonsil, with generally slight con-
stitutional disturbance ; the cervical glands generally enlarge about the
fourth day, earlier than in sclarlatina; tongue foul, but not punctated
as in scarlatina ; nose full and tumid, and sometimes a slight acrid dis-
charge from the nostrils ; prostration, without typhoid symptoms ; pupils
lax ; pulse feeble ; albumen sometimes found in the urine, more fre-
quently in the late stages. Death takes place generally about the
eighth day.

Treatment. Destroy the patches with solid nitrate of silver, once or
twice if necessary. It may be necessary to administer a large dose of
calomel in the early stage ; pencil the enlarged glands with nitrate of sil-
ver: follow first dose of calomel with aperients, till the evacuations are
regular ; fresh air, abundant food and stimulus, and especially after the
sixth day keep the patient fiat ; give muriatic acid with chloric ether every
few hours, or full doses of ammon. sesquicarb. (Dr. S. Monckton, in
Medical Times and Gazette.) N. Y. Med. Press.

Insanity Among Negroes. In Louisiana, the proportion of insane
negroes is 1 in 2,477 ; in South Carolina, 1 in 2,999 ; in Massachusetts,
1 in 43 ; in Maine, 1 in 14 ; showing conclusively that freedom does
not agree with an African's understanding.

The deaths among the Africans in New York, are twice as numerous
as those of the whites in the same city. The number of the black popu-

1859.] Miscellaneous. 719

lation in the West India Islands is steadily and rapidly decreasing. The
disease from which the greatest mortality proceeds, is pulmonary con-
sumption, arising, it has been suggested, from the want of adequate nu-
triment, in the most fertile section in the world, but which the African
is too indolent to cultivate. It is computed that, at the present rate of
diminution a tenth part of the whole population every four years the
negro race will have almost ceased to exist in the British West In-
dia colonies, before the termination of another century. [Rich. DispatchT
and X. T. Med. Press.

Hernia. Wiifzer's Operation. The needles in present use are too
short, and apt to slip. They should be at least six inches long. The
instrument should not be withdrawn at an earlier period than eight
days, and not later than fourteen days. The instrument may be made
of much lighter materials than usual, as malacca or bamboo cane, or
metallic cylinders with a central tube for the needle. If within five or
seven days no discharge of epithelium, fat, or serum appears from the
invaginated scrotum, some preparation of cantharides, as the emp. or
acet. lyttje should be introduced. (Mr. E. Lister, p. 180.)

Radical care of Femoral Hernia. Several interesting cases of the
radical cure of femoral and ventral hernia are related ; they are the
first attempted in this country. The mode of operating was the follow-
ing : The patient being on his back, and the buttocks well raised, the
hernia is returned, the little finger being carried well through the crural
canal and femoral ring. A well-curved c .inula needle is carried on the
finger, and its point made to press against the abdominal parietes; the
needle is then thrust through them, and a silver wire being passed into the
eye, it is drawn through. A small piece of vulcanized India-rubber,
about the size of a split pea, is attached to the crural end, and fastened
by means of a split shot ; the other extremity is then passed through
another piece of rubber about the size of a florin, and the two extremi-
ties drawn tightly together and fastened by a split shot. A portion of
integument is thus drawn into the canal, and by an incorporation of this-
invaginated-plug with the borders and surfaces of the crural canal, the
radical cure is effected. The wire may be loosened on the eighth or
ninth day. From the cases related (six in number,) the conclusions
arrived at are : that this is an operation " unattended with danger ;,y
that "though the peritoneum be wounded (even in three places,) its per-
foration is innocuous.*' (Mr. R. Davies, p. 180.) Bra'dkwaite's Retro.

Hereditary Influences in the Production of Insanitij. Hereditary in-
fluences, striking as these often are, really exist in but a very small pro-
portion of all the cases of insanity ; and even where they do, the indi-
vidual who is strictly mindful of natural laws, avoids excesses of alf
kinds, and is happy in his domestic and social relations, may be really
much better off than those who lead a different kind of life, and yet
have never known an ancestor to suffer from such an affliction. Dr.
Kirkbride's Hospital Reporter, and Vir. Med. Journal.

720 Miscellaneous. [October,

Formula for the Combination of Nitrate of Bismuth with Copaiba
and Cubebs. According to the observations of M. Caby, the nitrate of
bismuth combined with balsam of copaiba and powdered cubebs, posses-
ses the property of neutralizing the irritating effects produced habitual-
ly by these medicines on the digestive canal. The formula which is em-
ployed at the. Hospital of St. Lazare is a mixture of equal parts by
weight of balsam of copaiba, powdered cubebs, and nitrate of bismuth,
with some essence of peppermint as a flavouring ingredient. This com-
bination is said to be supported easily by the most delicate stomachs ;
there is no excitement, epigastric heat, or diarrhoea, so that the action
of the medicines being entirely concentrated upon the genito-urinary
passages, the desired results are more rapidly and easily obtained. [Bul-
letin Generate de Therapeutique, from Brit, and For. Med. Chir. Rev.

Formula for a New Elixir of Pepsine. The syrup of pepsine, recom-
mended by M. Corvisart, not being capable of preservation for a long
time, and the elixir of Garus having a disagreeable taste, M. Mailhe has
invented a formula of pepsine associated with wine, alcohol and sugar,
in sufficient quantity to conceal the peculiar taste of the ferment. The
proportions are six grammes (about 3iss.) of amylaceous pepsine, twenty-
four grammes of distilled water, fifty-four grammes of white wine of
Lunel, thirty grammes of white sugar, and twelve grammes of spirits of
wine. This elixir has a very agreeable taste, and women and children
can take it with pleasure. It is administered immediately after each meal,
in the dose of a tablespoonful, containing exactly the quantity of pepsine
necessary for digestion, namely, one gramme (about fifteen grains.) Ibid.

On an Inexpensive Mode of Administering the Protoiodide of Iron.
The protoxide of iron has been given in the form of pills, syrup, or oil.
The first two furnishes good preparations, but they are expensive, and as
the treatment with iodide of iron often requires to be long continued,
the poorer classes of patients are sometimes obliged to abandon its use.
The mode of administration reeommended by a Belgian pharmaceutist
is by preparing a solution of iodide of iron in such proportions that one
or two drops represent five centigrammes (about one grain) of the iron
salt. This is preserved in a stoppered bottle, and some iron filings are
added, in order to preserve it from decomposition. When the solution
is to be used, one or two drops of it are poured either upon a piece of
sugar or in a spoonful of water, beer, or gruel. [Ibid.

On the Combination of Iodine and Sulphur by the Medium of Oil.
The combination of iodine and sulphur having very little stability, M.
Vezu, a pharmaceutist of Lyons, has proposed to combine the iodine and
the sulphur by dissolving them each separately, beforehand, in oil of
sweet almonds. The sulphur is heated in the oil until it is dissolved, but
the iodine is dissolved in the oil while cold. The resulting compound
has the taste and smell of heated oil, and has a chestnut colour.[ Ibid.

La Charite. MM. Andral and Rayer have resigned their positions as
Physicians to this institution, which they had so long held with credit
and honor.

1859.] Miscellaneous. 72l

Ipecacuanha and Delirium Tremens. The jail physician of Chicago
has had 100 cases of delirium tremens the past year, of which only four
proved fatal. Of his manner of treatment, the doctor says Ipecacu-
anha, which I have tried in thirty-six cases, I found most remarkably
successful, quieting the nervous system, exciting the appetite, acting on
secretions, and uniformly producing sleep. "When a case is not of too
long standing. I give it as an emetic the first dose, and afterwards I give
from 15 to 18 grains every other hour. Connected with this remedyT
I use shower-baths, and let the patient drink strong beef-tea, without arnr
alcoholic stimulants." [Newspaper.

Atropia in Tetanus. The editors of the Semi-Monthly M
report the successful treatment of a case of tetanus with atropia, in dosei
of one-twentieth of a grain, repeated every third hour until narcotism
was produced. They say. "So far as the illustration of its influence in
the treatment of this case furnishes us authority for speaking, we are
satisfied that our appreciation of atropine, as a remedy in tetanus,
cannot be overestimated. It subdued time and again, with a prompti-
tude and a measure of extent too striking to be mistaken, the increasing
spasms, and soothed the general excitement of the system. [Ibid.

The Leniceps. M. Mattie, presented very lately to the Academy of
Medicine of Paris, an instrument for the extraction of the child, which
differs from the m ordinary forceps, by being very short, and by the
branches locking upon a transverse wooden handle. The inventor con-
siders that his instrument does not frighten the mother, as it may be
used without her knowledge, and that it acts very gently upon the child.
He therefore proposes to call it leniceps (leniter capiens,) in contradis-
tinction to forceps (fortiter capiens). London Lancet and Vir. Med.
Journal.

Itching of the Anus. There are few things more distressing and
troublesome. Use the following ointment : Glycerine, one ounce ;
purified tar, half a drachm ; and with the aid of heat, powdered starch,
half an ounce. This makes an ointment of thin consistence, and easily
spread. It dries up excoriations, checks exhalation, and dissipates slight
cutaneous phlegmasia^ Another preparation of pitch is the following :
Cod-liver oil, two parts; oil of pitch, one part; used for itching and ex-
coriations, as the other. (M. Gilbert, p. 185.) [Braithicaite's Retro.

Mal-assimilation in Children. Sometimes a pallid cachectic emacia-
ted child will in a few days gain some pounds in weight, after the ope-
ration of a brisk cathartic. What explanation can be offered of this
fact ? If the intestines of such children be examined, the mucous absor-
bent surface will be found to be covered by a thick tenacious mucus,
completely preventing assimilation of the chyle. A brisk cathartic, es-
pecially calomel, which may be combined with rhubarb and scanimony,
will wash this away, and the lacteals thus be left free to absorb the chyle,
with which, for the first time thev come in contact. (Mr. M. Henry, p.
264.) Ibid.

722 Miscellaneous.

Anodyne Liniment in Otitis. M. Trousseau recommends the follow-
ing liniment in acute otitis, namely a mixture of the alchoholic extract
of belladonna in water, with glycerine. A cotton ball, soaked in the
mixture, to be placed in the external auditory canal.

Strange Provisions in a Will. It was lately announced at a parochi-
al meeting in St. Mary-le-bone, says the Lancet of June 25th, that Mr.
William Kensett, a well known reformer of that parish, who died of
cholera in Paris, had stipulated in his will that his body should be given
up to one of the Medical Colleges of the metropolis, for dissection, and
that his bones and remains should then be handed over to the Imperial
Gas Company, on condition that they consumed them in one of their
retorts. [Med. and Surg. Reporter.

Serous Bronchocele treated by Puncture. The cystic variety of bron-
chocele is interesting from its rarity as compared with the hypertrophy
of the thyroid gland.

A young woman was recently admitted into King's College Hospital,
with a considerable enlargement of the thyroid, but mainly depending
upon the presence of a cyst, which had been progressing for 15 years.
The growth was prominent and well defined, soft and fluctuating.

Mr. Fergussen after giving chloroform divided the super-strata of tis-
sue, and then the cyst, when out gushed a large quantity of dirty, brown-
colored, serous fluid. The cyst was stuffed with lint, and compresses
and bandage applied. [Ibid.

Condylomata. In those raised patches of skin, known as mucous tu-
bercles, or condylomata, existing about the verge of the anus, and around
the genitals, but especially those which are wide spread and flat, the ap-
plication of a powder, consisting of equal parts of savin and alum, will
be found very successful in producing diminution of the swelling, and
causing them to dry up. [Braithwaite 's Retrospect.

Lepra Inveterata. In the treatment of this most obstinate affection,
much will be gained by a proper regulation of the diet. Bread, milk,
eggs, and vegetables, as potatoes, water cresses, &c, should alone be
allowed, and all alcoholic drinks avoided. A warm bath twice a week
is of the greatest use. The medicinal means principally of use are,
arsenic, bichloride of mercury, and iodine, for which the decoction of
elm bark forms a good vehicle. An ointment containing calomel and
pitch, is one of the best local applications. (Dr. Willshire, p. 230.)-[Ibid.

Poisoning by Mercurial Vapor. The Pacific Med. and Surg. Journal
reports a case of mercurializng by being exposed to volatilized quick-
silver, in the operation of burning it from the amalgam, which is the
practice in the gold mines of California.

Gonorrhoea and Leucorrhcea. In weak and lymphatic subjects, injec-
tions of the perchloride of iron have been tried with success, the propor-
tion of the perchloride being twenty drops to three ounces and a half of
water. (M. Demarquay.) London Lancet.

SOUTHERN

MEDICAL AND SUBGICAL JOURNAL.

(NEW SERIES.)

Vol. XV.] AUGUSTA, GEORGIA, NOVEMBER, 1859. [No. 11,

ORIGINAL AXD ECLECTIC.

AKTICLE XXV.

An Essay on tlie Adaptation of Climate to tlie Consumptive, for a
permanent residence; embracing an Examination of the climate
of certain localities of frequent resort; and also, an Investigation
of the degree of adaptedness of the Pacific Climates of the United
States. Presented to the Medical Society of the State of Geor-
gia, at its annual meeting, held at Atlanta, April 13th, 1859*
By William Henry Doughty, M. D., of Augusta, Ga.
(Ordered to be printed.)

(Continued from August No. page 625.)

The State of Oregon, and that portion of Washing*

ton Territory upon the Coast, as contrasted

with the Columbia Valley.

In the investigation of the climate of the Pacific slope, increased
difficulties are met at every step, as we advance from California
northward ; because none of those sections at which we arrive
seriatim, have been occupied sufficiently long to admit of a full
comprehension, much less a correct appreciation of their meteo-
rology. Hence, any attempt at their elucidation must be liable
to error, as it is based to a great extent upon those generally
recognised, and controlling physical laws in their various clima*
tological bearings, wrhich have been already adverted to in this
essay. Guided then by these laws, and such of the develop*

K. S. VOL. XV. NO. XI. 51

724 Doughty. An Essay on the Adaptation of [November

ments of the special climate, as have been made, we shall endea-
vor to present, as lucidly as possible, those of the meteorological
features of this portion of it, which influence a residence of the
consumptive there.

One would suppose, that really the differences between Cali-
forniar and the State and Territory north of it, excepting those
due to latitude, would be so small and insignificant, as not to
require elaborate exposure. And, there is much plausibility in
the idea, when regarded in reference to the general investiga-
tions of promiscuous writers ; but when viewed in connexion
with a special examination of its adaptedness to invalids of
peculiar habits, and requiring certain peculiar, unchanging me-
teorological surroundings, we cannot but feel justified in the
attempt, to expose as thoroughly as possible, its meteorological
conditions. Here local conditions, not general ones, are to be
enquired into, and in order to their study, some degree of mi-
nuteness must be descended to.

In the advance up the Pacific slope from California, we ob-
serve a continuation of the same general mountain features, yet
these undergo differences both in the mode of their arrange-
ment, and in the degree of their influence upon climate. The
Cascade mountains, the prolongation of the Sierra Nevada, pre-
serves, by its almost perfect parallelism with the coast, its great
height, its precipitous and abrupt sides, and its power to modi-
fy climate upon the right and left, all of the general features of
the latter range ; yet from a simple change of position some-
what nearer the coast line, it presents manifest differences in the
neighboring climate, since it extends the western limits, of the
arid and bleak interior, and increases the relative humidity of
the coast.

Greater alterations mark the northward extension of the
Coast Kange of California. Having approached the boundary
line between the two States, it is apparently broken down in
all effort at continuity, resolving itself into an irregular plateau
region. And it is not until after having been thus broken
down, that we observe it rising again about the central line of
latitude of Oregon, possessed of sufficient dimensions to alter
the phases of climate. From this point to beyond the Colum-
bia Kiver, it presents the character and appearance of a range

1859.] Climate to the Consumptive, &c. 725

of small mountains. Another noticeable distinction which re-
sults from the respective changes of these two mountain ranges,
is the destruction of that great valley formation between them,
which characterizes the topography of the State of California.
From the point of reappearance of the Coast Range, to the Col-
umbia River, and between the two systems of mountains, there
is an imperfect valley formation, the Willamette Yalley, the
meagre representative of the great conjoined valley to the south,
whose impressibility of climate is not to be compared with the
latter.

Looking to the interior, we also descry some differences in
local topography worthy of notice. Here, the great Columbia
with its forming streams, the Lewis and Clark Rivers, embracing
within the limits of their origin, the entire extent of the territory
to the Rocky mountains, instead of seeking a southern outlet,
as does the Great Colorado River, assumes at the centre of the
area, an almost due-west direction to the Pacific, passing
through the Cascade Range. Again ; near the junction of the
Sierra Nevada, and the Cascade Range, there is a mountainous
extension almost at right angles to them, which reaches across
Washington Territory, nearly to the Rocky mountains. The
Blue mountains of Oregon are also connected with this latter
branch, and they together constitute that elevation of the south-
ern part of the territory, which both yields the precipitation of
the Lewis or Snake River, and determines a northward flow of
its waters.

Besides these, there are material differences in the altitude of
different parts of this interior. Its southern part continues the
great elevation of the plateau of the Great Basin, but towards
its centre, the altitude greatly diminishes to about eight hundred
or a thousand feet, with inclined planes extending to the sur-
rounding mountain bases. In this central depression is the
junction of the two rivers already mentioned, the point at which
the Golumbia River is formed.

A remaining field for an inspection of local differences of cli-
mate, is the circulation of the Pacific waters. We have seen
that the distinctiveness of the climate of California is to a great
extent attributable to a peculiar circulation of the ocean itself.
Wherefore we are led to enquire whether similar peculiarities

726 Doughty. An Essay on the Adaptation of [November,

do not mark that off the coast of this section of the western
slope, or whether the same mode of circulation prevails here
also. The importance of examining this feature, will appear as
we advance. We may therefore ask, do the cold masses or cur-
rents of water, found prevailing along the coast of California,
extend as high up as the State of Oregon ? or in other words,
what is the most northern point on the coast touched by this
mass of water ?

From the few authors which it has been our privilege to ex-
amine on this subject, it is impossible to fix definitely, either the
exact place of origin, the northern or northeastern line of
limit of this cold current, or to define its specific width. Indeed
whilst they have at an early period detected the presence, and re-
cognised the influence of some such controlling climatological
agent, as evidenced in the singularly mild and uniform tempera-
ture of the southern part of the coast ; in the variations of the
summer distribution of heat, in the advance up the coast ; and
also in the differences of the entire coast, as compared with the
west of Europe, (its want of analogy); yet beyond the mere diff-
erences of the absolute temperatures of the waters off the Cali-
fornian coast of the winter and summer, little or nothing is
known. They speak of it in general terms, as originating some-
where "northward and westward from San Francisco," and
"westward of Alaska ;" and recognise " the existence of a gen-
eral movement from the northwest, 'r but do not attempt to fix
its limits, or to particularize its dimensions.

To one in our present line of study, it is a matter of deep re-
gret, that the northeastern boundary line of this summer cur-
rent, has not been accurately pointed out, because where-
ever along the coast it is found to prevail, it exerts a direct in-
fluence, both upon the temperature and humidity of the land
atmosphere, which it cannot exercise indirectly, or by mere
proximity to it. This difference of its effects, authors generally
need not enquire especially into, because the results at which
they aim, are general in their nature, and tend only to the
elucidation of general facts. But when, as in the present case,
those local, but distinguishing features of climate, which are
often observed between places and localities, even under the
same parallel of latitude, or it may be upon the same meridian

1859.] Climate to the Consumptive, &c. 727

of longitude, are to be exposed, a specific designation of the di-
mensions, and the degree of access of such currents, is absolute-
ly necessary, since their effects upon land climates are in direct
relation with them. . Hence the necessity for an endeavor on
our part to give this current other than a general signification
and location.

All perhaps agree that the reduction of the summer tempera-
ture along the Pacific, from thirty to fifty degrees of latitude,
which so greatly distinguishes it from the western coast of Eu-
rope, is due to a great extent to the operation of this mass of
water. But their writings tend also to the presumption that
the effect upon at least one-half of this extent, namely from
forty to fifty degrees, is more or less indirect, and is not effected
by direct contact of the waters with the shore.

Mr. Blodget says, (page 195, Climatology of the U. States,)
" apparently an immense cold current approaches the coast here
at thirty-five to forty-five degrees of latitude, which in summer
exercises a wide and decisive influence on all the included
coasts, its maximum and central point being nearly at San
Francisco." Again he remarks; "but the refrigerating cur-
rent appears to originate westward of Alaska, and to^>ass nearly
due southeast from that point toward the continent in the latitude
of Monterey ; not entering the indentations of the Russian and
British American coasts, probably in any degree," (See page
278.) But in another place, (page 261) this author, while treat-
ing of the distribution of heat for the spring, uses the following
significant language : "for the mean of the three months, the
sea-temperatures observed off this coast,* (Pacific,) are striking-
ly uniform, and they show but little if any advance on those of
winter. For some hundreds of miles on the fortieth parallel, there
is little difference in the sea-temperatures, for the entire year ; and
in spring, such observations as we possess, show them to be
quite the same between the thirty-fifth and fortieth parallels, for
thirty degrees of longitude westward from San Francisco." Yet
again, he says ; " a portion of the coast of Oregon has tempera-
tures noticeably higher, for the brief period of the record there,
which may perhaps prove the position of the cold line to he a little
distance off that coast at sea," (See page 275.) Moreover, he as-

* The parenthetic word is our own.

728 Doughty. An Essay on the Adaptation of [November,

serts, that " the cold current is a comparatively narrow mass
at the point of its rising on the coast, and evidently is not felt
north of the forty-fifth parallel." (See page 118.)

These quotations are sufficient to show,, that this writer was
unable to designate the precise point at which the northern
edge of this current impinged against the continent, nor indeed
to indicate the exact direction of its northern boundary towards
the place of its origin. To say the least, they were not well
appreciated by him, for some of his remarks are somewhat con-
tradictory of each other on these points. To this, however, we
would attach no censure, for the generalized facts of climate as
sought to be developed in the scope of his work, required only
the knowledge of the existence, and the demonstration of some
such controlling refrigerating agent, without regard to any defi-
nite size, and treated of it only in its relation to the entire con-
tinent. Hence there was no need of greater specification, than
has been given to it.

Now with a view of attempting to fix the northernmost point
at which this current touches the coast, amidst the obscurity
with which it is surrounded, we propose to ascend the coast
from San Francisco, and observe the distribution of heat, with
its differences of degree, at such places as have it recorded. It
must not be forgotten, however, that it is not necessary, that
direct contact of the cold waters with the shore should be had,
in order to refrigerate, or to reduce the mean of its temperature
distribution. For, simple proximity, with a general atmospheri-
cal circulation, and other contributing local peculiarities, as
heated plateaus, valleys, etc., may produce such a degree of re-
frigeration as is scarcely transcended by an immediate contact :
For example, if we suppose the northern limit of this current,
to be in a direction due southeast from the peninsular point of
Alaska, and to impinge against the western coast at the fortieth
parallel of latitude, we would not expect its influence upon
that coast, to be limited to that south of the point of contact, but
on the contrary, would look for it many degrees farther north-
ward. Moreover, the direction of the winds which blow over
and about that mass, would deeply affect the result, since they
must inevitably carry away with them the attendant cold sur-
face atmosphere. An analogous instance has already been

1859.] Climate to the Consumptive, &c. 729

mentioned in this paper, in the character of the atmosphere in-
duced by the prevalence of easterly winds along the Atlantic
coast for a few days, during which the air is rendered "sultry,
oppressive, and heavy," by a transfer of these conditions from
the Gulf Stream.

The first post that we meet in the ascent of this coast, is Fort
Humboldt, lat. i0.-i6/, near Humboldt Bay, California, and
eastward two miles from the sea. " The locality is a plateau of
slight elevation, fronting the Ba}*, and fully open to the Pacific."
About a hundred miles interior to this, is Fort Jones, lat. 41.
36^, having a location " not closely confined, though with high
mountains on the south and east."* The first has an altitude of
fifty feet, and the second an altitude of two thousand five hun-
dred and seventy feet. The next station is Fort Orford, in Ore-
gon, lat 42.4r', situated upon a bay with a direct exposure to
the ocean.

The last that we shall introduce to the notice of the reader, is
Fort Astoria, lat. 46. II7, situated on the "south bank of the
Columbia River, near ten miles from the coast of the Pacific.
The locality has a free exposure over water surface and low
plains, to the sea, with rough hills at the south and east"

MEAN TEMPERATURES.

May. I June.

San Franoisco, Cal 55.2J 56.86

Fort Humboldt, " .
Fort Jones, " .

Fort Orford Oregon,
Fort Astoria, "

'o3.94

61.56

54. 8' :
55o.00,59.53

July. 1 Aug. Sept. i Oct. Sum'er-

~ 57. 33
57.T0
67Q.26
59<V95

70.91
o6o.7l 57. 3Q.00

710.50
590.73
61.55

68o.66 62.72 51o.S4
61.09 580.91 540.8S

63Q.76|58.13 55.45 Gl.58

Bearing in mind, that the maximum effect is produced at
San Francisco, the degree of refrigeration should diminish as we
proceed northward. "We have placed the posts in the above
table, in the order of their succession along the coast. Compar-
ing the first two posts, we find, notwithstanding the difference of
latitude, (2.58',) that they manifest great parallelism in the
mean monthly distribution of heat. Indeed there is an identi-
ty of the temperature statistic?, which points unmistakably to
the same active, operating agent at both places. Nevertheless

* We have taken the descriptions from the Army Met. Register.

730 Doughty. An Essay on the Adaptation of [November,

at Fort Humboldt the sea influence does not indicate that inten-
sity of operation, which was noticed at the former station ; for
Fort Jones, one hundred miles in the interior, shows no appre-
ciable effect from this cause. In other words, it does not pene-
trate so far into the interior as in the more southern part of the
State, but limits itself to the immediate coast. Its mean temper-
atures for the summer months are much higher, than those of
either of the preceding posts, and its mean summer temperature
is fully ten degrees (10) greater. It presents in the course of
the mean temperatures then, more of the ordinary manifesta-
tions of interior localities of similar altitude. This confinement
to the coast may be accounted for by reference to the absence
of the San Joaquin and Sacramento Valleys, with their furnace-
like temperature.

Examining the next in the table, FortOrford, whose situation
upon the immediate coast, and direct exposure to the ocean,
makes it a true exponent of the measure of refrigeration at this
latitude, we remark an elevation of two and sixty two hun-
dredths degrees, (2. 62) per month for the summer season over
San Francisco ; and a monthly average of two and seventy
hundredths degrees, (2. 70) over Fort Humboldt. AddiDg Sep-
tember to the three summer months, and taking the average
increase per month, it stands two and thirteen hundredths de-
grees, (2.13) over the first; and two and forty-nine hundredths
degrees, (2.49) over the second. Looking also at the mean
summer temperatures, that of Fort Orford is two and sixty-
two hundredths degrees, (2.62) higher than that of San Fran_
cisco ; and two and twenty-five hundredths degrees, (2.25\
higher than that of Fort Humboldt.

The last post of the table, Fort Astoria, situated near the
mouth of the Columbia River, latitude 46Q.11/ N., shows a still
higher elevation of temperature over these two places, the mean
monthly increase over them for the summer months, being four
and twenty-eight hundredths degrees, (4.28) over San Francis-
co ; and four and thirty-six hundredths degrees, (4.36) over
Fort Humboldt. Adding September to those months, we have
as the monthly average of increase for the four months, three
and eighteen hundredths degrees, (3. 18) over San Francisco;
and three and fifty-five hundredths degrees, (3.55) over Fort

1859.] Climate to the Consumptive, &e. 731

Humboldt. Its mean summer temperature is four and twenty-
five hundredths degrees, (4.25) higher than that of San Francis-
co ; and three and eighty-eight hundredths degrees, (3.88)
higher than that of Fort Humboldt.

Let us recapitulate ; from San Francisco, lat. 37.48', north-
ward 2.58' to Fort Humboldt, we observe a continuation of
the same reduced monthly mean temperatures, with a strict
parallelism throughout the dry season. To this point, the re-
frigerating influence appears to be about the same. Progress-
ing 1.58/ farther northward to Fort Orford, Ave observe a sud-
den and material increase of 2.70 per month, over Fort Hum-
boldt for the summer season ; and from June to September, an
average monthly increase of 2.49 ; also a higher mean summer
temperature by 2.2o. Then continuing 3.27' farther up to
Astoria, we have an elevation of 1.66 per month, over Fort
Orford, for the summer ; and a monthly average of 1.05, from
June to September. Hence we see within a distance of two
degrees of latitude, a sudden elevation of temperature amount-
ing to 2. 70 per month for the summer. And within five and-
a-half degrees of latitude, a mean monthly elevation of 4. 36 for
the summer over Fort Humboldt, and a difference in the sum-
mer means of 3.88. To what may this difference of tempera-
ture within so short a distance be attributed ?

Now perhaps we are better able to locate the northern edge
of this cold current, and to appreciate the point near which its
direct effects cease, and where those of simple proximity begin.
Fort Humboldt certainly falls within the range of its region of
contact, for the slight and mere nominal differences that exist
between it and places five or six degrees of latitude farther south,
afford positive proof of the fact. That it extends any distance
above this point, is exceedingly problematical, for an advance
of not quite two degrees of latitude, gives a much greater- differ-
ence of temperature, than has been noted for at least six degrees
south from that point. And advancing five degrees from this
point, such differences are observed as point to an almost entire
absence of its influences, direct or indirect. It is likely that its
proximity to the coast off Fort Orford, largely affects its tempera-
ture distribution, and prevents the more material and increased
differences, which would otherwise occur between it and Fort

732 Doughty. An Essay on the Adaptation of [November,

Humboldt. Besides if we take as strictly true the remark of
Mr. Blodget, that this cold current passes " nearly due south-
east," from the point of the peninsular of Alaska, and estimate
its breadth at seven or eight degrees of longitude, (the distance
westward from San Francisco, which gives the reduced mean
temperatures); and establish its probable northern line of limit
by this assumed direction and width, it will appear to approach
the United States coast, somewhere between Forts Humboldt
and Orford, latitude 40.46; to 42.44'. We do not presume
that this northern boundary is as distinct from the waters be-
yond it, as some may suppose, or even as distinguishable by the
thermometer, as the Gulf Stream is by the eye from its cold
banks. Yet if it can be represented by a straight line, that
would, we are led to believe, extend from the point of Alaska
to the western coast, at or about latitude 41 N. This then
would bring within the scope or direct range of this current,
but an extremely small portion of the coast of Oregon, and as
has been intimated, prove " the position of this cold line to be a
little distance off " at sea.

Deeming this short and imperfect notice of these surface pecu-
liarities, and the differences of conformation, together with the
difference of the external or oceanic influences, found operating
upon them, sufficient to show the necessity for a separate, careful,
and extended investigation of the climate of this State and Ter-
ritory, we now pass to a notice of the general climatological features
of each locality. The entire area included, extends from latitude
42 to latitude 49 N., and embraces about 15 longitude at its
greatest width, and 11 at its narrowest. The extent of surface
thus embraced, amounts to about three hundred thousand square
miles. The two great ranges of mountains that are found, the
one upon the right and the other upon the left, are most remote
from each other at the southern boundary, and in their northern
course gradually approach each other ; so that having arrived
at the northern limit of Washington Territory, they are nearer
to each other by at least four or five degrees of longitude. The
Cascade Range upon the left, runs almost entirely parallel with
the shore line, which has here a somewhat north-by-east direc-
tion ; whilst the Rocky Mountains on the right, have assumed
a direction a little to the west-of-north. Hence, as actually

1859.] Climate to the Consumptive, dec. 733

occurs higher up in British America, these ranges appear
gradually to run into each other. Both are coutinuous in
their character, and each presents a single interruption in its
course, namely, the South Pass of the Rocky Mountains, and
the perforation of the Cascade by the Columbia Kiver in its
course to the Pacific. They seem to be providential, as if to
facilitate transit across them, and establish relationships between
the two sections on either side.

This disposition of the mountain systems, reproduces the di-
visions adopted in the first clause of our subject, namely the
coast and the interior, and it is in this waj7", that we propose to
treat of it. The coast is a continuation of that of California,
and differs from it only in point of latitude, the extent of its
valley formation, and its width. It will be recollected that the
average in the middle parts of the latter is, one hundred and
eighty miles, and in the northern parts two hundred miles.
Here, however, we suppose that the average width, which is
about the same all the extent of it, is perhaps between one hun-
dred and twenty -five and one hundred and fifty miles. The
coast comprises a part of the State of Oregon, and also a part of
Washington Territory. The extreme south of this coast is an
imperfect plateau formation, and those few small streams that
are formed by the precipitation at this point, find a quick outlet
between the hills into the Pacific. About the centre of this
coast line, the Columbia River discharges its contents into the
ocean, having passed through the Cascade Range seventy or
eighty miles to the east. Between these two points, and the
two parallel ranges, on the ocean side, is the Willamette Valley,
the only attempt at an analogous valley district with that of Cali-
fornia. It has a northern declivity, and takes its name from
the river of the same name, which empties into the Columbia,
probably fifty or sixty miles from its mouth. North of the Co-
lumbia River, no peculiarities occur worthy of special mention.

Of the interior, which comprises all that expansive area north-
ward from Utah to the British possessions, and enclosed between
the Rocky and the Cascade Ranges, we shall treat under the
head of the Columbia Valley. It constitutes the northern-
most part of that interior basin, which Baron Humboldt de-
clared to be " the broad, undulating, flattened crest of the chain

734 Doughty. An Essay on the Adaptation of [November,

of the Mexican Andes, and is not the swelling of a valley be-
tween two mountain chains."*

With slight differences in degree, the same general characters
which were remarked in the Great Basin of Fremont, are here
repeated, or rather continued. There is a similar aridity of soil
and of atmosphere ; beds of alkaline earths, and salt lakes are
still to be seen ; a corresponding scarcity in the amount of pre-
cipitation ; scattered ranges of mountains here and there; the
same vegetable productions, namely, the artemisia and the cac-
tus, the sure exponents or indicators of a soil and atmosphere,
unsuited to the cultivation of the higher forms of vegetation ; and
finally, there are similar changes of temperature, accumulated
heat in the day and as excessive cold in the night, thus making
an extreme daily range of the thermometer the rule, and not the
exception. Periodicity, according to Mr. Blodget, still marks its
seasons, although he asserts that more or less rain may fall all the
year round. Near the junction of the Sierra Nevada, with the
Cascade Range, there is a mountainous extension almost at right
angles to them which reaches nearly across the valley to the
mountains on the right ; farther interior but connected with this
lateral arm are the Blue Mountains of Oregon ; and in the east
from the lateral projection of the Rocky Mountains, is an off-
shoot, the Bitter Eoot Mountains, which juts out into the eastern
part of this valley. It is within the area enclosed by these lat-
ter ranges, that is found the southern head of the Columbia
River, the Lewis or Snake River, whose transit through this
region is secured by those mountain gorges, denominated can-
ons by the Spaniards, and which also characterize the entire
plateau region s.f

Special Climate.

It would be entirely superfluous to dwell here upon the gen-
eral features of the spring climates, after all that has been said
in connexion with the general climate of the Pacific slope.
Those most interesting to us have been already noticed in
the investigation of the climate of California and its contigu-

* (Aspects of Nature.) See Blodget, page 113.

f " The Colorado of California and its great branches, the Grand and Green
Rivers, traverse these gorges through their whole course to within three hundred
miles of the sea." (Blodget.)

1S59.] Climate to tJte Consumptive, dc. 735

ous Territories, and also under the general consideration and
comparisons of it with the eastern slope, and the southern of
Europe. The variability of the coast here is greater than that
of California. Along the coast the rate of advance from month
to month is much more gradual than in the interior the dif-
ferences of alternate months, being scarcely greater than those
of the succeeding months. At Fort Orford, on the southern
part of this coast, the least difference in this monthly advance is
noted in the passage from March to April, and the greatest from
May to June. At Fort Vancouver, an intermediate post in the
north of the Willamette Valley, these observations are reversed,
the greatest difference being from March to April, and the least
from May to June. Greater uniformity of advance, for the en-
tire season, as far as the record at present extends, although quite
extreme in degree, is found at Fort Dalles, on the Columbia,
in the interior, than to the west of the Cascade Eange. And
compared with Fort Defiance, its analogue in the territories to
the south, it is both more mild and less extreme ; for the mean
monthly advance there is 8.56, whilst here it is only 6.88,
But the spring features of the coast, are placed in decidedly the
most interesting view, when contrasted with corresponding
ones for the coast lower down. Making due allowance for the
difference of latitude, the accessibility of each to oceanic influ-
ences is the same, therefore the differing results at each of the
places indicate distinctive differences in the character of those
oceanic influences. On the coast of California, both at San
Francisco and at Fort Humboldt, some distance farther north-
ward, there occurs in the passage from April to May an actual
retreat in the position of the mean temperatures, instead of an
advance, which we have attributed to an increasing intensity
of action of certain cold currents of the ocean, found prevailing
at that time. At Fort Orford, ho vr ever, a progressive advance
is observed, which can only be brought about by a diminished
effect of those controlling sea-temperatures. Hence that degree
of refrigeration which is observed along the former coast is not
experienced here, being only subject to the ordinary influences
of sea-coast localities generally. This, of itself, is collateral
proof of the position we have assumed in regard to the course
and direction of the cold waters off this coast, for from Fort

736 Doughty. An Essay on the Adaptation of [November,

Humboldt, south five degrees of latitude, their influence is
such as to subdue or overwhelm the ordinary continental
influences by reducing the mean of May below April, and
in the middle of the dry season, that of August below July.
So that twice during the dry season, this inordinate reduction
of temperature happens, and indeed it is not improbable that
the same effect would be produced as far south as San Diego,
if it was not for the mere latitude of this place, and their own
increase of temperature in their course southward. Certainly
if they extended as high up as Fort Orford, with latitude in
their favor, they ought to manifest at least an equal degree of
influence. Their withdrawal, on the other hand, produces
greater abruptness, and a greater increase of temperature for the
season, than at the south.*

Upon an inspection of the general range of the monthly
mean temperatures for the entire region, the Willamette Val-
ley shows the greatest variation in their relative position:
the range for March transcends largely that of the far inte-
rior post in New Mexico, namely, Fort Defiance, and equals
many of those variable posts in the southern part ef the eastern
slope of the United States, and around the Gulf. Even posts
in the Columbia Valley, as Fort Dalles, present a much fairer
record, for the mean range for the season there is only 3. 84,
whilst here it is 8.09. The coast, however, as usual, presents
by far the least variation in this respect, for the greatest range
is only 4.52, which took place in May ; and it has an average
for the season of only 2.9i. Indeed for the limited period of
observation here, the coast of Oregon, as exhibited in the range
of the monthly mean temperatures at this post, is superior to
that of California. For March here gives a difference between
the highest and lowest means of only 3.31, whilst at San
Francisco it is 6.82 : and the mean of the entire season is only
2.91, that at the latter place, being 3.76. This superiority

* It is as well to state here as elsewhere, that the temperature of the waters
off this part of the Pacific coast, are perhaps of a more or less uniform tempera-
ture all the year round, and also that the waters themselves constitute a part of
the same current which has been seen to prevail during the wet season of Cali-
fornia. If so, they are probably at or about the same temperature of the latter.
So that we have at this point, and doubtless farther northward also, an un-
changing temperature of the sea at all times.

1859.] Climate to l/ie Consumptive, d-c. 737

may be attributed to the uniform temperature of the sea-
waters, which secures a regulation in the advance of temperature
for the season, and a mitigation and moderation of continental
influences. At the south at this time, the currents are shifting
and substituting; hence greater abruptness in the monthly ad-
vance. The proximate cold masses cannot exert any influence
here, until their full sway is established below, and the heat
and rarefaction of the plateaus and valleys of the interior, at-
tract their atmosphere inland.

The extent to which the thermometer may fluctuate through-
out this area, as indicated by the extreme single monthly obser-
vations, can, at the present time, be only approximative of the
constants. The freezing point may be attained at any part of
it, and the lowest recorded point is about nineteen degrees (19)
at Fort Vancouver. Low down upon the coast, it is always
reached in the month of March, although the few records fur-
nished do not show its occurrence during April and May. The
degree of cold experienced at Fort Orford during the months of
March and April, is greater than at San Francisco, although
their possible ranges of the thermometer do not indicate that ex-
tent of fluctuation in temperature, which is observed at the lat-
ter place. The possible range here for March, is two degrees
(2) less than at San Francisco ; that of April is fourteen
degrees (14) less ; and that of May is just equal to it. These
cannot be taken as altogether reliable, for the observations of a
single year are not sufficient, nevertheless they give a fore-
shadowing of their probable temperature statistics.

As we recede from the shore line towards the Cascade Range,
the extremity of these observations rapidly increases. In the
"Willamette Valley, at Fort Vancouver, the possible range of
the thermometer for March is increased over that of Fort Or-
ford, fifteen degrees (15) ; and over that of Fort Astoria, thirty-
three degrees (33) ; the lowest at Fort Orford, being nine de-
grees (9) greater, and the highest six degrees (6) less; and at
Fort Astoria, the lowest is eleven degrees (11) higher, and the
highest is twenty -two degrees (22) less, April, however, in this
valley is not so extreme, the two extremes manifesting a ten-
dency to come together ; yet the highest for the month, is ten
degrees (10) higher than at Fort Orford on the coast, and its

738 DOUGHTY . An Essay on the Adaptation of [November,

lowest is nine degrees (9) less, so that, the possible range for
the month, remains nineteen degrees (19) greater. Moreover its
possible range is seven degrees (7) greater than that of Fort
Astoria, for the same month. The extremes here for May are
excessive, extending from the frost point to blood heat. The
highest at Fort Vancouver for three years, was ninety-eight de-
grees (98,) and the lowest, thirty-nine (39.) There is an in -
crease of twenty degrees (20) over the highest of April, and
eighteen degrees (18) over that of March ; whilst the lowest is
eight degrees (8) higher than that of April, and eighteen de-
grees (18) higher than that of March. The possible range
for the month, however, is only equal to that of March, and is
twelve degrees (12) greater than that of April. The highest
single observation recorded throughout the entire section at this
season, occurred at this post. It is eighteen degrees (18) high-
er than the highest of the coast, and four degrees (4) above that
of the interior station, Fort Dalles. It also approaches those
extraordinary records* for this season in the San Joaquin
Valley.

Looking now to the far interior, we find at Fort Dalles small-
er differences between it and the coast, than between the latter
and the Willamette Valley. When compared with Fort Defi-
ance, in the first part of this essay, it shows a much higher
attainable degree of heat, and more conservatism in its distri-
bution.

Winds and Weather of Oregon and the Columbia Valley^ for the
Spring Season.

No more striking contrast of the two sections of coast, exam*
ined in this essay, could be exhibited, than is found in a com-
parison of their mode of circulation of the atmosphere. If the
changes in the temperature manifestations between San Fran-
cisco and Fort Orford are great those in the circulation of the
atmosphere are greater. At the former place, throughout the
season, winds from the south and west were in the ascendancy,
although of the single winds, those from the northwest were
oftenest observed, and increased in force and prevalence with

* In May 1852, at Fort Miller, the thermometer reached the enormous height
of 113.

1859.] Climate to the Consumptive, <tx. 739

its advance. At the latter,* the southwest and west winds,
during the month of March, were rarely recorded, and during
the remaining two, no record whatever is made of their pre-
valence, except of the west wind, once in May. Winds
from the north, southeast, and northwest, were prevalent
throughout the entire season, and of these no particular one
maintained a uniform ascendancy. Those from the southeast,
were by far the most forcible ; those from the northwest next,
although the latter greatly increased in strength with the ad-
vance of the season.

Advancing still higher up to the mouth of the Columbia
River at Fort Astoria, there are other recognizable differences.
During March, there was no particular circulation ; winds from
all points were recorded, those however, from the east and
southwest, were the predominant single ones. In April and
May, the south and west winds were ascendant, and of the sin-
gle ones, the southwest and northwest. Here then, a partial
restoration of that along the southern coast of California occurs.
"Whence the difference of circulation at the intermediate coast
station, Fort Orford? Why, an almost complete reversal
here ? Is it attributable simply to local peculiarities of con-
figuration, or has it some connexion with those occurring differ-
ences of temperature, and of circulation of the sea-waters near
it? These are interesting questions at this juncture, and will
require for their answer a longer period of observation. At
Fort Vancouver, great irregularity exists as to the prevalence of
the winds. In March, during four years' observations, the north
and east winds were most numerous, those from the east and
southeast predominating. In April and May, the south and
west were ascendant, but during the latter, the north-west was
frequently recorded.

Repairing to the interior at Fort Dalles during two years, we
find the same general features, that were stated as belonging to
Fort Defiance. But between it and the coast stations, especial-
ly Fort Orford, there is great dissimilarity. The south and west
winds were always in the ascendancy and the southwest and
west of the single ones.

* This remark is based upon the observations of a single year, and are there-
fore of little reliance : but they are sufficient to show, that the course of the
winds off the Californian coast does not extend to all parts north of it*

V. s. VOL. xv. so. xi. 52

740 Doughty. An Essay on the Adaptation of pSfovemberr

Of the weather \ the subjoined table affords a sufficient exposition.

MARCH.

Id,3 k

Sno'y
^ Rainy
< Clo'dy

Fair.

Sno'y
, Rainy
2 Clo'dy
Fair.

Fort Orford, Oregon, (1 year.)

" Vancouver, " 4 "

" Dalles, C. Valley, 2 " ....
" Astoria, Oregon, 1 *

10. |21.
11.7 19.2
19.5 11.5
It. 020.0

13. 1 1. | 6. |24. |19. 1 0.
10. 2. 510. 7,19.210.7 0.
3.5 3.0 20.0 10.0 8.0 0.
19.0 0.0 10.0 '20.0|16.0i 0.

14. jl7.
19.711.2
26.5 4 5
10.0120.0

8.
4.
2.5
16.0

0.
0.
0.
0.

The respective means for the same season are, as follows:

Fort Orford, Fair 10.0 Clo'dy 20.6 Rainy 13.3 Sno'y 0.3
" Vancouver" 14.0 " 16.5- " " 8.2- " 0.83
" Dalles,
u Astoria,

M 22.0

8.6

u

4.6

a

1.00

" 10.3

u

20.0

u

17.0

u

0.0

Along the coast, the number of fair days for March and Aprilr
as compared both with the interior post, and with those on the
coast of California, is greatly diminished. For the three sta-
tions, there is about an average of ten fair days for March, and
eight for April ; and of cloudy days, an average of twenty for
March, and twenty-one for April. Here also the proportion of
rainy days, as compared with the cloudy, is very large, there
being an average of fourteen rainy days in March, and
fifteen in April. At Forts Orford and Vancouver, for May,
there is a decided increase in the number of fair days, and a
diminution in both cloudy and rainy days. At Fort Astoria,
however, the same general features are noticed throughout the
season. The greatest number of fair days are recorded at Fort
Dalles, and they steadily increase with the advance of tbe sea-
son ; whilst the others decrease. The respective means for the
season, show nearly three times the number of rainy days at
Fort Orford, that there are at San Diego, and nearly twice that
of San Francisco. Fort Astoria gives three and a half times
the number at San Diego, and two and a half times that of San
Francisco. We may add here alsor that although there is a
large proportion of cloudy days recorded of the latter places, as
the mean for the season, yet the number of rainy days is scarcely
one half of them; whilst along the coast of Oregon, the latter
have increased to about two-thirds the former.

1859.] Climate to the Consumptive, Sc. 741

Bain in Inches.

At Fort Orford, the monthly means are as follows : March,
8.24 inches; Apiil, 5.64 inches; May, 5.24 inches ; the mean
for the entire season is 19.12 inches. At Fort Vancouver, as
follows: March, 3.79 inches; April, 2.74 inches ; May, 2.75
inches, with a mean for the season of 9.28 inches. At Fort
Dallas, as follows: March, 1.07 inches; April, 0.99 inches;
May, 0.57 inches; and of the season, 2.63 inches.

As we advance up the Pacific coast, the duration of the wet
season increases to such an extent, that the dry season cannot,
strictly speaking, be said to commence until the summer months
are reached ; and if we should continue our advance to Kussian
America, and thereabouts, so great an encroachment would be
found to be made upon the latter as to obliterate it, this being
a region of almost constant precipitation. The amount of pre-
cipitation also increases rapidly with the latitude ; the mean
quantity for the spring at San Diego, is 2.74 inches; at San
Francisco, 8.81 inches; and at Fort Orford, 19.12 inches; an
increase of 16.38 inches in ten degrees of latitude, which is
about 1.63 inches to every degree of latitude. As we recede
from the coast, the degree of precipitation declines, that at
Fort Vancouver for the season, being only one-half, and across
the Cascade Range, the proportion is reduced to about one-
seventh that at Fort Orford.

ARTICLE XXVI.

Fracture of the Neck of the Scapula. By L. A. Dugas, M. D.,
Professor of Surgery in the Medical College of Georgia,
(Read before the Medical Society of the State of Georgia, at
the meeting in April, and ordered to be printed.)

At the annual meeting of this Society in 1857, I had the honor
of reading a paper " Upon Fractures of the Scapula, with Oases,
&c." which was ordered to be published. It accordingly ap-
peared in the pages of the Southern Medical and Surgical Jour-
nal in June of that year, and although well received by the
profession in general, I am sorry to say that it did not alto-
gether escape the notice of one of those writers of " Biblio-

742 Dugas, on Fracture of the Scapula. [November,

graphical Notices" who seem to think their only duty to find
fault with the papers placed in their hands, even at the expense
of justice. The disingenuous perversion of quotations and infer-
ences in the "notice" to which I refer, cannot fail, however,
to be detected by any one familiar with the subject, and there-
fore needs no refutation in this place. With your permission,
I will now read the history of another instance of Fracture of
the Neck of the Scapula, which came under my observation
since the publication of those to which I have just referred.
My apology, if any be necessary, for bringing this case before
you, will be found in the fact that injuries of the shoulder joint
are often so obscure that, although they have been long
studied by able and experienced surgeons, their diagnosis is
still the subject of controversy. In the absence of post-mortem
confirmation, we have to rely principally upon the accuracy
with which symptoms are investigated and detailed.

On the 9th of May, 1858, Mr. Partlow, of Abbeville District,
South Carolina, brought to me for consultation his negro boy,
Lewis, between six and seven years of age, well formed and
well grown. Mr. P. stated that about two months before, the
boy, while at play in the woods, was stricken down by the
falling of a tree, one of the limbs coming down upon his left
shoulder. The direction in which the blow was received was
not known, but upon approaching the boy he found him ration-
al, and was told that he had not lost his consciousness at the
time of the accident. There was no evidence of injury to
the head, nor any where else than in the shoulder. The boy
complained of his shoulder, and said that the pain was also very
great in the arm, the ability to move which was entirely lost.
Upon feeling the pulse, it was found much more feeble in the
left than in the right limb, and the temperature of the injured
arm was lower than that of the other. In handling the limb and
shoulder Mr. P. detected nothing like crepitation, and therefore
concluded that there was no fracture. Swelling supervened in
the shoulder, soon after, accompanied with great pain in the
arm down to the elbow, but none below this. At the end of
ten or fifteen days the swelling had disappeared, the shoulder
was flattened and seemed to droop, but the pain in the arm con-
tinued much longer.

Cold water dressings, and subsequently stimulating frictions,

1859.] Dugas, on Fracture of Hie Scapula. 743

constituted the treatment to which the patient had been subject-
ed prior to my seeing him.

Examination. By causing the boy to stand erect before me,
with his chest bare, the left shoulder appears drooped, emacia-
ted and very much flattened. The deltoid muscle feels loose
and flabby, as though in a state of atrophy. This is not so per-
ceptible in the other muscles connected with the shoulder ; yet
the supra-spinatus, infra-spiriatus and pectoralis major are evi-
dently smaller here than on the other side. The acromion
process projects in a sharp angle, and the head of the humerus
is depressed about three-fourths of an inch ; but may be easily
replaced by pushing up from the elbow. The left hand can be
carried upon the right shoulder while the elbow rests against
the thorax, thereby precluding the idea of a dislocation proper-
ly so-called.

By grasping the head of the humerus, which is distinctly felt,
with one h?nd, and rotating the lower end of the bone with the
other hand, it is found that the head moves continuously writh
the shaft, and without any crepitation whatever. There is
therefore no fracture of the humerus at any point.

By placing one hand upon the shoulder so as to fix the body
of the scapula, the acromion process and the clavicle, at the
same time that various movements upward and laterally are
imparted to the humerus, very distinct crepitation can be per-
ceived in the shoulder-joint. Crepitation is also distinctly
induced by grasping the head of the humerus with the ends of
the fingers resting upon the margin of the glenoid cavity in the
axilla, where it is easily felt in this case, and moving simultane-
ously both the head and the glenoid cavity, while the body of
the scapula is fixed as above mentioned. There must then be
a solution of continuity somewhere between the glenoid cavity
and the body of the scapula.

The coracoid process is here very distinctly felt, and it does
not follow the movements of the humerus when this is alter-
nately carried up into its proper position and allowed to fall.
By placing the fingers upon the coracoid and the acromion pro-
cesses they are found to move in unison with the lower angle
of the scapula without crepitation, and are therefore continuous
with it, showing that the fracture must implicate some point
between the glenoid cavity and the root of the coracoid pro-

744 Dug as, on Fracture of the Scapula. [November,

The body of the scapula, its spine, the acromion process, and
the clavicle are uninjured.

The boy is unable to move any muscle of the limb not even
those of the fingers. The whole limb is shrunken and much
cooler than the other.

The pulse at this wrist is more feeble than it is on the right
side ; and there seems to be no abnormal distribution of the
arteries. The sensibility of the skin is very obtuse, and no de-
gree of pressure upon the ulnar nerve at the elbow gives any
pain.

Kemarks. This case was peculiarly favorable for a minute
examination, in consequence of the atrophy of the muscles,
which allowed the bones to be distinctly felt at all points. In
muscular adults, and during the existence of swelling, the diffi-
culty is very much increased and may render accurate diagnosis
almost impossible. I believe that it will be conceded that this
examination demonstrates satisfactorily that this was a case of
fracture and not of dislocation ; and that the seat of fracture was
between the glenoid cavity and the roots of the coracoid and
acromion processes. Was it what is technically called a fracture
of the glenoid cavity, or was it a fracture of either the anatomi-
cal or the surgical neck of the scapula ? It was certainly not a
fracture of the surgical neck, or, in the language of Sir Astley
Cooper, "through the narrow part of the bone, immediately
opposite the notch of the superior costa," for the coracoid pro-
cess was not implicated. I must confess that it is difficult to
determine whether it was a fracture of the glenoid cavity or one
of the anatomical neck of the bone. But, when we take into
consideration the age of the patient and the comparative facility
with which in early life articular surfaces are detached, together
with the positive fact that the margin of the glenoid cavity was
felt in the axilla and could be elevated with the head of the
humerus, I must believe that this was a fracture of the anatomi-
cal neck. One or more fissures in the glenoid cavity would not
satisfactorily account to me for the phenomena of this case.

The sudden paralysis induced by this accident is worthy of
attention, especially as it constituted also a peculiar^ in the
cases heretofore reported by me. The censorious critic above
alluded to, takes exception to my statement, that writers make

1869.] Lecture upon Cerebral Fever. 745

no mention of it in such cases, and cites instances of dislocation in
which it occurred. He forgets that I was not treating of dislo-
cations, but o{ fractures. He says, however, that he reported
somewhere a case of sudden paralysis of certain muscles, follow-
ing a fall upon the shoulder, in which there was no dislocation,
I have no recollection of seeing his report, but even this was
unlike my cases, inasmuch as he says nothing about the exist-
ence of any fracture. I therefore reiterate the assertion, that
this peculiarity has hitherto passed unnoticed, at least by sys-
tematic writers, in Fractures of the Keck of the Scapula. As
this sudden paralysis occurred in the three cases I have seen,
should it not be taken into consider ition in establishing the
diagnosis of injuries of the shoulder? It has been long known
that it may accompany dislocation ; we now know that it may
also be induced by fracture of the neck of the scapula ; and it
will be interesting to determine with precision under what other
circumstances it may be looked for.

Clinical Lecture upon Cerebral Fever* By Trousseau. Trans-
lated from La Clinique Europeenney by J. C. Reeve, M. D.r
Dayton, Ohio.

I am about to speak, to-day, of an infant which appeared doomed
to a certain and almost speedy death. The disease from which
it suffered, merits, in many respects, your most careful attention.
It was a case of cerebral fever, which followed a regular course
in its premonitory as well as its complete stage.

The patient was a little girl aged eight months, nursed by its
mother. It was taken ill about six weeks ago, its constitution
being good. At that time it presented a peculiar sad or heavy
appearance, which was not usual, and which could not be attrib-
uted to dentition. The first group of teeth had been cut at the
age of four months, and the superior incisors, the next to be ex-
pected, had not yet made their appearance, and would not proba-
bly do so within fifteen or twenty days, supposing the child lived
that length of time. Dentition, then, could not occasion the
illness which caused this heaviness, a symptom the importance
of which I can not too strongly impress upon you, and which,
succeeding all at once to the liveliness and playfulness of the

Synonyms: Tubercular meningitis Wood, Meigs; Acute hydrocephalus
"Watson, West; La meningite granuhusc Bouchut; Lie hitzige Wassergchirn-
sucht Meissner.

746 Lecture on Cerebral Fever. [November,

child, surprised and troubled the mother. Its sleep became bro-
ken and unequal, but there was an absence of one symptom so
frequently seen at the commencement of this disease; it had none
of those startings from sleep, accompanied by a peculiar cry,
which I shall have to describe in giving an account of this terri-
ble affection. Eight days ago vomiting commenced. Every-
thing which was given to it, drinks of various kinds, and its natu-
ral food, were thrown up again, and the mother became seriously
alarmed. Her apprehensions were increased five days ago, by
the appearance of another symptom, which she has well described
to us, and which it is essential to mark. Whenever she took up
the child it commenced to cry ; it seemed as if every touch gave
it acute pain ; and this was the fact, for there was then general
hyperesthesia. Finally, four days ago, convulsions came on
first on the right side, then on the left ; and then the little patient
was brought here. Let us pass rapidly in review the symptoms
which it presented, and compare them with those which may
occur in other similar affections.

At first sight we observed strabismus convergent strabismus
of the right eye, the pupil of which was dilated, but not so widely
as that of the left. Upon that side the child seemed blind, for
upon moving the finger rapidly before the left eye, there was no
closure of the lids, that natural and involuntary movement for the
protection of the menaced organ. There was then blindness, or
great feebleness of vision ; and this is an accident of cerebral
fever, which children who can talk complain of readily, and
which is here very plainly indicated by the wide dilatation of
the pupil, and the convergent strabismus of the other eye. We
observed, besides, a slight bending of the head backwards, and some
stiffness of the left arm, which was agitated from time to time
with movements of extension and flexion. The thumb of this
side was forcibly adducted into the palm of the hand and covered
by the fingers convulsively flexed upon it ; this flexion, however,
yielded readily to our attempts at extension. Upon removing
the child's clothing, we observed that the abdomen was excava-
ted, hollowed out a symptom almost, constantly to be met with
in cerebral fever, and of great value, as it serves, in a large num-
ber of cases, to distinguish the disease from cerebral affections
occurring secondarily in other diseases typhoid fever, for exam-
ple. When the hand was carried to the face of the child, as I
did to examine its mouth in regard to dentition, we were struck
with the redness which immediately colored the skin. And if we
passed the nail over the abdomen, however lightly, in such a man-
ner as to make longitudinal and transverse lines, thirty seconds
did not elapse before the whole surface was covered with a live-
ly redness, which, diffuse at first, remained along the lines where
the nails passed, of a more intense and persistent color. This is

1859.] Lecture on Cerebral Fever. 747

the cerebral blush, which I first pointed out twenty years ago,
and which I have called the meningxtic blush. This singular and
inexplicable phenomenon is of great value, whatever may be said
of it, and of great aid in establishing the differential diagnosis of
cerebral fever. It is worth while to dwell upon it a moment, for
often this cerebral blush alone is of very great signification. The
parts upon which it most readily appears are, first and before all
others, the anterior face of the thighs, then the abdomen, and
next the face. Its characteristics are those we have just pointed
out in the case before us. In making light friction upon the skin
of the little patient, with the nail, or with a pencil, we saw the
points touched redden with remarkable vivacity. This redness
persisted a longer or shorter period eight, ten, fifteen minutes.
The existence of this cerebral blush has not been denied, it is
true, but the value which I give it has been strongly contested.
It has been said that it is a sign of no importance, since it occurs
in other diseases as well as in cerebral fever. This blush it is
true, does sometimes occur in other diseases, but it is then acci-
dental and exceptional, while in the complaint under considera-
tion, it is a canstant phenomenon, invariably occurring during
the whole duration of the disease, from its initiatory symptoms
until death a capital point as to its value in diagnosis. But a
still greater objection has been made ;. it has been said that this
blush can always be found, when sought for. in any child having
fever, even of the simplest kind ; but this is an error. I have
pointed out to those following me in the wards, children suffering
with fever accompanying violent stomatitis and severe pulmonary
inflammation, and we have sought to produce this blush by rub-
bing the skin rudely, even to rubbing off the epidermis; the fric-
tion has caused a lisrht redness, but this redness was not compara-
ble, either in intensify or persistence, with that seen after much
lighter friction in cases of cerebral fever. The redness of the
skin in those patients disappeared almost immediately; in the
little girl it persisted eight, ten, fifteen minutes; and it not only
occupied the points upon which firiction was directly made, but
extended several centimeters around, while in the other cases it
remained perfectly localized to the points touched.

If I insist so much upon this sign, I repeat, it is because, in a
great number of cases, it is one of considerable value, especially
in avoiding the possible confusion between cerebral fever and
other maladies. such as typhoid fever with cerebral complications,
and the convulsions to which children are liable, and those which
occur during the access of the exanthemata. This blush is never
produced in these kinds of convulsions, and if ever seen in tvphoid
fever, it does not attend all si >he disease, and never has

the same intensity nor the same persistence.

I have dwelt upon this point to prevent repetition. Let us

N. 5. VOL. XV. SO. XI. 53

748 Lecture on Cerebral Fever. [November,

return to the other symptoms which make up the history of the
disease.

The precursory stage is of very great importance. The writer
who has insisted most strongly upon this period, is M. Rillet, of
Geneva, the collaborator of Barthez in the work upon diseases of
children. He has reported a large number of cases in which he
was able to foresee an attack of cerebral fever from certain symp-
toms which I am about to indicate.

The first symptoms presented by a child about to be attacked
by a cerebral fever is generally, but not always, a change of man-
ner, which manifests itself during the month, or six or eight
weeks, preceding the outbreak of the disease. The patient is sad
and heavy, and takes less pleasure in its sports than usual; its
character changes, it becomes morose and irritable towards its
playmates and friends ; at the same time a very perceptible ema-
ciation takes place ; it does not sleep so soundly as formerly, or
there may be complete sleeplessness. In some cases the slumbers
are disturbed by painful dreams, and broken by sudden startings
accompanied by a peculiar cry which is characteristic of the dis-
ease. M. Rillet attributes these general symptoms to lesions of
the brain which already exist, and which, although giving a
chronic or subacute form to the malady, exercise, nevertheless, a
certain and injurious influence upon the functions of the encepha-
lon. When we recollect that w7e almost invariably find tubercular
deposits in children who have died of cerebral fever, either in the
bronchial or mesenteric ganglia or, what is more rare, in the
cervical we can easily understand how this tubercular affec-
tion can occasion the general symptoms we have mentioned, and
especially the emaciation. Further, as we almost always find in
these subjects, granulations occupying the periphery of the brain,
the fissures of Sylvius, and other points granulations which are,
in truth, tubercular, as the microscope incontestable proves we
can conceive that the morbid action, under the influence of which
these deposits are made, although taking place slowly, has never-
theless a decided influence upon the cerebral functions an influ-
ence which is maifested by the change of character, by the
agitated and broken sleep, and by the insomnia, of which we
have spoken.

Although the precursory symptoms more frequently precede
cerebral fever, than any other disease whatever, I do not think
we can regard them, as does M. Rillet, as exclusively character-
istic of this affection. They appear to me, indeed, to depend far
less upon the local lesions than upon the general pathologic state,
which, preceding in this case meningoencephalitis, precedes also
in other cases, latent pleurisy, or tuberculous engorgement of the
mesenteric ganglia, or in others, again, pulmonary or bronchial
tuberculization. In a word, the precursory symptoms indicate

1859.] Lecture on Cerebral Fever. 749

rather a morbid diathesis than a declared disease. We know how
much the character of a child changes under the influence of sick-
ness, but few among ourselves have not learned, by experience,
that such a change takes place in adults, even under the influence
of a light ailment! and the change takes place in children as much
more readilv as their characters are more mobile.

We can easily understand, then, this sadness of the child, this
unaccustomed repugnance to the sports of its age, this morose-
which is not habitual to it, without oalling to our aid any
local encephalic lesion. We have for their explanation the exist-
ence of a most grave, morbid state of the system a tuberculous
state not yet manifesting itself by local affections, but profoundly
affecting the entire economy. I should say, however, that, al-
though these precursory symptoms occur in the other diseases men-
tioned, thev are in no other cases so striking as in cerebral fever.

Finallv. more decided symptoms of the disease manifest them-
selves. Most generally it is vomiting, and uncontrollable vomit-
ing, which announces the commencement of cerebral fever. In
the greater number of cases, the friends of the patient look upon
this svmptom as of slight importance : and as the child has eaten
but a few hours before, and perhaps even with good appetite, they
consider it as only the effect of indigestion. During a day, or
perhaps two. they remain of this opinion, but finding the vomit-
ing persist, are compelled to abandon it. And. in truth, it is very
rarely that vomiting is repeated in indigestion after the stomach
has once emptied itself. This persistence of the symptom is then
a fact of great importance. When it occurs without febrile
action in a child which has been vaccinated, our attention should
be immediately directed to cerebral fever; occurring in one not
vaccinated, accompanied with fever more or less severe and con-
tinuous, with profuse perspiration, diarrhoea, and pains in the
loins, we should fear variola ; but, I repeat, in the absence of
these conditions, the vomiting described announces the com-
mencement of cerebral fever. It should be added that there is
generally obstinate constipation.

At the same time the patient complains considerably of head-
ache ; and although this is a symptom which strongly attracts the
attention of the friends and the physician, it is a symptom which
cannot be considered as of any great value in this complaint, for
there are many other diseases which are attended by headache,
more or less violent in proportion to the intensity of the fever.
However, there is this peculiarity in the headache attending cere-
bral fever: it is rare that the initiatory fever, of which it is one
of the epiphenomena, is limited, as in the other diseases, to a
single accession ; generally the patient has two or three chills in
the twenty-four hours, and after each chill, some heat of skin and
perspiration ; sometimes the chill returns each day at about the

750 Lecture on Cerebral Fever. [November,

same hour, in other cases, but more rarely, the fever is continued,
but moderate, with frequent remission. The febrile movement,
the violent headache, more or less limited to one part of the cra-
nium, the moroseness of the patient, its sleeplessness, the persist-
ent vomiting, are signs of capital importance. When the physi-
cian observes them, he should be carefully upon his guard. It is
not rare, even at this stage of the disease, to be able to discover
more serious symptoms, amblyopia, hemiopia, etc.

Such are the symptoms o( the first period of cerebral fever.

In the seeond period, to the sleeplessness, the febrile movement,
and the violent headache, succeed a deceitful calm and repose,
which is likely to tranquilize the uninformed physician, and above
all to quiet the apprehensions of the parents, who are always
ready to seize upon any favorable indications. But the practi-
tioner who has been taught by experience, informed by the symp-
toms of the preceding period which he has seen or been told,
knows too surely that cerebral fever is established, that it has
entered upon its apyretic stage, and that henceforward it will steadi-
ly pursue its fatal course. The pulse now shows a peculiarity ;
ordinarily regular in the first days of invasion, (I say ordinarily,
for sometimes in the first period there is irregularity which gives
valuable information to the physician,) it becomes now, in the
second period, remarkably slow, at the same time unequal, but,
above all, excessively irregular; while normally, in a child four
or five years old, there are between ninety and a hundred beats
per minute, and in an infant at the breast, from one hundred to
one hundred and twenty, in the second period of cerebral fever
the number of pulsations falls to sixty, sometimes fifty-five, or
fifty ; and it may fall even below that, while at the same time, it
presents great inequality and irregularity.

At this time the child remains in a state of somnolence which
contrasts singularly with the agitation of the first period. It en-
joys, in appearance, a peaceful slumber, which rejoices and com-
forts the friends who surround it ; but soon, seeing it prolonged,
they become justly troubled and alarmed. This somnolence per-
sists from four to five days. If the little sufferer is awakened, it
utters a cry of impatience, and immediately drops asleep again ;
yesterday terrified at vour presence, afraid of the physician whose
examination harrassed it, it no longer exhibits any alarm ; then
it could not endure even an examination of the pulse, the slight-
est touch agitated and tormented it, now it appears indifferent
to anything you may do ; you open its eyes, you pinch it to dis-
cover the degree of cutaneons sensibility, and if it appears for a
moment irritated, it drops immediately into its quiet slumber.
This is a symptom of most serious character, and which we find
in scarcely any other disease. About the end of two days, the
countenance presents a strange appearance. From time to time

1859.] Lecture on Cerebral Fever. 751

the child opens widely the eyes ; they are brilliant, and at that mo-
ment a bright redness overspreads the face, comparable to the
blush which modesty sends to the cheeks of a young woman.
This redness disappears in a minute or two, the eyes close again,
and the child returns to its former state. This reddening of tlie
countenance is repeated from time to time during the day ; it is
also of value. Soon it occurs more frequently, and in a great
number of cases; when it takes place the child utters a few plain-
tive cries, a characteristic phenomenon which Coindet has par-
ticularly pointed out ; this is the hydrocephalic cry, the cry of
cerebral fever ; it may be repeated every hour, every-half hour,
or at much greater intervals. It is a cry of pain, and the patient
having uttered two or three of these, falls again into the calmness
and into the sleep from which its sufferings had for a moment
roused it. This peculiar appearance of the countenance and the
hydrocephalic cry completes the description of the second period,
with the exception of one sign of which it is necessary to speak.
I allude to retraction of the abdominal parietes. The abdomen is
hollowed out, and this fact is especially important in establishing
the differential diagnosis between the disease under consideration
and typhoid lever, a disease in which the abdominal parietes are
always protuberant.

One other symptom, however, must still be mentioned ; it has
struck those who observed the little girl, who is the subject of the
present lecture. I refer to irregularity of respiration. It was well
marked in our patient, as I have said, but less so than in many
others I have seen. How did she respire ? In counting the
respirations, watch in hand, there was extreme difficulty in follow-
ing them ; first, there was a feeble inspiration followed by a feeble
expiration, then a stronger inspiration and expiration, and again
a feeble one, and finally a period of cessation. These four respi-
ratory movements were accomplished rapidly, and the chest re-
mained motionless afterwards during three, four, five, and six
seconds. That is what occurred yesterday; that is what occurs
today ; to-morrow, in place of an interval of five or six seconds,
there will be one of ten, twelve, or fifteen.

In a child of two years, in the Hospital Necker, afflicted with
this disease, I was able to count by the watch, periods of cessa-
tion of respiration of thirty, thirty-five, forty, and even of fifty-
seven seconds; and it is remarkable that this irregularity of res-
piration extends to the third period of the disease, when the slow-
ness of the pulse has been succeeded by great frequency this
infrequent respiration occurs with a pulse beating, as in the case
of our little patient, as high as one hundred and sixty per minute.
In no other disease can this singular anomaly be found ; this un-
equal respiration does not occur in the idiopathic convulsions of
infancy, nor in typhoid fever, so that in cases where we hesitate

752 Lecture on Cerebral Fever. [November,

in making a diagnosis, and these cases are still too frequent, this
fact, in addition to the cerebral blush upon which I have so
strongly insisted, should have a great significance. It is of im-
portance in view of diagnosis, but it is far more so in regard to
prognosis and for this reason : the termination of cerebral fever
is almost always, if not always, fatal. In the course of a long
medical career, I have never but twice seen recovery take place.
Once it occurred under my own care, in the children's hospital,
where wTe were able to verify the fact by an autopsy. There
seems a contradiction between the words recovery and autopsy,
which may require an explanation, and this can be easily given :
the acute disease had subsided, but was followed by a serious
chronic affection, which terminated the life of the patient five
months afterwards. My interne presented to the Society of
Anatomy, the brain, which had evidently been the seat of soften-
ing four or five months before.

The other example of cure was in a child I saw in Bolougne,
near Paris, in consultation with M. Blache. These two children
are the only ones, I repeat, which I have had the good fortune to
see recover in a long practice. It shows how serious is the dis-
ease which furnishes such results ; to me, its incurability seems
nearly absolute. You can comprehend, then, of how much im-
port the question of diagnosis must be when it is impossible to
form a prognosis without it ; and here prognosis is of vital impor-
tance. We must distinguish from cerebral fever, typhoid fever
with cerebral complications, and the idiopathic convulsions of
infancy. We cure, in fact, the greater number of young subjects
attacked with typhoid fever, even when it is of the most grave
character even when accompanied by serious cerebral compli-
cations ; and we cure ordinarily the convulsions of children. But
if we do not make the distinction if we take for cerebral fever
diseases of which we have just spoken, (and typhoid fever may
easily be confounded with it,) we shall imagine that we have cured
many cases of the disease, and be astonished at hearing practi-
tioners of great experience avow that they have never been for-
tunate enough to save a single one.

The third period of cerebral fever is characterized by a return
of the febrile movement. We have seen the fever of the first
period occurring in paroxysms of short duration, several times
repeated in the twenty-four hours, or continued, but moderate,
and with frequent remissions. In the second period of the dis-
ease, the pulse, on the contrary, was remarkably slow ; in the
third period, it becomes extremely frequent, and this frequency
goes on increasing until death terminates the case. It is at
the same time sharp, and the skin is warm, but it is singular, and
the fact is of value in the diagnosis, that the thirst which gener-
ally attends fever of every kind, does not exist in the disease

1859.] Lecture on Gerebral J' 753

under consideration. While children, suffering from cerebral
complications in typhoid lever, from scarlatina., from any other
pyrexia, or any inflammation, demand drink eagerly, or it' unable
to talk., make known, by certain pantomimic actions, the thirst
which torments them, nothing of the kind is seen in patients at-
tacked with cerebral fever. There is no thirst, or. at least, no
evidence of any is given. Not only do the little patients not ask
for drink, but when it is offered they manifest repugnance to it.
Does this repugnance arise from the difficulty of deglutitiou ex-
perienced by them ? This may be ; but whatever the explanation,
the fact is the same.

Already in the second period, a symptom had made its appear-
nce which, although present then, is of course much more
rongly marked in the third. I allude to the state of depression
into which the patient has fallen. Completely indifferent to
what passes around it, it observes nothing, is disturbed by noth-
ing ; everything which pleased it formerly, its toys, the amuse-
ments of its age, are now unnoticed, and it lies in a state of com-
plete immobility : sometimes it responds when spoken to, but
never asks questions of its own accord ; while in everv other
disease, it will call for its mother, its nurse, and those it is accus-
tomed to see, manifesting in a word desires, in cerebral fever it
seems to have no spontaneous ideas and no wants. In the first
period of the disease, we can awaken the patients by disturbing
them. They complain and cry upon being irritated; but in the
third period this is no longer the case nothing rouses them from
their deep depression.

Convulsions are sometimes, but rarely, observed at the com-
mencement of the disease ; in the second or apyretic period, there
are none, properly speaking, but there is something resembling:
them something analogous to the epileptic vertigo ; the child
opens its eyes quickly, and they remain singularly" motionless.
This convulsive movement manifests itself more decidedlv in the
third period, and then also appear symptoms of jxiralysis, which
in some cases occur towards the end of the former stage. Thus,
when our little patient opened its eyes, one of them was much
more widely opened than the other, for the levator palpebrae be-
gan to be sluggish ; there was also strabismus. These symptoms
indicated clearly that paralysis was commencing:, and an attentive
examination showed that it had already extended to other parts
of the body. In an infant, we can establish this fact, by laying it
upon its back and tickling alternately the soles of its feet : it
draws back one foot much more readily than the other: the pow-
er or motion is impaired upon one side, sensibility is also less,
and a greater stimulus is required upon this side to produce the
same effects. The parents will tell you. besides, that their child
allows one arm to lay along by its body more than the other,

754 Lecture on Cerebral Fever. [November,

and if you examine this member you will find motion, power and
sensibility more or less affected. The paralysis of cerebral fever
has this peculiarity about it : it appears to be variable. 1 will
explain what I mean; one day you ascertain the fact that upon
tickling the soles the child withdraws one of its feet more readily
than the other ; some days afterwards, in repeating the experi-
ment, you find that it is no longer the right leg, for example, which
it moves more easily, but the left. It seems, and let me repeat
the word, it seems as if the paralysis had ceased upon the right
side, and passed to the left ; but this is not so. The member pri-
marily paralyzed remains so, but the paralysis not increasing, it
retains the movements which you have seen executed more
feebly than upon the healthy side ; but the other side, healthy
until now, is paralyzed in its turn, and the stroke being more
severe than upon the side first affected, sensibility and power
of motion are almost abolished, and it seems now alone affected,
while in truth the other is also paralyzed, but in a less degree
than the second.

The lesions which we find afterwards at the autopsy give an
explanation of this fact; for if the paralysis has remained limited
to the right side, the cerebral lesion is found only upon the left
side, while if the paralysis has seemed to pass from one side to
the other, there are cerebral lesions upon both sides, but more
marked upon one side than upon the other. I have thought
necessary to dwell upon this peculiarity of the paralysis in this
affection, for, in my belief, it is seen only in cerebral fever.

Let us return to the convulsions. Rare in the first period,
occurring in the second only in a modified form and resembling
epileptic vertigo, in the third period they make their appearance,
first in the form called convulsions internes [inward fitsy in the
common language of this country,] afterwards increasing to
attacks of general eclampsia. If we observe closely a child in
this stage of the disease, we see at certain times its countenance
is distorted, and its jaws move mechanically as if chewing, while
its thumb and fingers are flexed into the palm of the hand ; to
this stiffness complete relaxation succeeds ; there has been a true
tonic convulsion of certain classes of muscles, and not one
alternately tonic and clonic as in general attacks implicating
the muscles of the extremities. These are the internal con-
vulsions, having a duration of eight, ten, twelve, or fifteen min-
utes, during which the eyes are turned upwards and inwards,
and agitated by slight oscillations. The diaphragm, and the
muscles of the glottis may be seized with these convulsive move-
ments, and then the patient is suffocated respiration can no
longer be performed.

As the disease approaches its fatal termination, general convul-
sions come on, and generally death occurs in one of these attacks ;

1859.] Lecture on Cerebral Ft

they are repeated every hour or every hall' hour, and the patient
dies in a state of d em i- asphyxia, as in epileps

The convulsions are a prominent symptom of the ihird period
of cerebral fever ; but in this stage another accident also takes
place. The patient fallen into a state of deep drowsiness, closes
the eye-lids but partially ; the eye being insensible, the cornea
remains exposed to the air, the act of winking is no longer per-
formed, the eye dries, the conjunctiva inflames, and then you ob-
serve a deep suffusion of. the membrane at the same time that the
edges of the lids become bleared. This is also seen in other
grave diseases, (typhoid fever, for example,) and it is an accident
to which I have often called attention, and which 1 made the
subject of a note published in the first volume of the Archives
Generates de Medecine for the year 1850.

The termination of this disease is. as I have already said in the
course of this lecture, always fatal, for the exceptions of this rule
are so rare, as not to be worth mentioning.

After so sad a prognosis, I should have little to say upon the
subject of treatment, since whatever we do is in vain. Never-
theless you have seen me resort to remedies in the case of the
little child whose case we are considering. I instituted treatment,
not with the expectation of rescuing it from its fate, but to afford
some consolation to the mother. Is it not in fact cruel to say
to a mother who calls you to her child, or if not to say it in
words to indicate by your actions, that medicine is powerless,
and that her child is doomed to certain death ? Although,
therefore, the physician, instructed by long experience, is unable to
see a glimmer of hope, he should act, he should undertake the
case, and apply all the means at his disposal to sustain the
courage of a family which implore him for aid, and not leave
them to the bitter regret that nothing was done to save their
child.

For a long time I have employed everything in the treatment
of this disease, everything extolled by others, everything which,
upon my own part, I had been able to imagine. I have given
calomel in large doses, and I have given it in minute ones; I
have had recourse to drastic purgatives and to sedatives ; I have
administered the iodide of potassium as recommended by Otter-
burg ; I have applied large blisters to the head, I have applied
ice and cold affusions, and never, except in two cases, have I
seen the disease retrocede, and in those two cases I am confident
my remedies had nothing to do with the result. Farther, at the
children's hospital, I have treated the patients comparatively,
some energetically and some upon the expectant plan, and I must
say that the fatal event followed more rapidly in the former than
in the latter. Now, therefore. I feel obliged to pursue a course
of medication far from energetic, and designed, I repeat, rather

756' Attempted Abortion and Death. [November,

to afford consolation to the parents than to act against a disease
which I consider invariably fatal.

Thus you have seen me give our little patient musk and syrup
of ether, and nothing else. In other cases, you may try anti-
spasmodics, or the mercurials in small doses; but remember, the
prognosis must nevertheless remain the same.

It suffices to see the lesions produced in cerebral fever, to com-
prehend why the prognosis should be as I have said. Our little
patient died, and these are the pathological conditions found at
the autopsy : considerable softening of the cerebral centres, of the
fornix, of the corpus callosum, of the median septum and floor of
the ventricles; these cavities contained a certain quantity of
slightly turbid serum. About the chiasm of the optic nerves,
behind the decussation, a fibro-plastic, purulent infiltration was
seen in the thickened membranes. This infiltration did not exist
in the interlobular fissures, where it is usually observed, and what
is also very rare, there were neither granulations on the surface
of the hemispheres nor tubercles disseminated through its sub-
stance. Neither were there any in other organs where they are
almost constantly found none in the mesenteric ganglia, none in
the lungs, none in the bronchial glands ; and yet of thirty infants
dying of cerebral fever, twenty nine will present tubercular
lesions, of which, in this child, there is not a trace.

This proves once more, that cerebral fever runs the same course
and has the same characteristics in children not tuberculous as in
those who are so. Because we find granulations in the encepha-
lon of the latter, it does not prove that those granulations were
the cause of the encephalo-meningitis. They do not cause it any
more than do the granulations of the pleura cause tubercular
pleurisy; far from having caused the inflammatory disease, they
are themselves developed under the influence of inflammation.
If, therefore, I refuse to cerebral fever the name of meningitic,
it is because I consider the inflammation of the meninges to be
only of secondary importance. The lesions of the cerebral en-
velopes are of very far less importance than those astonishing
lesions which are always found in the brain itself, that softening
which destroys the fornix, the septum lucidum, the corpus callo-
sum, the optic thalami and the posterior portions of the lobes of
the cerebrum. Cerebral fever is therefore for me an encephalo-
meningitis. [Cincinnati Lancet and Observer.

Attempted Abortion and Death from Introduction of Air into the
Veins.

One of the most painfully familiar topics of our current medical
experience, arises from the familiarity and indifference witb
which the large mass of community have come to regard the

1859.] Attempted Abortion and Death. .'"

production of abortion; so that everywhere we bear the lament
of the honorable physician, of the unconcern with which he is
consulted for this puj b<th the unmarried female, who

may be supposed to have the more anxious solicitude to hide
her shame, and alike the respectably wedded mother, who has no
such motive to afford a plausible pretext.

The danger which is associated with these attempts, does not
appear to be duly estimated even by the members of the profes-
sion, in many instances; and popularly a great many expedi-
ents, instrumental and medical, are used and regarded as perfect-
ly innocent and harmless. Every now and then, however, we
read of and observe sudden and almost inexplicable death to
ensue in cases of this kind.

An instance in point fell under our observation within less
than a year in this city. We were summoned, about half past
eleven o'clock P. M., (near midnight,) to see a lady, and found
her already dead. Upon inquiry, and in the subsequent details
of the coroner's inquest, it transpired that she, although a hap-
py wife and mother, had determined not to allow any further
additions to be made to her nursery cares. Finding herself,
therefore, pregnant, she had consulted one of those dames repu-
ted to be skilled in such matters, and had held repeated private
interviews with her for a number of days before her decease.
The night of her death, her husband was engaged away from
home until about eleven o'clock. The servant girl remained up
until after ten o'clock. The husband arrived at home at eleven,
and found his wife deceased and the girl and children asleep.
Certain instruments were found about the person of the deceas-
ed, which indicated that she had made an attempt to throw up
a strong stimulating injection into or about the mouth of the
uterus. What she actually did is, however, left in some conjec-
ture, but death must have been very suddenly produced, con-
sidering the brief time in which she was left alone, and in view
of the fact that the girl in the next room was unawakened.

It will be a happy time when this truth shall become impress-
ed upon the popular mind, that whenever a woman places her-
self in the hands of "abortion procurers," she positively runs the
risk of her life in every instance.

The following case, reported by Dr. John Swinburne, of Al-
bany, X. Y., and which we copy from the Medical and Surgical
Reporter, in full, is in point, and affords some especial light upon
the character of danger in these cases, and how death may ensue,
and very suddenly :

Miss M. A. S., aged twenty three, unmarried, was admitted
to the house No. 40 Franklin-street, for the purpose of having
an abortion procured, on or about the thirteenth of March.

It is ascertained that attemp made, from day to day,

758 Attempted Abortion and Death. [November,

to rupture the membranes with a blunt steel instrument. These
efforts only produced slight inflammation, softening, and partial
separation of the membranes and placenta,

On the evening of the twenty -sixth of March, Dr. J. H. Case
was summoned in haste to the above mentioned house, where he
found that the young woman had just died. An examination
before the Coroner's Jury the next morning elicited, among
other testimony, the following statements :

Dr. J. H. Case, sworn : Knows Mrs. Hasten ; was called to
attend a patient at her house about six months ago ; her given
name is Oscillea; her ostensible business is an astrologist. The
patient whom I visited six months ago was a young woman ;
she had inflammation of the womb. Was called by Miss Curry
last night at nine o'clock ; said that Mrs. Masten wanted I should
call as soon as possible, that a lady there had fainted and was
very sick ; went to 40 Franklin-street, and found Mrs. Masten
on the walk ; she said she was glad I had come, as the woman
was very bad, and she was afraid she was dead ; she said it was
only an India rubber that she was using, and that the deceased
fell right back dead. Found a body lying on the bed very pal-
lid, and dead to all appearances ; Mrs. M. did not go in with
me ; thought it might be a case of suspended animation ; gave
her some stimulants, but they did her no good she was dead ;
told Mrs. M. so, and she said, " Oh, Doctor, what shall I do ?"
The girl Curry, then said, wringing her hand, "What shall we
do?" I told Curry that they could do nothing with her; Mrs.
Masten said to her, " No, I am to blame ; I shall have to stand
it." She again asked me what she must do ; advised her to throw
herself upon the mercy of the law; she asked me if I didn't
think it best for her to try and escape ; told her that it would
be impossible if she undertook it ; she also said it was a bad
time for her, as she had no time to fight it out or money to es-
cape; but that she expected some on Monday, and if she had
that she would clear right out in half an hour ; she again repeat-
ed that she didn't know how deceased came to die, as she could
show me the instrument, and that it couldn't hurt her; went
into the bed-room again, and another young lady said she
thought deceased was reviving; wanted me to try and revive her;
Mrs. Masten turned down the bed-clothes and produced a gutta
percha catheter. [The article was produced and identified.] She
said that was the instrument she used, and that it could not hurt
her ; also, that it wasn't the one she generally used ; that it was
milder, and the girl's death surprised her ; that while using it, the
patient, as she thought, fainted away ; that she tried to fetch her
to, and failing, had sent for me; think it was about nine o'clock
when I got to her house ; don't think that over fifteen minutes had
elapsed until I saw the deceased, after being called. Mrs Mas-

1859.] Attempted Abortion and Death. 759

ten indirectly asked me to loan her money to escape with : I
found three or four young girls in the house when I first got
there; one of them said that she had got through with her
troubles, and that she thought it best for her to get aw;
soon as possible; asked her if she was able, a
said she was all right ; suppose, from what I saw and heard,
that all the young ladies were "in trouble;'1 think I know one
of the young ladies 1 saw there ; believe I prescribed for her
some time since.

Assisted by Charles H. Potter, Professor of Chemistry, Dr. C.
P. Staats, and my students; Messrs. Moeier and Cove], I made a
post mortem examination fourteen hours after death. The fol-
lowing detailed description is given for the benefit of medical
readers.

External appearances of body natural, but very pallid. On
cutting through the integuments into the cellular tissues, air was
observed to issue from the divided veins in the form of a frothy
fluid. On exposing the heart, its right cavities were found to be
greatly distended with a spumous mixture of blood and air, and
slight compression of the heart was seen to force out bubbles of
air from the divided intercostal veins. A thorough examina-
tion showed that the jugulars, and the veins emptying into
them, even to the small vessels of the brain, were all distended
with air.

The uterus was found to be of a dark livid or maroon color
at its lateral portions, and its veins and sinuses were so fully dis-
tended with air, as to give it the appearance of a bag of angle-
worms. The sensation communicated to the touch was analo-
gous to that of varicocele, with the exception that in the latter
the tissues are soft and distended with liquid, whereas in the
case of this uterus the presence of air was unmistakably mani-
fested by its characteristic crepitus when the vessels were com-
pressed by the finger.

The membranes of the ovum were entire, and contained a
normal amount of amniotic liquor, and an apparently heal-
thy female foetus of about five months' growth, presenting no
appearance of decomposition, or any change to indicate death of
the foetus at any period long prior to that of the mother.

On the internal surface of the membranes was a slight exuda-
tion of lymph, as from inflammatory action. Externally they
were separated from the womb on its right latero-posterior sur-
face, as was also the placenta in part. Beneath the lower bor-
der of the latter, was an effusion of blood in the form of several
small coagula. The os and cervix were opened to the extent
of two lines, and filled with bloody mucus.

On examining the membranes and their contents, the internal
surface of the womb exhibited the following appearances : 1.

760 Attempted Abortion and Death. [November,

Slight softening of the tissues; 2. Several abrasions evidently
not naoural ; 3. A perforation communicating directly with the
uterine sinuses, about two inches from the cervix, and in the
right latero-posterior region. This opening communicated
directly with the veins of the broad ligament, and thus with the
ascending cava. The direction of the perforation was parallel
with the longitudinal axis of the uterus. All the other organs
of the body were in a perfetly healthy condition.

These post mortem appearances, conjoined with the description
of the young woman's death, can not be accounted for by any
other cause than that of " air in the veins." Death occurred
while the instrument was in the uterus, and was immediate, for
the woman mistook death for syncope.

The point of interest in this case, is as to the manner in which
the air was introduced. Several deaths have been reported
from ingress of air into the large veins of the neck, and even the
subclavian is liable to the same thing under favorable circum-
stances, such as tension upon the vein from the subject's position
during surgical operations, or by traction upon a tumor during
excision, the vein being temporarily canalized or prevented from
collapsing.

Under all circumstances, this canalization of a vein, or its con-
version into a rigid tube, is the indispensable condition requisite
for the intrusion of air. But this condition is inadmissible in
the case of the uterine veins and ascending cava, from the nature
of physical laws which govern the movements of the fluids in
the body, no less than in inorganic matter.

In the twenty-second volume of Braithwaite! s Retrospect, on
page three hundred and nine, will be found an article by Dr. J.
R. Cormack, in which is discussed the possibility of introduction
of air into the venous system through the medium of the uterine
veins immediately after parturition. He instances the experi-
ments of Legallois upon animals, whereby that author became
satisfied of the posibility of the intrusion of air in this way, and
by analogy conjectured that many cases of death in the human
subject might be accounted for in a similar manner.

He also quotes from Dr. Simpson, of Edinburgh, who reports
an autopsy of the body of a female who died after delivery,
where the entrance of air through the uterine veins was conjec-
tured to be the cause of death. The examination, conducted
carefully, so as to exclude all apparent sources of error, resulted
in the discovery that the lower cava, hypogastric, and uterine
veins were distended with frothy blood and air.

Dr. Simpson also explains the manner in which air might be
forced into the veins by the contraction of the uterus after hav-
ing been filled with air, which is not seldom the case. This
organ being distended with air, the os tincse being closed either

1859.] Diphtheria. 761

by its own sphincter or by a coagulum of blood; the uterine
veins being large and patulous, and the forcible contraction of
the organ these furnish, in his opinion, the mechanism capable
of accomplishing the fatal accident. (See Brad/iwaites Retro-
spect, xix., page 262.) In the pre.- no such conditions
are furnished, and throwing aside the hypothesis
ingress, we are compelled to fall back upon the presumption
that the abortionist forcibly inflated the entire venous system,
by means of the catheter introduced into the uterus, perforating
its parietes, and in contact with the lacerated vessels of that
organ. And this presumption is stregthened by the fact that
the opinion prevailed, at the time of the coroner's inquest, that
abortion might be produced by inflating the space between the
membranes and the womb.

The fact of forcible inflation is incapable of proof, there being
no third person present at the time of death, and hence no wit-
ness. Absolute certainty can only be arrived at from the con-
fession of the guilt}7 woman herself. [Cm. Lancet and Obser.

Diphtheria.

Dr. David Wooster thus sums up an able article on Diphthe-
ria, which has appeared in the Pacific Medical and /Surgical
Journal : '

I. Diphtheria is a specific disease.

II. It is distinguished from scarlatina by the absence of erup-
tion ; from gangrenous sore throat, by the absence of ulceration
and sloughing; from croup, by the aplastic nature of the exu-
dation.

III. Diphtheria may properly be divided into two varieties :
the mild and the severe.

IV. The mild is seldom fatal : slight, or no difficulty of deg-
lution, little fever, no engorgement of cervical glands, neither
coryza nor lachrymation, but presenting the positive diagnostic
sign of aplastic exudation on the tonsil, palate, or pharynx.

V. The severe is recognised by the diagnostic aplastic false
membrane, high fever at first, coryza, lachrymation, engorged
glands about the jaw. difficult deglutition, difficult utterance, or
complete aphonia, great diminution of animal power, cyanosis,
vomiting towards the close of the affection, and intense gangre-
nous fee tor from the decomposition of the exudation.

VL Diphtheria is contagious.*

* The experience of the French epidemics has made abundantly clear one verv
important fact in the history of Diphtheria, which has not yet been so clearly
eliminated from the observed facts, of the English epidemic. It may be very
clearly shown by the evidenee collected, that contagion plays the principal part

762 Uijj/Uheria. [November,

VII. The simple form is easily controlled by treatment which
is the same as for the severe form, modified according to the
comparative urgency of the case.

VIII. The severe form is with difficulty controlled, and the
prognosis is always extremely unfavorable, even at the begining.

IX. The treatment is the local '-application of hydrochloric
acid, diluted or not; solution of nitrate of silver, one or two
scruples to the ounce of distilled water; strong solution of sul-
phate of copper, drachm and a half to the ounce of water ; con-
centrated solution of the perchloride of iron ; Monsel's Salt, in
powder; solution of chloride of sodium, etc., according to the
educated judgment of the physician.

Externally strict cleanliness ; in the first stage of the disease,
while the engorgement is red and hot, cold, wet compresses ap-
plied to the neck, and often repeated, can scarcely fail to relieve,
at least for a time. Farther along, when the engorgement of
the throat becomes oedeinatous, warm fomentations should be
substituted. Never liniments, mustard, nor anything of the
kind; for these appliances increase the anguish of the patient,
and do not mitigate the affection.

Internally first, a thorough emetic of ipecacuanha, given in
full dose and largely diluted, so as to be vomited immediately.
This should be repeated daily for the first two or three days.
The bowels should be moved once a day by glysters, if possi-
ble ; if not, by some mild laxative. Drastic cathartics should
be carfully avoided. Iced milk and water, or iced gum-water,
or iced infusion of ulrnus fulva, should be given in minute
quantity, frequently as the patients desire. These iced fluids
will be found very grateful to them.

Quinine in small doses, say from one-fifth to one-half of a
grain, often repeated, should materially assist in the tonic treat-
ment universally recommended.* The mixture of " sesquichlo-

in the propagation of Diphtheria. There is in this country, a great deal of skep-
ticism as to the contagious character of this disease ; but the mass of evidence
to prove it is overwhelming. Thus Bretonneau has collected some crucial cases.
One is that of M. Herpin, Surgeon to the Hospital at Tours, and Professor at the
school. A child seized with Diphtheria, who had transmitted the disease already
to its nurse, was placed under his care; and at one of his visits, by access of
cough, part of the diphtheritic matter was ejected from the mouth, while the
process of sponging the pharynx was being performed, and it lodged on the aper-
ture of the nostril of M. Herpin. Occupied with his task, he neglected for a mo-
ment to remove it. A severe Diphtheritic inflammation of the part ensued,
which spread over the whole nostril and pharynx. Extreme constitutional dis-
turbance occurred, and the prostration was so severe, that convalescence occu-
pied more than six months. Dr. Gendren, of Chateau de Loire, received a show-
er of tracheal Diphtheric exudations, expelled by a young patient during an
access of coughing. Laryngeal Diphtheria set in, with urgent symptoms.
Prompt measures saved him. Lancet, April, 1859, p. 288.

* Of the many internal remedies which have been advised, we do not know of
any on which so much reliance can be placed as on the tincture of sesquichloride

1859.] Diphtheria. 763

ride of iron with chlorate of potass, chloric ether, and hydro-
chloric acid sweetened with syrup," may be employed by those
who fancy many not incompatible compounds in one conglome-
rate. But care must be used not to give this mixture with the
milk and eggs recommended in the same paragraph of the Lan-
cet's Commission ; and yet it is hard to see how this could be
avoided, if all are to be given " frequently." I would suggest
another remedy combining tonic, nutriment, and stimulus :
ferruginated cod-liver oil and brandy, in the proportion of two
fluid drachms of the former to one of the latter, repeated four or
five times a day, or ofteuer, if the stomach will bear it.

I believe chlorate of potash harmless, but of unproved effica-
cy in diphtheria. I have employed it, but saw no results ex-
cept mitigation of fcetor of expiration, when the false membrane
was in the stage of decomposition. Charcoal, chloride of soda,
etc., perhaps act in a similar manner. Ablation of the tonsils
at the beginning of the disease, it appears to me, cannot be too
strongly insisted upon. Tracheotmy cannot be ignored, but
should be resorted to where other means fail to relieve the
cyanosis, and suffocation is imminent from obstruction of the
fauces and larynx, or even the fauces alone, the larynx being
intact. In this latter condition, tubing the larynx should first
be attempted.

It is less difficult to prevent this disease than to cure it. The
most scrupulous cleanliness of persons and surroundings, free and
constant ventilation, should be insisted on. If there are many
children, and the rooms are small, as frequently happens in fami-
lies where this disease appears, the well ones should be sent away,
if possible ; and if not, kept out of the room in which the infected
child lies. M. Duche insists on the free use of sulphur as a
prophylactic : he says, those children who took sulphur were
not attacked, in any case ; while others, under the same circum-
stances, fell victims to the malady. It is a simple, harmless
remedy, and should be tried as a preventive. M. Duche may
be right.

Finally, all our knowledge of this disease may be thus epi-
tomized.

1. Diphtheria is a specific, new, zymotic disease.

2. Its diagnostic sign is an aplastic membranous exudation.

of iron, with chlorate of potass, chloric ether, and hydrochloric acid, ia the form
of mixture, sweetened with syrup; full doses being employed, according to the
age of the patient, and frequently repeated. A. free use should be male of gen-
erous wine, beef-tea, coffee, eggs in combination with brandy and wine, milk,
and whatever other form of nutriment the ingenuity of the surgeon or the fancy
of the patient can suggest. When food is refused, then enemata similarly com-
posed must be administered frequently, in small quantities of two ounces and
upward, that they may not be rejected; for it is of the first importance that inan-
ition should not open the last portals of life to the advancing disease. Lancrt
Commission.

ff.S. VOL. XV. NO. XI. 54

764 Atropine in Epilepsy. [November,

3. The indications of treatment are to remove the exudation,
and prevent its re-formation.

4. The treatment is tonic, antiseptic, stimulant, and nutri-
tious.

5. The means of prevention are cleanliness,- pure air, free
living, and possibly sulphur taken internally.

Conclusion. Diphtheria is the most,* certainly fatal epidemic
that ever visited our race ; but it is not de natura sua incura-
ble. American Med. Monthly.

Atropine in Epilepsy.

Dr. Max. Maresch, availing himself of his position as physician
of an establishment for the insane, at Vienna, has submitted
some epileptic patients to the influence of atropine, and has
published the results in the Vienna Journal of Medicine. Dr.
Maresch's experiments were made upon eight patients in the
female department, and ten more in the department of the in-
curable insane ; four of these were men, and six women.

Of the ei^ht first patients, three were completely cured, and
the condition of the five others so notably ameliorated, that it
was impossible to deny the beneficial effect of the atropine. Of
the ten patients belonging to the class of incurables, eight expe-
rienced a marked diminution in the violence and frequency of
their epileptic attacks, as well as in the exacerbations of their
physical troubles. These results, united to those obtained by
others in the treatment of epilepsy by atropine, merit serious
attention.

Maresch has carefully noted the therapeutic phenomena
which have arisen during the administration of this remedy.
One-fiftieth of a grain of atropine, gave rise, in every case, to
effects which habitually follow the administration of this agent,
such as dryness of the throat, difficulty in articulating, visual
aberration, dilatation of the pupils, etc.; phenomena to which
by degrees the patients become habituated, which, however, do
not cease during the entire treatment. In every case the pulse
lost eight or twelve pulsations during the first hour after taking
the remedy, but the pulse resumed its normal frequency so soon
as the other therapeutic phenomena manifested themselves.
There did not occur, in any case, a marked and permanent ac-
celeration of the pulse, under the influence of the dose above
indicated. As special phenomena, Maresch observed in those
cases while under the influence of atropine, an exanthem analo-
gous to roseola, which soon disappeared under the influence of
warm baths and the discontinuance of the remedy. It is, be-
sides, worthy of remark, that atropine did not give rise, in any

1859.] Diarrhoea of Infants at the Breast. 765

case, to digestive derangement, or any other unfavorable symp-
tom.

The administration of this remedy has not proved beneficial
in the other forms of mental diseases. Dr. Maresch administers
atropine as follows: he dissolves a grain of it in five hundred
drops of rectified alcohol, and of this solution he gives from five
to ten drops, (from ong-hundredth. to one thirtieth of a grain.)
This dose is administered once, in the morning before breakfast,
from which coffee, tea, and chocolate must be excluded, as these
substances interfere with its action. This is continued from six-
ty to ninety days, without interruption, then is to be resumed
after an interval of from thirty to forty-five days. With women,
there is no need to suspend its administration during menstrua-
tion, as it favors and augments this discharge. Barely does
atropine give rise to constipation, more frequently to diarrhoea,
which necessitates, when it becomes severe, a suspension of its
administration for some days. Translated from L Union Medi-
cate, by s. E. c. American Med. Monti dy.

Reflections upon the Use of Raw Meat in the Colliquative Diarrhoza
of Infants at the Breast. By Dr. J. . Weisse, Director of
the Hospital for Children, at St. Petersburg.

JL period of seventeen years has elapsed since the attention of
my confreres was called to the great value of this remedy in
this disease, but it did not come into general use until five years
later, and after the publication of more extensive works upon the
subject. About this time, Dr. Behrend, of Berlin, addressed me
a letter which contained the following passage: "You cannot
imagine how much interest your communication upon the treat-
ment of the colliquative diarrhoea of infants at the breast, by
raw meat, has excited ; we now use it exclusively in this disease."
Soon after, Dr. Behrend inserted in the sixth volume of his
journal, a letter from M. Marotte, Physician of the Central Office
of the Hospitals of Paris, addressed to Professor Trousseau, in
which the author gave a theory to account for the results which.
I had obtained. From this latter time, the treatment by raw
meat has been generally admitted everywhere, and its utility has
become incontestable.

Among the numerous favorable reports recently published, I
will cite that of Dr. Eichelberg: "In consequence of the short
time which has passed since this treatment was recommended, I
have by me only a limited number of observations, (twenty,)
but all prove its efficiency. The cases in which infants refuse
raw meat are very rare ; the majority swallow it with avidity.
I have observed two cases which were very striking ; in these

766 Dtarrhcea of Infants at the Breast [November,

the children took the meat for several weeks without repug-
nance ; a very great amelioration was felt in the general system *
all at once they refused it, as if guided by a natural instinct.
The want of osmazome induced the infants to devour the meat,
but as soon as the equilibrium was established in the economy,
this want disappeared."

Dr. Eichelberg makes use of raw meat only in the treatment
of diarrhoea which attacks children fifteen days or three weeks
after they have begun to take the breast ; the cure is then cer-
tain ; for myself, in ordering this regimen, I also have employed
it in this affection onty ; and now after twenty years of experi-
ence, 1 maintain that raw beef, reduced to a pap by scraping,
is, to the exclusion of all other medication, the veritable specific
for this diarrhoea which causes so much ravage. I am not able
to admit the assertion of Mr. Charles Hogg, in recommending
beef-tea, so well known in England: " Beef-tea is an excellent
aliment, very nutritious, and easy to digest; it replaces com-
pletely the juice of the meat obtained by scraping, which is so
lauded by Dr. Weisse, of St. Petersburg." I have found raw
meat not an aliment for infants, but a remedy for diarrhoea;
further I have never spoken of the juice of meat, but have re-
commended the muscular substance itself, hashed or grated in
such a manner as to be easily swallowed and digested. The
end proposed is to cause the muscular substance itself to pass
into the digestive tube, and beef-tea has no more effect upon the
diarrhoea of children at the breast, than the excellent decoction
of meat, praised by Liebig. These two liquid aliments, from
the simple fact of their fluidity, traverse too rapidly the intesti-
nal canal. By giving the meat in pap, the solid parts sojourn
longer in the intestine, acting by contact, and being able, by
exciting the intestinal mucous membrane, to stimulate absorp-
tion ; it is also probable that this means contributes to neutral-
ize the acidity of the gastric juice. I cannot partake of the hope
expressed by Dr. Beer, of seeing cod-liver oil replaced in the
Materia Medica by hashed raw meat. Each of these excellent
remedies has its sphere of action marked out in the treatment of
the diseases of infants; raw meat combats the diarrhoea of the
newborn ; cod-liver oil triumphs over rachitic affections with or
without atrophy.

The treatment of infants by raw meat has come into general
use at St. Petersburg, and this use has been propagated rather
by proofs of its good effects, than by special writings. The
most part of our confreres, employing it with the ordinary means
have failed, have also verified the good results obtained by my-
self. So far as it concerns myself, I have employed this treat-
ment in nearly two hundred cases, and the result has been al-
ways satisfactory when the disease was taken in time. I say

1859.] Action of Mercury on the Secretion of Bile. 767

when the disease was taken in time; for, if the malady is too
far advanced, and has assumed the characteristics of gastro-
malacia, (softening of the stomach,) a cure is rarely obtained.
Sometimes, even in these circumstances, we may succeed in
calming some symptoms so fatiguing to the little patient, such,
as the inextinguishable thirst, and tbe vomiting.

In a large number of patients cured by raw meat, verminous
affections have been observed, and particularly taenia, otherwise
very rare at St. Petersburg. Dr. Braun stated this as his opinion,
and two years after, a high authority, Prof Yon Siebold, of
Munich, expressed the same idea, in the last paper of his inter-
esting work, " Weber die Band und Blasenivurmer" Leipsic, 1854:
" We should no longer be surprised at the fact, and must credit
those physicians who have declared that they have found in
many patients submitted to a diet of raw meat, the taenia. And
Herr Yon Siebold has remarked that in every case the taenia
solium was found, and he believes that in all probability, this
worm, which is not indigenous to St. Petersburg, has been
brought there by the cattle driven from Tocherkask and Podo-
lia. Some weeks before my departure from St. Petersburg, in
the month of June of the present year, a taenia, more than ten
feet in length, was sent to me by a confrere, to whom I had
warmly recommended meat in the case of an infant aged 18
months. The taenia was expelled after the administration of
the etherial oil of male fern. This remedy was employed be-
cause the child, having been cured of its diarrhoea by the raw
meat, had several times passed parts of taenia.

I ought not to forget to say that in the hospital for children,
which is in my charge, I have often tried, but unsuccessfully,
the raw meat in the diarrhoea of children more aged, who were
sick from no cause connected with dentition. More frequently
this diarrhoea was caused by ulcerations of the intestinal ca-
nal. [Excerpta tran stated from U Union Medicate, by S. E. C.
\N. Orleans Med. and Surg. Journal.

Action of Mercury on the Secretion of Bile.

Among the effects of medicine which are usually considered to
be well established, the action of mercurial preparations in in-
creasing the flow of bile has been admitted without question.
Physicians speak about stimulating a sluggish liver by blue pill,
or calomel, as if it were not only the easiest thing in the world,
but as if we had ocular demonstration of the process ; and the
frequency with which the liver is thus stimulated to an increased
secretion of bile, is in proportion to the ease with which it is
supposed this may be effected. No matter what the disease, it

768 Defective Assimilation in Infants. [November^

is the commonest thing to begin the treatment by an active
mercurial purgative.

Some experiments by Dr. Geofge Scott, of Southampton,
England, made on dogs, with a view of ascertaining whether
mercury really increases the flow of bile, lead to the conclusion
that the hitherto-received opinions on this subject, are erro-
neous, and that calomel, at least, does not increase the biliary
secretion. Having ascertained the average quantity of bile se-
creted in twenty-four hours,- by collecting it in a vessel, after the
common duct was tied, Dr. Scott administered calomel to the
dogs, and then noted the amount of bile, the quantity of food
and drink taken being the same. The four experiments of Dr.
Scott all gave the same result, that there was a, diminution in
the amount of bile secreted after the administration of large doses of
calomel. If these experiments should be confirmed by future
ones, a revolution may be expected in the treatment of diseases
supposed to be connected with a deficiency in the biliary secre-
tion ; and that much-abused organ, the liver, will be allowed
some rest from the incessant appeals which are made to it, as the
source of so many functional diseases. We are glad that Dr.
Scott has undertaken to investigate the effects of calomel on the
liver by direct experiment. We hope he will continue his re-
searches, and extend them to other subjects connected with the
action of medicines. There is no department of our science in
which so little is known, or in which more light seems capable
of being thrown by direct experiment. Boston Med. and Sur.
Journal, and N. Y. Monthly Review.

Defective Assimilation in Infants its Prevention and Treatment.

Dr. Kouth read a paper on this subject before the Medical So-
ciety of London. The object of the paper was to show that
most of the mortality of infants was due to defective assimilation.
Defective assimilation was almost always the result of want of
breast milk and the use of injudicious food; the disease was
most effectively prevented by supplying this milk. Dr. Kouth
then detailed the result of breast milk exclusively given, artifi-
cial food without breast milk and with it, or the development and
mortality of children, from tables of Messrs. Merei and White-
head ; from which he showed that in proportion as breast milk
predominated, in proportion was good development observed,
and vice versa. He then showed that the most frequent diseases
amongst children were abdominal diseases, occurring in the pro-
portion of 23.4 per cent. ; developmental diseases in that of 8.8 per
cent, of all cases; rachitic diseases constituting 3.2 per cent. ; atro-
phy or marasmus, 5.2 per cent. He believed, however, that all
these were produced by defective assimilation, the former in most

1859.] Defective Assimilation in Infants. 769

cases being sequela? of it; atrophy or marasmus being only the
more marked and characteristic stage.

Dr. Routh then described the disease as consisting of three
stages: first, or premonitory, in which peevishness, some loss of
flesh, occasional attacks of indigestion, acid eructations, &c.,
were most prevalent; in the second stage, emaciation was more
marked, eyes became unusuall}7 bright, much loss of digestive
power, sometimes with diarrhoea and lienterv ; third, or ex-
haustive stage, generally attended with diarrhoea, aphtha?,
frightful emaciation, complete loss of digestion, &c. Somtimes
the disease from the second stage passed on to tuberculosis, ra-
chitism, and most developmental disorders, and not to the third
stage.

Causes. The predisposing causes were hereditary tubercu-
lar habit, and exanthemata; exciting causes bad air, want of
cleanliness, injudicious food, and especially an atmosphere con-
taminated by too many children being congregated together.

Post-mortem Appearances. Three kinds: emaciation very
great, loss of adipose, cellular, and muscular tissue, in all varie-
ties; but in one, where diarrhoea has been present, red patches,
or aphtha? over the alimentarj- mucous membrane, these aphtha?
often containing the o'idium albicans. In other cases, also with
diarrhoea, the mucous membrane exuding a reddish coloured
mucus, intensely acid. In others, without diarrhoea or with it,
Peyers glands projecting, and enlarged in patches, as in Asiatic
cholera. In all, undigested matter in canal, with very fetid
fecal matters.

The disease seems to be gradual, passing on to entire loss of
jwimary assimilation : the scondary still persisting, although
inactive from want of assimilable matters to take up. Albumi-
nous, starchy and oily matters were not digested.

The treatment consists in supplying fatty acids and already
artificially digested animal, and occasionally vegetable substan-
ces, especially human milk. If this could not be sucked, it
should be collected in a cup and given by the spoon. I)r.
Eouth strongly animadverted here upon the absurd dogma, that
it is wrong to mix human and cow's milk. He, on the contra-
ry, believed the plan not only safe, but the very best practice
in many cases, and the only means of saving an infant's life.
Simple juice of meat, and this with vegeto-animal food, he had
found most useful in fulfilling these indications. The remedies
were of two kinds : 1st. Those calculated to increase cell growth
and development. Phosphate of soda producing au emulsion with
fats, thus allowing of their assimilation; chloride of potassium,
to dissolve carbonate of lime ; phosphate of lime, to enable the
blood to take up more carbonic acid, and thus hold in solution
more carbonate of lime, (these substances severally strengthen-

770 Cure of Stricture of the Urethra. [November,

ing muscular and bony structure) ; lime-water, to provide lime
to blood. 2d. These last also acted as some of the remedies cal-
culated to allay local irritation of the alimentary canal. Car-
minatives were useful, such as dill, but especially cinnamon-
powder, to correct flatus and to check diarrhoea. Anodynes
were also (however objected to generally,) strongly recommend-
ed by the author. For the diarrhoea, when present, nitrate of
silver and sulphate of copper were the best remedies. Wine
was also found very serviceable, even if given in large quanti-
ties. These remedies, however, it must be confessed, proved in
most cases of no avail in the third stage, which was, he might
say, almost incurable ; but they acted very effectively in the
second and first stages. Lancet and American Journal.

Perineal Section for Cure of Stricture of the Urethra.

Mr. Henry Smith states, that " about a fortnight since I had
in my house on the same morning, two unfortunate gentlemen,
in the prime of life, who had undergone the perineal section ;
one, five years since at the hands of a London surgeon of large
experience ; the other, three years previously, had been cut by
Mr. Syme himself in Edinburg. They were both in a wretched
condition ; the one had his perineum riddled with three fistu-
lous openings, but as Mr. Syme himself was not the operator
here, the proceeding was of course unskilfully and improperly
done, and I will say no more about it. The other case, how-
ever, was treated by Mr. Syme himself, and the operation was
of necessity done according to the rules laid down by that sur-
geon. Yet, where is the complete remedy? The unfortunate
gentleman assured me, that before he left Mr. Syme's care after
the operation, he felt the stricture returning, and that notwith-
standing he persisted in passing the instrument every fortnight,
as he was told to do, the canal contracted, so that he was un-
able at the expiration of ten months to pass anything at all.
Since then he has been roaming about from one surgeon to
another, in the hope of getting his stricture dilated. When he
first consulted me some six weeks since, I could only with the
greatest perseverance, succeed in introducing a small No. 4
catheter, although a distinguished surgeon in Dublin had intro-
duced a No. 8 only a fortnight previous. There was no fistu-
lous opening left here, as in the other ; but there is the irrita-
bility and contractility of the uretha as before, although Mr.
Syme performed the operation himself, and according to the in-
formation given to me by the patient, assured him it would be
a certain cure. I have before enunciated the opinion, that not
only does this operation not prevent the return of the stricture,

1859.] Cancerous Ulceration close to the inner Canthus. 771

but that the recon traction becomes more severe than before.
As I had not the opportunity of seeing this gentleman before
he was cut, I cannot positively state whether this holds good
here or not; but that the induration still remained, or had re-
formed at the site of the old disease, was quite evident by running
the finger along the perineum. Cutting cannot possibly get rid
of this ; and so long as this remains, the stricture will persist.
London Med. Times and Gaz..

Cancerous Ulceration close to the inner Canthus, treated with Sul-
phate of Zinc Paste.

Dr. William Mackenzie, of Glasgow, relates the following
interesting and instructive case. A patient, aged apparently
about forty -five, and who attributed the spread, if not the origin,
of his complaint, to the depression of mind arising from pecuni-
ary loss, applied to me on the first of February, 1859, on account
of a cancerous ulcer on the side of the nose, close to the inner
angle of his left eye. It was fully the size of a four-penny
piece, of irregular shape, covered with a scab, and surrounded
oy hard and elevated edges. The papillae and carunculae lacry-
males, and the palpebral conjunctiva were inflamed, and the
disease seemed to be extending in the direction of these struc-
tures.

I felt no doubt, that were the nicer left to itself, it would
gradually spread, and prove rebellious to all applications of a
soothing description. Having repeatedly found, also, that ex-
tirpation of such a disease by the knife, even when care was
taken to cut into the sound integuments, although followed by
a firm cicatrix and an apparent cure, was succeeded after a time
by a renewal of the scirrhous hardness and intractable ulcera-
tion. I determined in this case to try as an escharotic, the sul-
phate of zinc, as recommended by Dr. Simpson, of Edinburgh.
I was partly led to this course, too, by observing that I could
not extirpate the diseased part without removing the lower
papillae lacrymalis.

Having driven off by heat, the water of crystalization of a
few grains of the sulphate of zinc, and reduced the residuum to
a fine powder, I mixed it with a little glycerine, so as to form a
thick tenacious paste. Taking a little of this on the point of a
bit of stick, I appllied it over the scab and over the hard edges
of the ulcer, and covered the part with dry lint.

Next day, I found that the application had given very little
uneasines ; out that it had acted in destroying almost entirely
the hard edges of the sore, and left the whole of its surface free
from scab and of a florid healthy color.

772 Quinine Ether. [November)

Two or three times subsequently, I covered the edges again
with the zinc paste; after which I left the wound to cicatrize,
under the application of dry lint. I touched the conjunctiva
and papillae lacry males occasionally with the four grains' solu-
tion of nitrate of silver, under which application they speedily
freed themselves of inflammation.

On the 24th March, the patient called on me, with a firm
cicatrice, of a healthy hue, in the site of his former disease.
Ophthalmic Hospital Reports, and Ibid.

Quinine Ether.

M. ElSSEN" has recommended in the Gazette Medicate de Stras-
bourg, the use of quinine, introduced into the air-passages, for
the treatment of intermittent fevers. The process consists in
the inhalation of quinic ether, a combination made by M. Man-
ette, and first used by M. Pignacci, of Milan.

The substance, still incompletely defined, in a chemical point
of view, is obtained by means of the distillation of alcohol,
treated by sulphuric acid, (theory of ethers,) in presence of the
quinate of lime. The product of this distillation is a liquid per-
fectly limpid, colorless, of an agreeable odor, less volatile than
sulphuric ether, but still sufficiently volatile to evaporate at an
ordinary temperature without leaving -a deposit. It deserves,
then, the name of ether ; and its therapeutical action, besides,
seems to justify the qualification of quinic, which has been given
to it.

Quinic ether, says M. Eissen, fills all the necessary conditions
of a good therapeutical agent. It acts, at the same time, tuto,
cito etjucunde. Inhaled in the dose of a few grammes, (2 to 3,)
as chloroform is generally employed upon a compress, it checks
& commencing access, and prevents a return of subsequent access-
es. In all the cases in which it was tried, the access gradually
yielded, never to return, when the fever was simple, or under
a very mild form in cases of decided cachexia.

Since the first trial upon patients in Lombardy, who could
not be suspected of being slightly affected, other trials have been
made by Prof. Groh, at Olmutz, and with the same success.
The results have been the same : whether the inhalation was
made before or during the pyrexia, the access was lessened in
character in a marked degree, and the next anticipated access
prevented, in the majority of cases; the tumefaction of the
spleen disappearing at the same time. The inhalation, far from
being disagreeable, was followed by good results, or of a sensa-
tion of decided amelioration. We may add that, in their experi-
ments, our learned confreres, whpse names we have cited, were

1859.] Vegetation of the Genital Organs. 773

careful to establish negative proofs to confirm their judgment.
They submitted a certain number of fever-patients to in halation a
of pure sulphuric ether, or sulphuric ether holding sulphate of
quinine in solution. The inhalations of pure ether produced no
other effect than that of increasing, in an insupportable manner,
the hot stage; while in those taking the ether containing the
quinine, some anti-periodic effects were observed, after large
quantities of the remedy were absorbed; but in severe cases
these effects were so slight, after long trials, that the patients
themselves solicited more energetic measures. \_Amer. Mtd. Mon.

Vegetation of the Genital Organs Chromic Acid. [Translated
from the Gazette Hebdomadaire for the Boston Med. and Surg.
Journal] By 0. D. Palmer, M. 1)., Zelienople, Pa.

Case. 0., 23 years of age, of a good constitution, never having
been diseased, became pregnant ibr the first time toward the end
of October, 1856. About the same time she was taken with an
abundant blennorhagic discharge. Having arrived at the fourth
month of gestation, she experienced a sense of heat and suffer-
ing in the genital organs. This painful sensation was produ-
ced by the presence of numerous prominences in the vagina,
which had replaced the very copious and extremely foetid puru-
lent discharge. Careful cleanliness, injections, and baths, pro-
cured no ease. Two months passed, during which the disease
was making rapid progress.

C. presented herself at the hospital, where she was admitted
on the 30th of April, in the sixth month of her pregnancy. It
was ascertained that over the labia majora and minora the va-
ginal canal, and even the cervix uteri, was a growth of excres-
cences of considerable size, and in great number. The most
voluminous, as large as the fist, projected outside of the vagina.
Of these vegetations some were with pedicles, others were ses-
sile ; their tints were reddish, their appearance vascular. They
were for the most part divided and subdivided, forming ramifi-
cations, which in their aspect offered some analogy to the cor-
ymb of the millifolium. In the vagina these excrescences had
acquired such dimensions, such a development, as to fill all the
cavity, and not to permit, without the greatest difficulty, the in-
troduction of the speculum.

In searching for the cause of these vegetations, it was impos-
sible to recognize for them a syphilitic origin. The woman had
never had chancres. An attentive examination of the genital parts
did not discover any ulceration. There existed no engorgement
of the inguinal or sub-occipital glands, no squamous eruption.

In such a state of things we could not but foresee great diffi-
culty at the time of accouchement. It was, then, very important

774 Cases of Suppression of the Urine. [November,

to find means to destroy this obstacle. For this end, M. Rous-
set applied, first, crayons of nitrate of silver, then the nitric
oxide of mercury. This last means, continued during twenty-
five days, with much care, caused very smart pain. Like the
preceding, it was not followed by any advantageous effects.
Tincture of iodine had no good result.

On the 6th of Juhr, after all these failures, Prof. Rousset had
recourse to the use of chromic acid. He made application of a
solution prepared as follows: R. Chromic acid, 1 part; aquae
distilled., 3 parts. By the employment of a pencil, each excres-
cence was separately washed with this liquid, having care not
to touch the mucous membrane that surrounded it. The pa-
tient experienced immediately, in the part touched by the solu-
tion, a sensation of smarting and pain, which was calmed again
directly. Redness was manifested, a little swelling, in short a
slight inflammation, which was terminated by the formation of
pus. Some few washings with Goulard's water, and the use of
dry lint, constituted the whole treatment. In proportion as
suppuration was established, the excrescences were detached,
disappearing, and leaving in their place a reddish surface, in
some points excoriated, in others ulcerated, very superficially.
The cicatrization was regularly and uniformly established.

July 20th, the cure was complete ; the cervix uteri, the labia
majora and minora, and the vagina, were entirely freed from
these adventitions productions, and offered an aspect which was
altogether normal.

On the 26th accouchement took place without any accident.
The child of the masculine gender, was perfectly formed, and
afforded no traces on its body that could cause the mother to be
suspected of any affection of a specific nature.

The chromic acid has been extolled, these few years past, as
a caustic, both by Dr. Keller, of Germany, and by Dr. Marshall,
of London, for destroying vegetations developed on the genital
parts. Dr. Marshall uses the acid in solution. Dr. Keller ap-
plies it in the form of paste. Whatever process is adopted, this
caustic is easily managed ; its action is at the same time very
rapid, little painful and thorough. We have a right to conclude,
then from this case, that in these excrescences the chromic acid
is a powerful caustic, and preferable to others that have been
hitherto employed. [Caussade of the School of Bordeaux, and
Boston Med. and Surg. Journal.

Cases of Suppression of the Urine. By James Alexander, Esq.,
Surgeon, Wooler.

The pathology of the disease, described by our older writers
under the name of ischuria renalis, is little known, and the dis-

1859.] Gases of Suppression of the Urine. 775

ease itself is a very rare one. Dr. Abercrombie treats of sup-
pression of urine as resulting sometimes from disease of the kid-
ney itself; sometimes from disease, generally inflammatory, of
some adjacent organ ; and only very occasionally as proceeding
from some unknown cause affecting the nerves of the organ, and
leaving few or no morbid traces after death. The same view,
substantially, is taken by recent systematic writers; with a
strong inclination, perhaps,, to refer all, or almost all, cases of
suppression to some stage or modification of granular disease of
the kidney. I cannot pretend to throw any light on the inti-
mate nature of the disease ; nor have I the means of going into
the literature of it. But, perhaps the two following cases, which
occurred to me very recently, may possess sufficient interest to
deserve being recorded in the Edinburgh Medical Journal:

On the 13th February last, I was requested to visit a shep-
herd lad, aged 16, residing about seven miles from Wooler, who
appeared to be laboring under the symptoms of ordinary con-
tinued fever, which his friends imagined had been brought on
by cold and exposure to wet. He had been ill about ten days.
His pulse was about 100 ; his tongue loaded, and his throat
slightly inflamed and painful; he complained of headache, but
had little delirium ; there was a good deal of restlessness, and
his urine was scanty and high-colored ; there was no cutaneous
eruption. He was ordered some mild aperient, his diet careful-
ly regulated, and, as his pulse was weak, a small quantity of
wine was directed to be taken at intervals. On the 15th, the
symptoms were nearly the same, but the quantity of urine was
very much diminished ; on the 16th, totally suppressed ; and
about midnight of the 17th, he died, just a few minutes before
I entered the house. Before his death there was partial stupor,
but no profound coma, and slight irregular movements of the
muscles of the face and eyes, but no general convulsions.

Five weeks afterward, I was sent for to see a younger brother,
who was reported to be ill of the same disease of which the first
brother had died. I learnt that, in the interval between the
death of the elder brother and the seizure of the one I was now
visiting, a sister had been ill, as the people supposed, of the
same disease, but had passed through it so mildly that no medi-
cal advice had been sought for her. My present patient ex-
hibited similar symptoms to those presented by his brother; he
had been ill seven days; there was headache, slight sore throat,
great general uneasiness, and already the same noticeable dimi-
nution in the quantity of water voided was beginning to mani-
fest itself; there was also some spots on the abdomen resembling
the eruption of typhoid fever ; but as the youth was liable to
an anomalous rash in the spring months, I would not lay much
stress on that symptom. The following day the pulse had fill-

776 Cases of Suppression of the . Urine. [November,

len to 70, and became much weaker, and the urine was totally
suppressed; there was no delirium and no coma, no pain in the
back, nor the slightest tenderness over the abdomen. Free
leeching to the region of the kidneys was had recourse to, and
repeated thrice in the course of the next three days; the back
was rubbed with a strong turpentine liniment; and the bowels
opened by compound powder of jalap. After the first applica-
tion of the leeches, a small quantity of water was secreted, but
no change took place in the strength or frequency of the pulse ;
but gradually, under the use of the remedies mentioned, the
pulse began to rise, the urine became more abundant, and the
symptoms of affection of the brain gradually subsided, and in a
week's time all the symptoms of the urinary affection had ceased.
The symptoms of general feverish action ran on for a few days
longer ; but, in twenty days from the date of the first shivering,
the boy was convalescent, and continues to this time in good
health.

It must be acknowledged, that it is at least a singular coinci-
dence, the occurrence of two consecutive cases in one family of
symptoms so unusual as those I have detailed. The progress
of the case last detailed, and the occurrence of the girl's case
between those of the two brothers, renders it probable that I am
correct in considering these as original cases of ordinary fever ;
and if so, the uriary symptoms form a complication certainly
not usual and not altogether without interest. I have seen, in
the course of my practice, besides suppression more or less com-
plete from evident inflammatory affection of the kidneys or ad-
jacent organs, one or two cases of what I believe was genuine
ischuria renalis, as described by our older writers; and with a
very brief notice of these I shall conclude this paper. My first
case occurred in a young man, 22 years old, of unusually dark
complection, and developed itself suddenly. The cessation of
the urinary secretion was total in sixteen hours after the acces-
sion of the disease, and could be ascribed to no probable exter-
nal cause. The pulse was slow (under 60,) and there was some
degree of giddiness and somnolence almost from the beginning;
otherwise the general health was not materially affected. The
lad was bled to ten ounces from the arm ; leeches were applied
to the back; the warm bath was used ; and turpentine liniments
rubbed on the region of the kidneys, the bowels being sharply
acted on by calomel, followed by large doses of cream of tarter.
Under this treatment, at the end of sixty hours, a small quanti-
ty of urine was passed, which gradually increased, and in little
more than a week's time, he had nearly regained his ordinary
state of health ; nor was the secretion of urine ever subsequent-
ly interrupted. Another case occurred in a boy who had passed
through an exceedingly severe and prolonged attack of croup,

1859.] Cases of Suppression of the Urine. Ill

which had been treated in the usual way, by bleeding, calomel,
and antimonials. After having coughed up considerable por-
tions of false membrane, some fragments of which were distinctly
tubular, he had seemed, in about nine days, satisfactorily con-
valescent, the breathing perfectly free, the pulse natural, and all
the symptoms of the disease completely gone. The tenth day
from his seizure, I was summoned to visit him in haste, and in-
formed that he had made no water for nearly twenty-four hours.
To guard against the possibility of mistake, I passed a catheter
into the bladder, a precaution which, I forgot to say, I adopted
in all the cases I have related, with the result of finding, as I
did in all the rest, the organ quite empty. He was treated in a
similar manner to the last-mentioned case, but without any
benefit, and on the third day he died comatose, not very pro-
foundly so, however, death being preceded, as in the first of the
above cases, by slight twitchings of the facial muscles and dis-
tortion of the eyes, but not by any convulsive movements of
the limbs or body. About a week after the death of this last-
mentioned patient, I was requested to visit a boy aged 10, who
had not made water for nearly twenty-four hours; the boy was
moving about, nor was there the slightest symptom of indispo-
sition discoverable upon examination. His pulse was natural,
his tongue clean, his skin cool, his appetite good. His mother
had discovered thac he made no water while he was in her sight,
and upon questioning him he affirmed that he had made none
at all, and as his friends lived in the immediate neighborhood
of the youth who had died after croup, they took the alarm
and sent for me without delay. Leeches, purgatives and other
remedies were employed pretty actively, but without the slightest
effect in restoring the secretion ; the second and third day pass-
ed and no water came, still the boy gave no signs of indisposi-
tion, and except an occasional wrarm bath, and attention to the
state of the bowels, little or no further treatment was had re-
course to. And thus the boy went on for four weeks, without
voiding during the whole time one ounce of water, without any
noticeahle inconvenience, and without, as far as I could see, any
vicarious discharge. There was no urinary smell, either in the
faeces or in the sweat, which was little if at all increased. At
the end of a month the urine began to be again secreted, and
gradually increased in quantity till it reached its ordinary
amount, the first portions that were voided producing a good
deal of smarting and pain in the urethra, which, however, sub-
sided by degrees. It was, of course, impossible for me to have
this boy so constantly under my own eye, as to be able to state
from my own personal observation that no urine passed ; but
his mother was both an intelligent and respectable person, every
precaution was taken to prevent mistakes on the boy's part, and

778 On Suppression of the Menstrual Discharge. [November,

no conceivable motive existed for deception on the part of either
him or his mother. I have, therefore, myself no doubt whatever
of the fact I have stated. Both this case and the two immediate-
ly preceding it were communicated at the time to the Border
Medical Society; so, although the cases occurred many years
ago, I am quite confident of the accuracy of the facts I have de-
tailed. And I hope they may be deemed sufficiently interesting
to deserve a place in a more permanent record. [Edinburgh
Med. Jour., and Boston Med. and Surg. Jour.

Epilepsy succeeding a Suppression of the Menstrual Discharge,
Cured bg the Supervention of Dysentery, and the Restoration of
the Catatnenia. By Sampson Eagon, M. D., of Bot. County,
Va.

Miss T. R, set. 17, had the menstrual function established at
15, and it continued normally until the 17th year, when from
exposure of the feet to moisture and cold at one of the periods,
the catamenial discharge was arrested. For several periods she
suffered the ordinary pain and discomfort of amenorrhcea, and
at the fourth month of amenorrhceal suffering, she was attacked
with epilepsy ; I was at this period called to see her. After an
unsuccessful effort to re-stablish the catamenial flux, (it being a
period,) the patient was put upon treatment for epilepsy, the
treatment consisting principally in the use of tonics, antispas-
modics, revellents, and emmenagogues. The epileptic convul-
sions, however, continued to recur with undiminished violence,
notwithstanding the treatment was assiduously persevered in
for more than twelve months. The argent, nitras, several of
the salts of iron and copper, as well as sulphate of quinia, were
given a fair trial, but without decided benefit.

The paroxysms in this case were of the most violent charac-
ter, and lasted for several hours, night and morning of each
day. After having fairly tested the virtues of the most popu-
lar anti-epileptic means in the case, with so little success, Dr.
Woodson, (the consulting physician,) and myself abandoned all
hope of relieving her. In July, 1858, dysentery became epi-
demic in her locality, with which disease she was attacked in a
severe form. Having been called again to the patient at this
period, and hoping now that the constant tenesmus and irrita-
tion of the large intestine might extend by contiguous sympathy
to the torpid uterus, I was careful not to arrest the dysenteric
discharge too hastily, prescribing only a half grain of opium,
with two of the mild chloride of mercury, repeated every eight
hours. On the second day, I learned from the patient's mother,
that the menstrual discharge was regularly flowing, and I found

1859.] After-treatment of the Extraction of Cataract. 779

the young lady free from epileptic symptoms. The dysentery
soon subsided, and the young lady quickly returned to almost
perfect health, and is now quite well. The only means that
have since been employed in the treatment, have been a pretty
active purgative of aloes and rhubarb, conjoined with a warm
hip-bath, used for several nights before each expected return.
There are two points of interest, as I conceive, in the case
above detailed : 1st. The undoubted relation which here existed
between the amenorrhoea and epilepsy as cause and effect ; and
2nd. The means employed by nature to produce relief, an irri-
tation propagated from the rectum and colon to the uterus by
contiguous sympathy. [American Journal.

After-treatment of the Extraction of Cataract.

The old method of bandaging the eyes is never practiced in the
Central London Ophthalmic Hospital, and the modern one of
plastering the eyelids is adopted in its stead. The object is to
keep the eyelids motionless and closed, in order that the edges
of the wound in the cornea may be kept in accurate adaptation
by the gentle pressure of the eyelids. If a patient can keep his
eyes shut, no appliance is needed ; but few can do this. As the
bandages are ordinarily applied, they are useless. To make
them potent as bandages, would demand a degree of pressure
that must be injurious. Very much annnoyance is often pro-
duced from the cloth being stuck to the cheek, by the aqueous
humor when it trickles away ; and the night's rest is broken in
consequence. A couple of straps of court-plaster, the eighth of
an inch wide, accomplish all that is desired. Mr. Walton gen-
erally allows them to remain for a week ; but if any unplea-
santness is complained of, such as stiffness or hardness, they
are removed after the third or fourth da}\ To this plan, which
is wholly unobjectionable, Mr. Walton attaches much value ;
and he is convinced that the highest attainable results from the
operation of extraction cannot be obtained without it. He
always keeps the eyelids closed till the aqueous humor no longer
escapes from the corneal wound ; that is, till the cornea is quite
healed. At the end of the week, when the patient has opened
the eye, Mr. Walton does not raise the lid himself, but desires
the patient to open the eye naturally, which he considers far
preferable ; he again closes it, if requisite, with court-plaster for
some days. There can be no doubt of the prudence of this.
Many an instance of prolapse of the iris, with all the irritation
and ulterior consequences, has been produced by the use of the
eye before there has been proper reunion. Young operators
are often sadly puzzled to account for the secondary imperfeo
tion of prolapse of the iris, after they have had such promising
jr. 8. vol. xv. no. xi. 55

780 Dr. 0. C. Gibbs. Summary. [November,

results, when the eye was looked at a few days after the opera-
tion. This is the solution ; the eye is used far too soon, and by
the action of its own muscles the prolapse is occasioned.

The great proof of cicatrization of the cornea is the fulness of
the anterior chamber. So long as the iris is pressed forwards,
and there is not the natural accumulation of aqueous fluid, the
eye should be kept closed. A very little attention will enable
the practitioner to decide this point.

When the iris is wounded in the operation of extraction, pro-
lapse is very apt to occur under any condition ; hence, Mr.
"Walton lays it down as a rule, that much pains should be taken
to prevent the accident. He considers it far better on every
occasion to finish the operation with the secondary knife rather
than to complete it with the cataract knife ; when, by so doing,
the iris is not at all injured. The late Mr. Alexander, than
whom there never was a better operator, always made the sec-
tion of the cornea with two knives. As soon as he had effected
the counter-puncture with Wenzel's knife, he withdrew it, and
completed the section with the secondary knife. [British Med.
Journal, and Nashville Med. Record.

[From a valuable summary prepared by Dr. 0. C. Gibbs, of
Frewsburg, for the New York Medical MontJily, we select the
following several articles.]

Iodide of Zinc in Chronic Conjunctivitis. In the Peninsular
and Independent, for August, Dr. Waggoner, of Oconee, 111., has
a short article upon the treatment of chronic conjunctivitis.
After correcting the general health, if deranged, he advises the
application of one-sixteenth of a grain of sulph. morphine, dis-
solved in water and applied with a camel's-hair brush, twice a
day, until all irritability is allayed. After this follows the cura-
tive treatment, which does not materially differ from that usually
put in requisition, except that advised in his concluding re-
marks. He says, "Latterly I have incorporated in my materia
medica the iodide of zinc, the effects of which have proved satis-
factory beyond all anticipation. This drug is passed over in all
our standard works on therapeutics, in almost profound silence.
In no case, in which I have observed its effects in the treatment
of ophthalmia, has it deserved, in my humble opinion, a place
second to any other remedy. In one scrofulous case, it acted
like a charm. Will not the profession give attention to this
very deserving agent, and more fully prove its worth ?" The
Dr. does not give his formula for use.

Congenital Hernia. In the same number of the Peninsular
and Independent, Prof. Moses Gunn, of Detroit, reports a case o

1859.] Dr. 0. C. Gibbs. Summary. 781

hernia, descending through a congenital passage for the first
time after the age of thirty years. If this case is not unique,
such cases must be of rare occurrence.

Miasmata. In the Lancet and Observer for August, Dr. Har-
vey, of Springtown, Indiana, publishes a paper upon the above
ever vexations subject. It is difficult to give a synopsis of the
paper that will be sufficiently condensed to answer our purpose.
He says, " Those diseases originating from miasmatic causes,
are produced by a change in the relative proportion of the
several gaseous and mineral elements of which the living body
is composed ; in other words, diseases which appear both epi-
demically and sporadically, and some others, are produced by
the addition to, or subtraction from, the essential elements of
the body in health." Again, he says, " In intermittent, bilious,
and remittent fevers, the crassamentum of the blood is increas-
ed, and darker in appearance than in health. The red globules
are darker, and the quantity of serum less than the healthy
standard ; the fibrin having been either changed to albumen or
coagulated to a certain extent. Hence we may infer that there
has been carbonaceous matter from external sources added in
undue proportion, or a decomposition within the body." Want
of space will not permit us to give the premises upon which
this is based. Efe adds further, " In such diseases as cholera,
dysentery, &c, we must look for other causes ; but these may
be found in other gaseous or mineral elements or compounds,
emanating from similar sources as carbon, and also from the
earth. My opinion is, that cholera is produced by the action of
nitrous acid gas upon the blood. In certain electrical conditions
of the atmosphere, the oxygen and nitrogen of the air become
chemically united, and form nitrous oxide or protoxide of nitro-
gen ; and these two gasses, being disengaged from decaying
animal matter, become united also, with the same result; and
the resulting compound floats in the air, and is absorbed through
the lungs, skin, food, &c, into the system. I believe that the
great amount of moisture in the air, the great heat and elec-
tricity every where in those countries where cholera is raging,
causes a greater or less chemical union of the elements of the
air, thereby producing nitrous acid gas."

The miasmatic element, as productive of disease, and of vary-
ing diseases, has been an incomprehensible mystery and vexa-
tion to observing physicians for all time, and is likely to be for
some time in the future. Some have denied its existence alto-
gether, as an aerial poison, the product, of animal or vegetable
decompsition, and as causative of endemic or epidemic diseases.
We will here instance only S. Littell, M. D., of Philadelphia,
who refers such diseases to ^electrical agencies, and the late J.

Dft. O. C. Gibbs. Summary. [November,

K. Mitchell, M. D., who referred them to a crjptogamous origin.
That certain diseases occur only when there is a conjunction of
certain atmospheric and terrene conditionsr is almost universal-
ly admitted; that the terrene conditions exercise a controlling
influence, is a fact too well established to admit of doubt ; and
that that terrene condition or element is effluvial, is more than
problematical. But why dissimilar diseases from similar causes ?
That the plague and yellow fever occur only under similar, if
not absolutely identical conditions, is well known. High tem-
perature, humid atmosphere, lowness of site, density of popula-
tion, and animal and vegetable putrescence, with a preponder-
ance of the former, are necessary conditions to the production
of a miasm that will develop either of the above-mentioned dis-
eases. If the causes are the same, why not the results ? If these
conditions develop the plague in Constantinople, why not in
New Orleans ; and the reverse, in regard to yellow fever ? We
answer by putting another question. If sugar, starch, and gum-
arabic are composed of precisely the same ingredients, in two
of the instances, in precisely the same proportions, why are not
the physical properties of the resulting compounds identical ?
If dissimilar substances are isomeric, may not the causes of dis-
similar diseases be also isomeric ?

Intermittent, remittent, and bilious remittent fevers have also
terrene causative relations and dependencies, and those causa-
tives are apparently identical, and always present where these
fevers are endemic. The miasm of intermittent differs from the
miasm of yellow fever and cholera, but we are not prepared to
believe the difference to be what Dr. Harvey suggests. The
miasm of an intermittent has a more vegetable origin than that
of yellow fever, and its conditions of development are not the
same. If intermittent fever has always terrene causative rela-
tions, why is not that disease always present whenever those
causative relations exist ? True to our Yankee instincts, we
answer by asking, Why carbon and hydrogen, in the relative
proportion of five parts of the former to four of the latter, in
combination, are not always oil of turpentine, and not some-
times oil of lemons, as is well known to be the case ? Why is
not C, 2 H, 0 0, 0 not always starch, when in combination, and
not sometimes gum-arabic and gum tragacanth respectively ?

This is not the time or place to enter upon controversial ground,
the above thoughts are thrown out simply as suggestives.

Laryngismus Stridulus. In the same nnmber of the Lancet
and Observer, Dr. K. E. McMeens, of Sandusky, Ohio, reports a
case of the above disease, with a few remarks upon its patholo-
gy. Dr.. Hord, in the British and Foreign Medico- Chirurgical
Review^ declares the exciting and sustaining cause of the disease to

1859.] Dr. 0. C. GrBBS. Summary, 783

depend upon an enlarged state and disordered function of the
liver a condition of that organ vulgarly termed and treated by
nurses as " livergrown," and the laryngeal difficulty, dyspnoea
and spasm of the glottis, are sympathetically excited and secon-
darily involved; and offers, in support of the allegation, the
revelations of twelve autopsies of fatal cases, all confirmatory of
the fact. " To the truth of this proposition," Dr. McMeens
says, " I am disposed to differ, from the ostensible efficacy of
remedies adapted to such pathological inductions. Cathartic
doses of calomel, followed by free discharges of vitiated bilious
secretions, were invariably succeeded by a marked amendment,
while the absence or deficiency of such secretion was precursor
to a decided aggravation of the disease. As an alternative, the
proto-iodide of mercury had a most happy influence over the
secretions. Dover's powder usually sufficed to allay any distur-
bance or pain in the bowels. Frictions along the spinal column
were premised for the contractions and insensibility of the ex-
tremities, and the inhalation of ether, hyoscyamus, and anise, to
soothe the irritability of the larynx and allay cough. Under
this treatment, at least, the disease was manifestly modified, and
the patient steadfastly improved.

The pathology of this affection has been anything but defin-
itely settled, and anything concerning it we regard with interest.
Some, with Drs. Ryland and North, have supposed the disease
dependent upon cerebral derangement, while others consider it
dependent upon gastric irritation. Dr. Marsh thinks it ma^
proceed from irritation of the pneumo-gastric nerve ; while Dr.
hey supposes it dependent upon paralysis of the muscles which
open the glottis, in consequence of pressure of enlarged glands
upon the recurrent nerves. It is probable that the laryngeal
affection is due to a reflex nervous action, the seat of irritation
being variously located : sometimes in the gums ; at others, in
the medulla oblongata ; and still at others, in the liver, or any
part of the digestive apparatus.

Erysipelas. In the Medical and Surgical Reporter for August
13th, J. R. McClurg, M. D., of Philadelphia, has an able article
upon the above subject. In regard to treatment, after the action
of an emetic and a saline cathartic, combined with a mercurial,
if there be symptoms of billious derangement, he says : " I
always use some tonic medicine, and my favorite prescription,
and the one I uniformly use in all cases of erysipelas, of what-
ever form or character, as soon as the system is prepared for
it, is,

#. Spiritus aetheris nitrici, f. Sij.

Tinctura ferri sesqui chloridi, f. 3ij.

Quinae sulphatis, gr. xvj.

784 Dk. 0. C. Gibbs. Summary. [November,

Misce et S. Take a tea-spoonful every three hours. This con-
stitutional treatment I have found very successful in my hands,
and desire nothing better."

This corresponds very nearly to the treatment we have found
very serviceable. We are, however, in the habit of prescribing
the tincture of iron in a little larger doses, say twenty drops
every three hours; and the quinine in combination with Do-
ver's Powders, from one to two grains of the former to five of
the latter, every four or six hours.

A Case of Epilepsy Cured. In the same journal for August
20th, Dr. S. N. Pierce, of Cedar Falls, Iowa, reports a case of
epilepsy, cured under treatment in compliance with the follow-
ing prescription :

ty. Ext. stramonii.

" conii, aid gr. xv.
Strychnia, (cry.,) gr. ij.
Argent, nitr., Bij.
et div. in pil. No. xxx.

"Of these," he says, " I gave three a day. This course was
pursued perseveringly, the amount of the strychnia and nitrate
of silver being slowly increased, until I found the disease gradu-
ally yielding to its influence. I now have the satisfaction of
feeling that the disease is subdued." Patients have recovered
in cases of epilepsy under a variety of treatment that subsequent
experience has proved to be of non-effect.

One case is quite too limited to judge of the effects of any
medicines. The case of Dr. Pierce loses in interest when it is
remembered that the improvement at the time of the report was
of but five weeks' duration.

Mental Influence on the Products of Conception. In the Medi-
cal and Surgical Reporter for August 27th, Dr. Ziegler, of Phila-
delphia, reports a case of a mother, who, in the early weeks of
pregnancy, was badly frightened by what she supposed to be
one of her children cutting off the hand of another. She was
confined at full time of a child minus the right hand the radius
and ulna terminating abruptly in a stump at the wrist. The
editor adds that, four years since, he saw a woman delivered of
a child with a deformed nose, which was in exact resemblance
to that of an unfortunate girl's who lived next door, who had a
cancer of the nose.

The first case was doubtless a case of spontaneous intra-ute-
rine amputation, caused by the cord being wound around the
wrist. The second was doubtless a case of incomplete develop-
ment, which occasionally occurs as freaks of nature, of which

1859.] Secale Cornulam for t?ie Eyes. 785

hare-lip is a sample. We once saw a nasal deformity similar to
the above, but the lip was cleft. We hope our women are not
going to reproduce all the deformities they see.

Strychnia in Chronic Inter rnittents. In the New Orleans Medi-
cal News and Hospital Gazette, Dr. Harrison, of Arkansas, has
an article upon the use of strychnia in chronic intermittents.

The following is his formula :

" $. Strychnia, gr. iss.

Sulph. Quinine, gr. xv.
Capsicum, gr. vj.

Brandy, I iv. M.

" Of this mixture, I direct one tea-spoonful (for an adult) every
hour, for six or seven hours preceding the expected paroxysm ;
at the end of this time I require the patient to take a cup of
warm sage tea, and go to bed, (if he is not already there,) and
remain until the paroxysmal hours pass. This course is to be
repeated on the next * chill day,' after which a tea-spoonful of
the medicine is to be taken two or three times per day, until
the four ounces are exhausted."

With Dr. H. F. Campbell's views of the nature of this dis-
ease, and its relation to the nervous sj'stem, the philosophy of
this treatment becomes at once apparent. This, however, is not
altogether new treatment. Dr. Brainard, of Chicago, recom-
mended strychnine, in an eighth of-a-grain dose, three time a
day, in similar cases, more than twelve years ago. {See Indiana
Medical Journal for July, 1847.)

AYe are confident that the remedial powers of strychnia are not
yet fully brought out. So far as we know, we were the first to
use and recommend it, in sciatica and chronic rheumatism ; and
we have seen cases of dyspepsia and chronic costiveness yield to
it like a charm.

Secale Comutum in Disturbance of the Accommodation-power of the
Eyes.

When local hyperemia is dependent upon a laxity of the walls
of the bloodvessels, advantage attends, Professor Willebrand,
of Helsingfors, states, the employment of secale cornutum. He
was induced to use it in these cases by the expectation that a
means which acts so specifically upon the unstripped uterine
muscular fibre must excite some power over the analogous
structure of the arteries, and which its haemostatic action proves,
in fact, that it does. During his investigations he soon became
struck with the fact that the heart of persons employing it soon
underwent contraction in all its dimensions, and that even

786 Secale Cornutumfor the Eyes. [November,

within the first twenty-four hours a circumstance which he
has frequently verified since. The first case that came under
his care was an example of exophthalmos, accompanied with
enlargement of the thyroid gland and hypertrophy of the heart.
After a few weeks' use of the secale, the hypertrophy of
the heart and thyroid, as well as the projection of the eye, much
diminish. The patient however left off the medicine, and the
exophthalmos returned worse than ever. Since that period he
has employed the secale in various cases in which increasing
contractility of the muscles of the bloodvessels or other tissues
seemed to be indicated. It was found of especial advantage in
a disturbed state of the accommodation-power of the eye, es-
pecially induced by over-taxing the organ on small objects with
an insufficient amount of light. Children from some of the
schools have furnished the author with many instances, and they
have always been relieved by the secale. He relates a case in
which impaired vision was always brought on by sewing or
reading, and wherein the signs of some amount of chronic con-
gestion were visible. Belief rapidly followed, and when the af-
fection recurred some months after, it was as speedily relieved.
He has also found the secale of great use in several cases of
acute or chronic inflammation of the eye, and especially in
blepharitis and the pustular conjuDctivitis of children, the case
proving much more rapid, and relapse being much less rare,
than when local means alone are relied upon. No benefit
has been derived from it in granular conjunctivitis and tra-
choma.

Proceeding upon the theory of its stimulant action upon the
vaso-motoric nerves, the author has extended the employment
of the secale to other local disturbances of the economy ; and,
as already observed, he has had frequent occasions of observing
its transitory influence in hypertrophy of the heart, without
having any reason to believe that it is of any permanent utility
in affections of this organ, the heart always returning to its for-
mer size soon after the use of the secale has ceased. In many
cases of both chronic and acute hyperemia it has proved of
great service, and especially in cases of galactorrhea, and in in-
durations, tumefactions, and catarrhal affections of the uterus.
Also, it has been very useful in enlarged spleen from intermit-
tent fever, and when large doses of quinine have failed. It is
especially indicated in the cases of relapsing intermittent depend-
ing upon enlarged spleen. In erysipelatous affections, it has
often done good service applied externally as a cataplasm. The
author formerly gave ten grains ter die, but now gives but five,
combining it with magnesia, or, when chlorosis is present, with
iron. [Brit, and For. Med_. Chir. Review, and Am. Jour, of Med.
Sciences.

1859.] Divisions for the Cure of Deformities. 787

The Reparative Process in Human Tendons after Subcutaneous
Divisions for tlie Cure of Deformities.

W. Adams, Esq., read before the Royal Medical and Chirurgi-
cal Society (June 28) a paper on this subject, illustrated by a
series of specimens and drawings from fifteen post-mortem ex-
aminations. Specimens of reunited tendons after division were
exhibited from ten cases, and also drawings, made by Ford, of
the recent appearances in thirteen cases, at periods between four
days and three years after the operations. These specimens had
been collected by Mr. Adams during the last eight years, and
were principally from patients operated upon at the Royal Or-
thopaedic Hospital ; but for two specimens he was indebted to
Mr. Erichsen and Mr. Curling. After alluding to our present
scanty information on the subject, and describing the recent ap-
pearances in fifteen cases, the author gave a general summary of
the reparative process, describing 1st. The immediate results
of the operation. 2dly. The commencement and nature of the
reparative process. 3dly. The general appearance and structure
of the newly-formed connective tissue, or new tendon. And
4thly. The junction of the new with the old tendon. This was
followed by an account of the circumstances which may inter-
fere with the perfection of the reparative process, or entirely
prevent it, so that non-union of the divided tendon may result.
Complete failure of union had been witnessed by the author
only in the posterior tibial tendon, but it appeared that there is
considerable risk of such an occurrence whenever tendons are
divided in or near to dense tubular sheaths. It was shown that
imperfect union might result either from some constitutional de-
fect in the reparative powers of the patient, or from injudicious
after-treatment in a variety of ways, but principally from too
early and too rapid mechanical extension. The conclusions
which the author considered to be established by the above se-
ries of cases were arranged under nine different heads. It was
stated that tendon is one of the few structures of the body capa-
ble of reproduction or regeneration, and that the newly -formed
tissue acquires within a few months of its formation the structu-
ral characters of the old tendon so perfectly, as that, under the
microscope, it is with difficulty distinguishable from it; but it
does not acquire through its substance the uniformly opaque,
pearly lustre of old tendon ; in the mass it retains a greyish
translucent appearance, so that the recent section affords an easy
method of distinguishing the new from the old tendon. The
greatest length of perfectly formed new tendon which the author
had seen was two inches and a quarter, and this was in the
tendo-Achillis of an adult, a year and a half after it had been
divided by Mr. Curling. That the process by which new ten-

788 Divisions for the Care of Deformities. [November,

dons is formed is essentially similar in animals and in man ; that
the perfection of the reparative process is in direct proportion
to the absence of extra vasated blood and inflammatory exuda-
tion ; and that the sheath of the tendons, when consisting of
bone-textured areolar tissue, as in the tendo-Achillis and other
tendons surrounded by soft tissues, is of importance 1st. In
preserving a connection between the divided extremities of the
tendoQ. 2dly. In furnishing the matrix in which the nucleated
blastematous, or proper reparative material, is effused. 3dly.
In giving definition and form to the newly -developed tendinous
tissue. That the new tendon always remains as a permanent
tissue, and as an integral portion of the tendon, the divided ex-
tremities of which it has been formed to reunite. In the speci-
men exhibited, in which Mr. Adams had divided the tendo-
Achillis three years previous to death, an inch and a quarter of
new tendon was clearly traceable. The average length of new
tendon formed in children to reunite the divided extremities of
the tendo-Achillis, Mr. Adams considers to be from half an inch
to an inch, and in adults from one to two inches. The author
considers the facts adduced in this paper were amply sufficient
to disprove the linear-cicatrix theory the theory at present in
vogue, and supported by all his colleagues which assumed that
the newly-formed tendinous structure has a disposition to under-
go a process of gradual contraction, such as we see taking place
in the cicatrices of the skin after burns, to which it has been
compared, and that ultimately it becomes absorbed, the muscu-
lar structure at the same time becoming elongated by the force
of the contraction of the cicatrix, so as to allow of the reapproxi-
mation of the ends of the divided tendons, and the formation of
a linear-cicatrix. From the present observations it appeared
that in the cure of deformities, muscles are elongated by the in-
creased length of their tendons, obtained by means of subcuta-
neous division, and the development of new tendon formed for
the purpose of reuniting the divided extremities of the old ten-
don. The mechanical and physiological effects of this increased
length of the tendons wrere described; and lastly the author
stated that when recontraction of the foot takes place, and the
deformity returns at a distant period after tenotomy, this does
not depend upon absorption of the new material, or new tendi-
nous tissue formed previously to unite the divided extremities
of the old tendon, but upon structural alterations taking place
in the muscular tissue. In three cases of relapsed deformity of
the foot examined by the author, the new tendinous tissue
formed after the previous operations remained, and could be
easily distinguished from the old tendon. These facts were re-
garded as additional evidence against the linear-cicatrix theory.

\_Med. Times and Gazette.

1859.] Incision in Anthrax. 789

Incision in Anthrax.

Maurice H. Collins, Surgeon to Meath Hospital, says {Dull in
Quarterly Journ. Med. Sciences, August, 1859) that " the incision
into anthrax, whether made early or delayed till sloughing has
done part of the surgeon's work, must be deep rather than ex-
tensive. Usually it is said anthrax is a flat swelling. The fact
of its flatness, or rather of its extent, hides the real amount of
elevation, which is, in most cases, considerable. Hence incisions
into anthrax seldom go down through the inflamed skin and
areolar tissue. But even if they did go down to the fascia, they
would fail in effect unless they also went through it. The fas-
cia is highly inflamed in anthrax ; in fact the essential difference
of anthrax from furuncle .consists in the inflammation being
deeper and implicating the fascia. When fascia is inflamed, much
plastic exudation takes place, both in its substance and under
it ; and the tendency of anthrax to spread indefinitely is to be
thus accounted for. The pent-up plasma, quickly producing
pus and slough, can get no vent until there is an adequate open-
ing in the fascia, and this opening should be made by the sur-
geon as early as possible, if he would avoid the unpleasantness
of useless and repeated cutting, and the extensive sloughing
which will occur if he neglect to make it. Plastic exudations
find great facility in travelling under the fascia, dissecting and
destroying its vascular connections, and ultimately causing
much of it to perish. This is well known, as a general principle
of surgery, and it is strange to find it overlooked as the cause of
the spread of anthrax. We readily acknowledge the mischief
it does in periostitis, in diffused inflammations of erysipelatous
character or connected with paronychia, and in many other
analogous cases ; but books of surgery are, for the most part,
silent about it in the case of anthrax. And yet every one must
have observed phenomena which can only be explained by it.
The extent and mode of extension of the swelling, the real depth
to which the surgeon must cut if he is to do good rather than
harm, and the fact of large flakes of fascia ultimately coming
away as dead core (in addition to areolar tissue), leaving the
underlying muscles bare, must have been often observed, and
must often, doubtless, have had their influence on the practical
observer; but the junior surgeon and the pupil have not been
shown their practical bearing. The rule I have given above, to
cut deep rather than wide, is founded on the observation of
these facts, and will be found satisfactory, saving the surgeon
the opprobrium of cutting twice or oftener without benefit to
his patient. It is very easy to know when we are deep enough ;
by taking, hold of the flaps made by our crucial incision, we
feel if they are quite loose. Our incision is not deep enough un-

790 Editorial [November,

less we can lift up the point of each flap with ease from the
parts underneath. This cannot be done unless our knife has
gone through the fascia, and made a crucial incision in it almost
as extensive as in the skin. The wounds we have made should
be almost as deep at their extremities as in the centre, where
they intersect. If we have made our incisions early, before
actual sloughing has commenced, as we sometimes, though rarely,
have an opportunity of doing, the flaps will curl up if the wound
is deep enough, and will leave a widely gaping wound ; but if
we do not see the anthrax until more or less of the skin is un-
dermined and dead, the gaping of the wound will not be so
marked, and the best testis the one I have given above, of lifting
the flaps with a forceps, and proving that they are loose. If
this rule is followed, we shall have few cases in which we must
come and cut again. [Am. Jour, of Med. Sciences.

EDITORIAL AND MISCELLANEOUS.

A Convenient Fracture Apparatus. About a year ago, we pur-
chased the Fracture apparatus gotten up and improved by Dr. Welsh.
We have since applied the various portions of it, to nearly every variety
of fracture, and are much pleased with the comfort it affords to the
patient, as well as with its great convenience of application and security
in maintaining proper coaptation. In a case of extensive gun shot
wound of the leg, with fracture of the Tibia, we found the fracture-box
a most valuable means of keeping the injured limb quiet, while it ad-
mitted of the dressings being applied to wounded soft parts, with the
utmost convenience. The splints for fracture of the fore-arm are light,
and seem adapted to every variety of fracture in this region. But we
are particularly pleased with that portion of the apparatus intended for
fractures of the humerus high up. This splint consists of a trough of
thin material, which is fitted upon the outer side of the arm, while a
cap, attached by a hinge-joint, passes over the Deltoid and rests upon
the shoulder. This appears to us to be one of the most efficient and
convenient arrangements for the treatment of a variety of injuries in
the neighborhood of the shoulder joint, which we have ever seen. Its
most striking advantage being that all the pressure of the splint is made
on the outer side of the arm, while the nerves and bloodvessels on the
inner side, which every surgeon knows become very intolerant of pressure
in fractures near the axilla, are almost entirely relieved from com-
pression.

We have particularized the above pieces, as having given us special

1859.] Editorial and Miscellaneous. 791

satisfaction, but we regard the entire apparatus, with but few exceptions,
as one of the most complete and useful modifications of the various ap-
pliances for fracture, which has been presented to the Profession for
many years.

We would advise those of our readers who may wish to supply them-
selves with the above apparatus, to insist on having- from the agent, an
application of the various pieces, especially the mere complicated ones,
before he leaves, otherwise, they may be subjected to much annoyance
and the patient to much pain, while they are learning how to apply the
apparatus.

This request will doubtless be readily acceded to, by the higiily in-
telligent and urbane gentleman, who is now presenting this apparatus to
the notice of the Profession in this section of the country.

Necrology. We take pleasure in complying with the request to pre-
sent the following pleasing Tribute of liespect. We add no word of
comment. Those who knew him better than we, have better recorded
his many virtues.

Tribute of Respect.

At a meeting of the physicians of Montgomery, Ala., called to express
a sense of their loss in the death of Dr. A. B. McWhorter, Dr. Baldwin
was called to the Chair, and Dr. Seelye was appointed Secretary.

On motion of Dr. Norton, a committee of three was appointed to pre-
pare suitable resolutions fnr the consideration of the meeting. Drs. S.
E. Norton, R. S. Wilson and W. P. Taylor were appointed said com-
mittee, who shortly reported the following preamble and resolutions :

An eminently worthy and useful man has been called from our
midst. Through a long life he has passed with a character unstained ;
life's labors were performed with manly integrity, and its enjoyments
were received with thankfulness.

He came up to the measure of his duty as a physician. Many re-
member him for his skill, devotion, and humanity. Science and reli-
gion found in him a willing worker. Ready with his skill and his
means, he has w7orked well. An all-wise Being has called him from
earth to a higher, nobler life. Let the memory of such a man live with
as. Let his devotion to our profession, his high-toned morals, and his
active benevolence, stimulate us to the discharge of our duties ; that
like him we may come well to the end loved, honored, remembered.

It is fit that we should express ourselves on this sad occasion. There-
fore,

Resolved, That the decease of Dr. McWhorter, calls pre-eminently
upon us, as a profession, for an expression of sentiment so long among
ns active, useful, beloved we realize that a good man has indeed
fallen.

792 Miscellaneous. [November,

Resolved, That not only has the profession sustained a loss, but the
community which he has so long adorned, has cause for profound sor-
row in this lamented death.

Resolved, That we unaffectedly sympathise with the family of the
venerable deceased, and do hereby, as a body, tender our profound con-
dolence.

Resolved, That we attend the funeral, this afternoon, and that we
wear the usual badge of mourning for thirty days.

On motion it was ordered that the city papers be requested to publish
these proceedings, that the family be presented with a copy, and that
they be also published in the New Orleans and Augusta Medical Jour-
nals, S. D. Seelye, Secretary.

September 20, 1859.

Woman's Home Book of Health. By John Stainback Wilson, M.D.,

of Columbus, Ga.

We are gratified to learn that the above work, which we noticed in
these pages some months since, will soon be issued from the house of
Messrs. J. B. Lippincott & Co. The readers of this Journal are too well
aware of the ability of the author of the above forthcoming work, to re-
quire from us, his recommendation, as he has long been a frequent and
valued contributor to our pages. On the appearance of the wrork, it will
afford us pleasure to call attention again and more definitely to its merits.

Inductive Electricity, or Faradization, in Lead Colic. Of late, much
attention has been paid in France to the employment of electricity by
induction, or Faradization, as it is called, in the treatment of certain
diseases. Briquet, of La Charite, has employed this with success in the
treatment of the paroxysms of colica pictonum. The application is not
devoid of pain, and the latter is, at times, so great as to demand the
anaesthetic aid of chloroform during the operation. A wet sponge is
attached to one wire of the aparatus and placed at the upper portion
of the recti muscles, and a metallic brush being applied to the other, it
is passed over the part of the abdomen most painful, and this is con-
tinued until redness is produced, when the pain will disappear. The
operation may require repetition in some cases ; but if twenty four hours
pass without the re-appearance of any pains, no further application of
the process will be required. The after-treatment consists in a sulphur
bath every other day ; the internal administration, daily, of about four
pints of lemonade, containing from thirty to forty drops sulphuric acid.

" A gum portion is also prescribed, containing from thirty to forty
grains of alum ; and each night, or every alternate night, as the case
may be, a pill is ordered, containing one grain of the watery extract of
opium. * * In almost all cases, Briquet has remarked that the
bowels begin to act spontaneously from one to three days after the
Faradization has accomplished the removal of the abdominal pains."
This treatment is interesting from its simplicity, as compared with the
complex routine heretofore used at this hospital, in the treatment of

1859.] Miscellaneous. 793

colica pictomim. The latter . and was probably

one of the- - of anient in. 'id in modern

pitals. Our readers will find it given in detail ii 'a translation of

Trousseau and lie veil's 1 's Hand-Book. [Ibid.

Nocturnal Incontinence of Uri . A writer in the Bulletin do The-
rapeuiiquc. recommends the employment of

given in pills made with syrup. It is i 'hat thirty-two grammes

should be administered in four days, if the child is over ten ye
when under that age, the amount mentioned should be given in six or
eight days. If a cure does not result from the first trial, a second trial
with a like quantity should be made. But if the incontinence [
after the second trial, it is useless to continue the medication. The fail-
ures are, however, exceptional, as two thirds of the cases have been suc-
[1, even in patients from 18 to 24 ho had been affected

with this disgusting infirmity from infancy. [Ibid.

Value of Scientific Services. It is a most common complaint among
scientific men, that when called upon to do anj for the public,

their labors are generally miserably paid, it being thought sufficient to
have the honor of doing the work. It has become necessary for them
either to take the ground that they will not perform these services,
which many do, or for some one to take the initiative in making the
value of scientific labor appreciated. We are glad to see that the exam-
ple has now been set by Prof. Doremus, of this city. For his chemical
analysis in the Stephens case, in which two entire bodies were analyzed,
and which was by tar the most complete investigation ever attempted,
he has charged and received 83.000 for his services, and $800 for new
apparatus. This analysis will be of incalculable value to justice, and
will be referred to as long as law and science exist. We are gratified
to see that such a service has been appreciated ; though for the amount
of actual labor expended, which we have not space to detail, the pay is
certainly not two much, if, indeed, it be sufficient. We hope at some
future time to be able to present to our readers an account of the medi-
cal points in this interesting case. [X. Y. Monthly I

Excitement from Fast Traveling. Lord Shaftesbury says: "I have
ascertained that many persons who have been in the habit of traveling
by railway have been obliged to give it up, in consequence of the effect
upon the nervous system."

In our own experience of railway traveling, the dozy, listless appear-
ance of the travelei-s would incline to the opinion, that it is rather pro-
ductive of tranquility than nervous excitement. Of course this opinion
does not include railroad collisions, etc. ; when the individual, if not
entirely annihilated, might probably be somewhat excited. But for
that excitement, the fast traveling could not be blamed, as it would then
be at an end. The passenger would then he like the Irishman, who
said that he was not hurt by the fall, but u stopping so quick." [J
and Surgical Reporter.

794 Miscellaneous.

Publications of the Sydenham Society. The following works are
announced for the year 1860 :

" Clinical Memoirs on Abdominal Tumors and Intumescence," by Dr.
Bright; edited by Dr. Barlow. A Year-Book for 1859, on Anatomy
and Physiology, Medicine, Surgery, Diseases of Women and Children,
Forensic Medicine and Toxicology. French's " Clinical Account of
Diseases of the Liver." Hebra's Atlas of Illustrations of Skin Diseases ;
and Professor Simpson offers to edit a reprint of Smellie's Midwife-
ry. [Ibid.

The Workhouse, as pictured by Dickens, is, at even this time, no
myth.

The Medical Times and Gazette says, that a visitor at the Cork Work-
house was shocked at the appearance of the children, of whom a large
number are maintained in the building. Upon investigation he discov-
ered that an enormous proportion were afflicted with scrofulous diseases ;
many of them dying prematurely ; others becoming blind ; and those
who survived, dragging on a miserable and feeble existence to which
death itself would almost appear preferable.

Dr. Call an an says, when examined on oath before the Poor Law In-
spector : "On the day I arrived, it was the hour the boys were at din-
ner. I examined the food, and after their meal I inspected it. I asked
for a bowl of the soup ; I examined and tasted it, and I found it almost
perfect water. I asked of what it consisted, and was told of rice, oat-
meal, and vegetables ; some green leaves of leek were in the soup. I
went along the form while they were at the meal, and I found some of
the porringers untouched. I asked them why they did not take their
soup, and they said they could not drink it. I saw the bread, and
thought it very inferior ; it smelled sour, and was heavy and gluey."

On this evidence, says the above journal, Mr. Arnott makes the bitter
remark, that in Dickens' " Oliver Twist," the workhouse-boy astonishes
his superiors by asking for more, but in the case of the Cork Work-
house-boys, they prefer starvation itself to eating the food placed before
them. [Ibid.

Gallows Confession. We have before noticed the heresies which
afflict all varieties of quacks, when they attempt to band together for
the purpose of attracting public attention and mutual admiration. This
has been evident in such meetings as the late Homoeopathic Convention,
in which it was admitted that a portion of the order were inclined to
merge into "Eiecticism." And now a noted homoeopath, Dr. Hering
of this city, whom we have looked on as the very personification of
homoeopathy, and who, we supposed, relied on it with the devotion of a
fanatic, yields with an honesty not to have been expected, the following
acknowledgment, which we copy from an article by him in the Ameri-
can Homoeopathic Review.

He says : " We all know that the numbers in our homoeopathic ranks
are not lessening ; but it is the general observation that the num-
ber is year after year increasing, who, instead of deriving benefit from
homoeopathy, are made incurable by so-called homoeopathic practi-
tioners." [Ibid. i

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XY.] AUGUSTA, GEORGIA, DECEMBER, 1859.

[No. 18.

ORIGINAL AND ECLECTIC.

ARTICLE XXVII.

An Essay on the Adaptation of Climate to the Consumptive, for a
permanent residence ; embracing an Examination of the climate
of certain localities of frequent resort; and also, an Investigation
of the degree of adaptedness of the Pacific Climates of the United
States. Presented to the Medical Society of the State of Geor-
gia, at its annual meeting, held at Atlanta, April 13th, 1859.
By William Henry Doughty, M. D., of Augusta, Ga.
(Ordered to be printed.)

(Continued from November No. page 741.)

Summer of Oregon and Washington Territory, as con-
trasted with the Columbia Yalley.

Special Climate. We will first examine the difference of the
successive months.

June.
Mean.

June to July.
Advance.

July to Aug.
Advance.

Aug. to Sept
Advance.

Ft Orford, Oregon, 2 vis. .
" Astoria, " I jr..
" Vancouver, " near 5 vrs.
" Dalles, C. V. " 3 vrs. .
" Steilacoom.W.T." 6 yrs.

59.03
59.53
62.67
67.09
60.65

0.^70
2.02
6.04
6.13

3.58

l.36

2.23

-3.15

-2 . 45

-0.43

-2.18
-5.63
-4.75
-9.06
-6.05

There are no sea-temperatures, as in the case of California,
with which to compare these various data ; but if we assume those

k. s. VOL. XV. NO. XII. 56

796 Doughty. An Essay on the Adaptation of [December,

of the waters, contiguous to the lower part of this coast to be
the same as they are to the 40th parallel, and contrast them, we
observe much larger differences between the land and sea, than
was seen at San Francisco. For June, at the latter place, there
was a difference of only 0.36 between them ; here it amounts to
2.53. This is true of Fort Orford, but continued to Fort Asto-
ria, the difference amounts to three degrees, (3.00) notwithstand-
ing the increase in latitude. At the first post of this table, as con-
trasted with San Francisco, there is a manifest difference in the
rate of advance. For notwithstanding some parallelism exists
between them in the advance from June to July, indicating per-
haps an equal degree of refrigeration at the two points, yet this
apparent parallelism is destroyed by the continued advance to
August at the former, and the retreat at the latter the actual
difference between them in the degree of advance being 2.04. It
is further destroyed in the progress from August to September,
for the difference between them amounts to 3.22,. in favor of San
Francisco there being a decline of 2.18 from August at Fort
Orford. These circumstances point to changes in the intensity
of operation of the sea-influences, the latter being also less per-
sistent in their action. The degree of refrigeration experienced
at Fort Orford, which we have asserted to be in our judgment,
the result of proximity alone and not of direct contact of the
cold waters with the shore at this point, is much less, and yields
much sooner to the continental influences. At Fort Astoria,
farther north where proximity itself appears to lose its influence
and control, the monthly advance continues to August, and
then abruptly declines ; the rate of advance from June to July,
being about three times that at Fort Orford, and twice that at
San Francisco; and from July to August nearly twice that at
the first, and four times the second. Here then, (at the two
posts,) the history of sea-coast localities generally is manifested,
yet so far influenced by the general refrigeration to the south of
them, as to determine a uniformly small advance in the monthly
means.

Contrasting the immediate coast stations with the intermedi-
ate one, Fort Yancouver, we observe vast differences in the
course of the thermometer, as indicated by the monthly means
in their advance. July here shows the highest monthly mean,
corresponding with Fort Miller in this particular^ although ex-

1859.] Climate to flic Consumptive, &c. 797

tensive differences exist between them in regard to the degree
of heat reached, or the position of the thermometer.

The advance from June to July is eight and a half times that
at Fort Orford, and three times that at Fort Astoria ; and in the
progress from July to August, there is a difference of 4.ol
from Fort Orford, and o.38 from Fort Astoria. In the Wil-
lamette Valley, a much greater degree of heat is experi-
enced than along the coast, but nothing like that contrast
which exists between the San Joaquin and the immediate coast
of California. As a valley formation, it is both too far north,
and too open to external impressions, to show such indications
of heat.

Inspecting next the far interior post, we observe the highest
mean temperature for June of all the posts, with an advance to
July of 6.13, about that of Fort Vancouver : it also maintains
a similar relation to the coast stations. Compared with Fort
Defiance, it has a higher mean temperature for June, by 3.,
and manifests less abruptness in the rates of advance and decline
from month to month. This is owing doubtless to the excessive
altitude of the latter.

2xd. General Raxge of the Mean- Temperatures.

OBSERVATIONS.

J use. Jclt. August.

High'st Lowest Range Iligh'st Lowest Range High'st Lowest

3. "14 8.l9 62. "69

64/04
70.21
62.cll

Ft. Orford, Oregon, (2 vrs.) w. -i i ui . uoi *. jo , . u-j . |

" Vancouver/' (3 to *5y) 6T.11 56.e8o!l0.26 I 70.8S 67. '40 3.c43 I 66.c65

" Dalles, C. V., (3yrs) 71.19 63.c5l| 7.6S , 74. "92 71. "51 3.e44 | 71.34

" Steilacoom,W.T.(5v.) 63.00l 6S.C96| 4.'04 M.78| 62.c93l 3.S0 | 66.82

Range.

3. '19
2.61
l.13
4.71

Taking the entire region under its present representation, the
greatest uniformity is observed in July. Of the individual sta-
tions, Fort Orford presents the least variability in this regard, the
mean monthly range throughout the season, being only 3.09.
Next in order to this, is Fort Steilacoom, on the extreme northera
limit of the coast, whose average monthly range for the sea-
son is only 4.18, notwithstanding its high latitude. At neither
of these points however, is this range as low as at San Fran-
cisco ; nor indeed is that of either of the individual months, for
the least fluctuation in the position of the monthly means at the
latter was l.45 in the month of August, whilst the least in this
section was 2.89 at Fort Orford in June: although the limited

798 Doughty. An Essay on the Adaptation o [December,

number of observations at the latter scarcely afford comparable
measures.

At Fort Vancouver, the first summer month shows an ex-
treme range in its means, the greatest in five years being 10.26 ;
but during the other two, the greatest range is only 3.43.
But the most remarkable feature connected with it, when con-
trasted with its analogue, Fort Miller, is the loss of that extreme
degree of heat or elevation of temperature, which characterizes the
latter. The highest recorded here is 70.83 in July, whilst at
Fort Miller it is 90.92.

It is in the Columbia Valley, that the highest degrees of tem-
perature are experienced at this season. At Fort Dalles,
with three years' observations, the highest mean was 74.92,
and the lowest for the season is one degree higher than the
highest at Fort Orford on the coast. Its elevation of tempera-
ture is much higher than that of Fort Defiance in New Mexico,
the highest there being only 70.95 in July. Furthermore it
also shows greater variability in the range of the monthly
means, for at the latter, the average per month for the season is
3.10r whilst at the former, it amounts to 4.07. August here
presents the least variation of the individual months, but at
Fort Defiance shows the greatest. Hence, this valley -situation
of Fort Dalles, whilst it secures to it higher measures of heat, at
the same time bestows greater fluctuation in the relative position
of the means.

&rd. The extreme Single Observations in each indi-
vidual Month at the Different Posts.

June.
Observations.

ft Hd

O

o

July.
Observations.

K

W

August.
Observations.

W

p E5 a
o ens 3

: 2

F. Orford,Oregon, 1 yr. 177 .
F. Vancouver, " 3 yrs. 88.
F. Dalles, C. V., 2 yrs. 1 94.
F. Steilacoom, W.T. . . 93.

46.
44.
41.
41.

31.
44.
53.
52.

76.
96.
105
94.

46.
50.
42.
44

30.
46.
63.
50.

75.
96.
100
94.

48.
43.
47.
43.

27.
53.
53.
51.

29.33
47.66
56.33
51.00

Interesting comparisons of the coast station in this table,
with those along the coast of California, might be made if the

1859.] Climate to the Consumptive, dec. 799

time of observation here warranted them. Any comparison
under this head, at the present time between this section and
other places in different, or even corresponding latitudes, how-
ever analogous the climatological influences operating upon
them may be, is yet devoid of reliability, because it cannot em-
brace its meteorological constants. This remark does not apply
so forcibly to comparisons of its thcrmometrical means, annual
or monthly ; for the reason that there is less liability to ma-
terial variation or error in the relative position of the means,
requiring as they do, a more protracted influence of extra-
ordinary impressions to vary them, than in the case of individual
extremes. Therefore we shall forbear to make any contrast of
the coast stations here, with those of California, simply stating,
that if the highest and lowest points of the thermometer for
1852 at San Francisco be compared with those at Fort Orford,
for the same year, they will be found far more conservative.
The possible range at the former is much less for each month,
and the lowest observed point is much higher. Nevertheless
those observed at Fort Orlord show a very favorable position
of the thermometer, and doubtless will compare favorably
with corresponding situations on the same parallel. The
highest degree of heat during the record of a single year,
is 77. in June, and the lowest is 46. which is recorded in
June and July.

At Fort Vancouver, with three years' observations, much
greater extremity is manifested ; the highest point of the season
being 96. in both July and August, and the lowest 43. in
August. The possible monthly range increases with the ad-
vance of the season, and the extent of the latter is 47.66.

Between this and Fort Steilacoom, higher up but of corres-
ponding relation to the coast, there is great similarity ; the
highest here being 94. in July and August, and the lowest
41. in June, which gives a greater possible range for the months
and for the season.

The greatest degrees of heat throughout the entire space, are
recorded at Fort Dalles in the Columbia Valley ; the highest
single observations being 105. in July, and 100 in August.
Nevertheless the lowest position of the thermometer is equally
extreme with that of any of the posts of the table, being 41. in
June. The observations here recorded, resemble more those ex-

800 Doughty. An Essay on the Adaptation of [December,

treme ones, already given of Fort Miller in the San Joaquin
Valley, than any other post that we have examined ; and afford
a true index of the real amount of the monthly fluctuation of
temperature during the warmer part of the dry season. The
mean possible range of the thermometer for the season is very
extreme, but is not quite that at Fort Defiance, New Mexico.

4th. Winds and Weather of Oregon, &c.

Between the course of the circulation of the atmosphere along
the southern part of this coast, as at Fort Orford, and that of
California, similar differences are observed in the summer season
as in the spring, with the exception of the extremity of
those differences. Here during June, 1852, winds from the
south-east and north-west were observed throughout the month,
those from all other quarters being almost without record.
The greatest force was accorded to the north-west winds. And
during July, a total absence from all other quarters was marked ;
the north-west, still having the greatest intensity. And again,
for August, the same record was made. During the season there
was a progressive increase of the south-east, and nearly a
doubling of the sum of their forces with each monthly
advance. The north-west attained its greatest frequency and
force in July.

A little higher up at Fort Astoria, where a partial restoration
of the mode of circulation at San Francisco and at San Diego was
noted during the spring, winds from all points of the compass
were frequently recorded for June, although those from the south-
east, west, and northwest were often est observed of the single
ones. But of the relative force of these particular winds, that
of the latter was much the greatest. The same general charac-
ters were recorded during the other two months, although a
diminution in the force and frequency of the north-west occur-
red in August from July. Hence we perceive a more complete
restoration of what may be styled the normal circulation of the
Pacific coast, than was remarked in the spring.

Still higher up at Fort Steilacoom, near the northern boun-
dary of the section, during four years' observation, great irregu-
larity in the circulation of the atmosphere was observed. Those
from south-east to north-west inclusive, were about the same in

1859.]

Climate to the Consumptive, &c.

801

force and frequency, and beyond their irregular predominance,
no definite permanent circulation was manifested. Sometimes
each was more frequent than the others, but with the progress
of the season, the north and north-west increased.

Having arrived at the remaining post, Fort Dalles, we have
a record for the entire season of the south-west and west winds
as the prevailing ones. The first are the most frequent and the
strongest of the two, and increase in strength to July. The
north-west winds were infrequent, during the season. The re-
cord of the winds in this part of the Columbia Valley, shows
much greater regularity in their circulation, and a more special
mode of circulation for this season than was noted in the terri-
tories to the south of it. It may perhaps be assigned to the
absence of those distributing elements (the conjoined valleys,
with their excess of heat and aridity,) which so signally interrupt
the course of the winds to the interior.

The State of the Weather as Represented in the
Following Table.

JTJNE.

JULY.

AUGUST.

Dsya.

Days.

Days.

Fair.

26.0

Clo'yj
4.0 1

ilain.

Fair.

Clo'y

Rain.
3.0

Fair
23.0

Clo'y
8.0

Rain.

Ft Orford,

Oregon, 1

yr-

1.0 25.0

6.0

To"

Ft

Astoria

1

yr-

12.0

18.0

7.0 113.0

18.0

0.0

13.0

18.0

6.0

Ft

Vancouver, " 3

yrs.

17.33

12.66,

6.0 126.33

4.66

3.0

23.33

7.66

2.0

Ft

Dalles,

Col. Val. 2

yrs.

24.0

6.0

3.0 130.5

0.5

0.5

26.5

4.5

2.5

Ft

Steilacoom, W. T. 5

yrs.

16.8

13.2

7.6 |19.2

11.8

3.0

16.6

14.4

5.2

The respective means for the season are, at

Fort Orford

Fair 24.66 Cloudy 6.0 -

-Rainy 2.0

a

Astoria,

" 22.66 " 18.0

" 4.33

n

Vancouver, " 22.33 8.32

- " 3.66

n

Dalles,

" 27.00 " 3.66-

" 2.00

a

Steilacoom

u

17.5J

5

u

13

13-

(<

5.

26

The spring season at each of these stations, whether examin-
ed in regard to the monthly means of the several divisions of the
weather, or the respective means for the entire season, when
contrasted with this table, presents many striking and import-
ant differences. At nearly all of them, the advance of the
dry season, as indicated by an increase in the fair days
and a dimnution in the cloudy and rainy, is much more

802 Doughty. An Essay on the Adaptation of [December

rapid than at San Francisco or San Diego in California ; al-
though such a number of rainy days is recorded at each of them
as to give a much larger proportion than was observed at
either of the latter, and also to indicate that the dry season as
understood at California is not so fully established in Oregon
and Washington Territory. Nearly two and a half times the
number of fair days, that were recorded in the spring, are noted
at this season at Fort Orford, and more than three times the
cloudy, and about one-seventh the rainy ; whilst at San Fran-
cisco, there is an actual retreat in the fair days of summer, from
those of the spring, and an increase in the cloudy ; and at San
Diego, for the summer season there is only an increase of 5.16
days in the fair, and a diminution of about five days from
the cloudy days. Fort Astoria constitutes the chief exception
to the remark above made, for but slight differences really exist
between the relative proportion of the fair and cloudy daysj
although the rainy days comprise only about one-fourth those
of the spring. This preservation of an almost continuous num-
ber of cloudy days throughout the spring and summer, may be
induced by its northern latitude and its relation to the Columbia
Kiver.

But if we are permitted to draw close comparisons between
the stations along the immediate Pacific coast, in the face of the
limited period of observation at this portion of it, we would
invite particular attention to a contrast of the individual months
at Forts Orford and San Francisco. This can be neither unin-
teresting nor unimportant, since it serves to throw some light,
however dim it may be, upon the relations of the oceanic circu-
lation to the different parts of the coast, and the character of
the peculiarities at those parts. At San Francisco, for June,
there were 21.0 fair days, and 9.0 cloudy; for July, 12.66 fair
days and 18.33 cloudy ; for August, 10.66 fair days and 20.33
cloudy. At Fort Orford, for June, there was 26.0 fair days and
4.0 cloudy ; for July, 25.0 fair days, and 6.0 cloudy ; for Au-
gust, 23.00 fair days, and 8.0 cloudy. Thus we perceive, that
at the first, there is a material, and in some measure, an abrupt
diminution in the proportion of the fair days ; and an average
monthly increase of nearly six cloudy days to the end of the
season, making the number of these for June and August, as 9
to 20.33. Whilst at the second, with a high relative proportion

1859.] Climate to the Consumptive, <c. 803

(26) of fair days for June, a difference of only three days exists
between it and August; July, being intermediate to them ; and
with a small relative proportion (4) of cloudy days, (less than half
of that of the other place,) there is only a difference of four days
between it and August, and of two days between it and July.
Why these differences between them ? The answer is found in
the withdrawal or removal of that disproportion of temperature
over land and sea that exists at the former, and an absence of that
degree of refrigeration at the latter, which belongs to the atmos-
phere of the Pacific off San Francisco, induced by the tempera-
ture of the cold masses themselves. If a similar comparison be
made between Fort Astoria and San Francisco, as marked dif-
ferences will be seen between them, notwithstanding the
changes between Fort Orford and the former. For instead of a
diminution at Fort Astoria from June to August in the fair
days of about one-half the number, they remain about the same
for each month of the season. And the cloudy days instead of
doubling themselves in the monthly advance from June to
August, preserve a uniform number (18). So far as the
proportion of rainy days at the three posts is concerned,
it is much less at San Francisco than at either of the others,
notwithstanding the disproportion or increase of the cloudy
days.

At the interior post, Fort Dalles, as compared with Fort De-
fiance in New Mexico, the principal difference appears to exist
in the relative number of rainy days ; the average for the sea-
son, being of rainy days 8.66 at the latter, and 2.00 at the
former. Moreover, at Fort Defiance, with the monthly advance
there was a material increase in them to the end of the season,
whilst at the other, they show no advance whatever ; the num-
ber of rainy days in August being less than those of June.
Finally, to this table we have added without purposing comment
upon it, Fort Steilacoom, as there may be those whose curiosity
would lead them to an enquiry as to the relative number of
these days higher up towards the northern limit of the section.

5th. Kain in Inches.

The mean quantity of rain at Fort Orford for the season, is
3.00 inches ; at Fort Vancouver, 6.23 inches ; at Fort Dalles,

804 Doughty. An Essay on the Adaptation of [December,

0.42 inches ; and at Fort Steilacoom in the north, 3.85 inches.
The relations of the interior to the coast in this regard, are com-
pletely reversed to those of the Oalifornian coast and the interior
territories, as indicated at Fort Defiance. Here the fall of rain
upon the coast is several times that in the interior, whilst the
contrary is true at the other place.

Autumn of Oregon, &c.

It would be quite superfluous to enter into a minute and
elaborate exposition of the fall climate of this region, inasmuch
as there are no special peculiarities requiring comment, and
none so characteristic as that they have not been foreshadowed
by our previous investigations. It is sufficient to remark, that
the period of declination of temperature begins earlier at this
part of the Pacific shore, than lower down near the latitude of
San Francisco. August at the coast stations, has the highest
monthly mean, and at the intermediate posts, as Forts Vancou-
ver and Steilacoom, July has the highest. Nevertheless at the
former, as Forts Orford and Astoria, the mean of September is
generally higher than that of the same month at San Francisco
and its vicinity. In the monthly decline of temperature, how-
ever, no such uniformity exists here, as at the latter place ; and
between the decline of the fall months, and the advance of the
spring months, no such parallelism is noted as was remarked of
the other section. Hence an earlier commencement and a more
irregular and abrupt declination of temperature is the record of
this section. The higher sea-temperatures of the Pacific gener-
ally at this season is the cause of the elevation of the temperature
of the first fall month, which is slightly below that of August-
September, however, being passed the rate of decline to the
other months rapidly increases, and in proportion as we recede
from the shore-line. The relative position of the monthly ex-
tremes presents however, one of the most material differences
from the autumn of California ; the degree of fluctuation or the
possible monthly range of the thermometer, being far greater.
At every part of this region, frost may be formed during Sep-
tember a constant formation throughout its whole extent, ex-
cept at the southern part of the immediate coast, where it is an
occasional visitant. Indeed, " at all points remote from the

1859.]

Climate to the Consumptive, dr.

805

coast, temperatures below 36 might be expected in this month
for every year." October and November always bring such
extremes as uniformly produce severe frosts even at the coast
stations.

To these limited remarks we will add a table of the highest
and lowest observed points of the thermometer, and a brief
summary of the winds and weather, with which will end our
notice of the autumnal season.

SEPTEMBER.

OCTOBER.

November.

OBSERVATIONS.

CO

w

r-

c

o
w

o

'.'

fed

a

CO

o

o

8

c

td

H

en
a

CO

P
i

o

S"

H
p

ere

p

Fort Astoria, 1 year

84.i44.|40.

82.

42.|40.

74.|33.

41.

" Orford, 2 "

92.O'40.|52.

77.

39. 38.

74.|38.o

36.

" Vancouver, 3 "

90.J40. 50.

82.

28.

54.

59. 25.

34.

" Steilacoom, 4 "

85. 28. 57.

78.

29.

49.

t;:;.;27.

36.

" Dalles, 2 "

S8.|45.0|43.0

84.

25.

59.!60.|22.

38.

The dry season being less distinct in this region, than farther
southward on the Pacific slope, we would naturally expect the
supervention of the wet season at an early date. Hence, as
actually occurs, there should be even in September along the
coast, where the wet season is most thoroughly established, a
perceptible and material diminution of the fair days, and an
increase in the cloudy and rainy. This month being passed,
October should reveal still farther differences, and so on to the
winter season, each month giving a relative advance over that
immediately preceding it. At Fort Orford, there is a very
evident decline in the proportion of fair days from August to
September, and so great is the rapidity of the advance of the
wet season to November, that this last has but one-third the num-
ber of fair days that the first fall month has, and less than half
that of the second. And the cloudy days from September to
November increase in such a ratio, that October has more than
twice as many as September, and about three-fourths those of
November. Of the rainy days, there are five times the number
in October, that there are in September, and in November near-
ly nine times the latter*. The means for the entire season are

* This is the record of 1852. It varies with different years ; as in 1854, there
were in September 3 rainy days ; in October 14 ; and in November only 7.

Doughty. An Essay on the Adaptation of [December,

14.1 fair, 16.1 cloudy, and 11.6 rainy days. These, however, if
compared with the spring season, are much more favorable. The
winds at this post during this season, were very various, al-
though opposite winds, the north-east and south-east, of the
single ones, were much the most frequent and strongest. And of
these it is observed, that the south-east rapidly augmented in
strength with the advance of the season, and that the other de-
clined perhaps as rapidly. It will be recollected that the south
and south-east winds are the attendants of the rain ; hence the
greater proportion of rainy days at this season determines a
greater prevalence of the latter.

At Fort Yancouver, proportional but corresponding changes
took place, material differences in the circulation of the atmos-
phere, being noticed however. Winds from all quarters were
recorded, but if any can be said to have a predominance over
others, those from the east and west had it. JSTo uniformity
however in this regard can be claimed for them.

The interior post, Fort Dalles, indicated much uniformity in
this regard, the south-west and west being ascendant in force
and frequency to the end of the season. Here also the other
weather data were perhaps not so extreme, although snow was
recorded in November. Of the precipitation for the autumn,
Mr. Blodget says : " On the coast of Oregon the periodical
rains occupy a large share of these months, beginning before
the close of September, and becoming quite Continuous through
the latter part of October and in November. At two posts of
the immediate coast, Forts Orford and Astoria, the mean quanti-
ty is twenty inches, and at the partially interior post of Steila-
coom, fifteen inches.* At Sitka, the mean for two years is
thirty-four inches, and it is evident that the humidity increases
rapidly along the whole coast from California northward. The
periods are not sufficient to give reliable mean quantities, how-
ever, and it can only be generally stated that the Pacific coast
north of 42 of latitude is characterized by profuse precipitation
through at least half of the three months of autum." The Co-
lumbia Valley is among those districts, found deficient in rain at
this season, there being'only an average of three inches over
the greater part of it.

* At Fort Vancouver of corresponding situation, the mean quantity is 10.30
inches for the season.

1859.] Climate to the Consumptive, <c. 807

Winter of Oregon and Washington Territory, &c.

For purposes of comparison, between the various sections or
divisions, of the Pacific coast, the winter climate presents con-
ditions which ensure far greater fairness and justice, than any
other particular season. For at this time the same influences
are brought to bear upon the entire coast from the southern
boundary of California northward ; therefore such changes as
are experienced in the progress upward, or such differences as
are brought out by those contrasts, are entirely owing to the pecu-
liar climatological features of each, and are in no wise attributa-
ble to those changing sea-temperatures, wrhich are found influ-
encing and moulding the climate of other seasons. We have
nowhere seen anything which tends to the supposition, that the
temperature of the Pacific waters at this season, along the entire
coast is not of a uniform degree. No statements of the mea-
surements of these absolute temperatures have ever fallen under
our inspection, beyond those which we have already quoted in
the consideration of the winter of California. But we may add,
that our idea of a general uniformity of temperature is based
upon the general remarks of other writers. Mr. Blodget in the
course of some general remarks upon the Pacific climate, says
that, "on the Pacific side," the absolute temperatures are both
higher than those of the land, and those of the water tempera-
tures in summer ; meaning to apply this to no particular section
of the coast, although he shortly afterwards gives the various
means " for successive areas of five degrees extent, both in lati-
tude and longitude," off the coast of California. This idea is
also supported by the number of isothermals of five degrees' dif-
erence, that can be made to cut this coast to the southern limit of
British America, of which there are only three, and also by their
course : they bend abruptly to conform to the differences of
temperature between the land and sea. Furthermore it is
presumable that this uniformity of the sea-temperature over
such an extent of latitude, has something to do with the pro-
duction of that very small and regulated decrease of the
winter means in the advance up the coast, which " is but ten
degrees for fifteen degrees of latitude, from San Diego to Asto-
ria, or two-thirds of a degree of temperature to one of latitude,"
and " nearly the same proportion," continued to Sitka, in Rus-

808 Doughty. An Essay on the Adaptation of [December,

sian America. If in connexion with tfcese, we bear in mind
the reputed source of the warm waters of the Pacific at this sea-
son, namely the China stream, of similar nature with the Gulf
Stream, it will give force to the conclusion that a comparative
uniformity must exist throughout this north-eastern part of the
Pacific. Mr. Blodget speaks of " a division of the great warm
currents of the Asiatic coast," "producing the general effect on
the Pacific climates which the Gulf Stream produces on those
of Europe."

With thes-e preliminary remarks, we proceed to an exposition
of the special winter climate of this section, as far as the present
limited record will admit of it. And we will notice first the
difference of the successive months.

o a &

2-V &

DECLINE FROM
Nov toDec|Dec to Jan Jan to Feb Feb to Mar

Fort Orford, Oregon, 2 yrs.
" Astoria, " 1 yr.
" Vancouver, " 6 yrs.
" Dalles, Col. Val. 4 yrs.

51.o87
46. o44
46. ool
41.o33

-5.70
-o.78

-10.000

-7. 67

+2.21
+2.34
t4.05
-8.24

-0.50
+0.62
+1.10
+6.92

+ 1.%9
+2.11
+2.48
+6.44

The period of reaction at the coast stations commences in the
passage from December to January, the former of these giving
the lowest monthly mean for the season. In this respect they re-
semble San Diego in the southern section. The decline from
the mean of the fall month is quite material upon the immedi-
ate coast; but it is nearly twice as great at Fort Vancouver,
the intermediate post. In the further advance of the season,
those upon the immediate coast shadow forth the operation
of similar causes upon them ; the degree of increase of heat
to January being about the same ; a decline in this rate to
February, and then a firm advance to March. In the Willa-
mette Valley, at Fort Vancouver, the reaction from the fall
temperatures occurs a month earlier than at Fort Miller in
the San Joaquin ; although the point to which the monthly
means recede at the first is, at least twelve degrees lower than
at the second ; and the January mean of the latter is not
reached at the former until sometime in the spring. Between
Fort Dalles and Fort Defiance, the most remarkable differences
exist ; the chief of these, being the higher degree of heat expe-

1859.]

Climate to the Consumptive, cfr.

809

rienced during this season at the first. The lowest monthly
mean at Fort Defiance is 26.18 in January, whilst at Fort Dal-
les, it is 33.09 in the same month. From November, the tem-
perature continues to decline in a rapid degree to January, but
then as rapidly advances to the spring season. The rapidity of
advance at the two places is greatest at Fort Dalles.

The degree of declination of temperature on this coast from
the fall months, is somewhat more extensive than lower
down. The difference between the means of the first fall
month, and the coldest winter month, being at Fort Astoriar
16.38, at Fort Orford 10.53; whilst at San Francisco, it is
8.66. Nevertheless the rate of monthly decline is so equally
distributed that this extent of decrease does not appear so
prominently as it otherwise would. As you recede from the
coast, the monthly distribution of heat becomes both more irregu-
lar and extensive.

2d The Extreme Monthly Observations.

December. January.

February.

- - -

si- 1

so

-

-r^

73 an

~ z
z~ <

rr

Fort Orford, Oregon,

66. 31. 35.

71.

33. <>

3S.70.o

33.|87.

" Astoria, "

56.

2S.

I

81.0 38.0

" Vancouver,"

58. | 7. 51.

01.

19.

42. 61.

19.|42.o.

" Dalles, Col. Yal

60.|-5.u h5.

55

-15

70.|61.

19.o|42.o

The mean possible range for the season, is at Fort Orfordr
36.66; at Fort Astoria, 32. ; at Fort Vancouver, 45.; and at
Fort Dallas, 59..

If we were not withheld by the short period of the record
here, we might go on to show the favorableness of the thermome-
ter (its relative position,) along the coast, and to contrast it with
good results with the records of the Californian coast. At Fort
Orford especially, would this record be worthy of note, for the ob-
servations of each month, together with the possible ranges of the
months and the season, show a conservatism of temperature un-
surpassed by any post that we have yet examined. The lowest
observed point, which occurred in December, is 31.r three degrees
higher than that of San Francisco; and the highest is 71. in Janu-
ary, thirteen degrees less than the highest of the latter, which gives

810 Doughty. An Essay on the Adaptation of [December,

a reduction of nineteen degrees (16.) in the extreme range of
the season for the former. Here the lowest temperatures are
experienced in December, there being a decided advance to the
others ; their lowest degrees being above the freezing point, and
their highest four or more degrees above the highest of December.
At Fort Astoria, with a record still more limited than Fort Or-
ford, there is a decline from the above figures, the highest of
December being seven (7.) degrees below that of Fort Orford,
and the lowest, nine (9.) degrees less. A further reduction
occurs at this place in January in the highest extreme, although
the lowest is raised six (6.) degrees, which reduces the possible
range of the thermometer niue (9.) degrees under that of De-
cember. Advancing to the last month of the season, we find
an addition of heat, which is manifested in the elevation of both
extremes, and brings the relative positions of the thermometer
nearly to those of February at Fort Orford. In regard to the
possible ranges of the thermometer for the entire season, it may
be remarked that it is less both at Forts Orford and Astoria,
than at San Francisco.

Passing next to the intermediate post, Fort Vancouver, we
observe that the highest monthly observations approach more
nearly those of the station (coast) near its own parallel, namely
Fort Astoria. But at the same time, the lowest is always found
far below those of the same post, indicating a more extreme de-
gree of refrigeration than is present at the latter, The greatest
severity of cold is experienced in December, the thermometer
standing at seven (7.) degrees in that month, and through-
out the season an extreme degree is preserved, for tempera-
tures of nineteen (19.) degrees are felt in January, and Feb-
ruary. Its imperfect valley situation seems to exert but little
effect in preserving an elevation of temperature, and when com-*
pared with its analogue, Fort Miller, it is far below it in the
degree of heat which characterizes it.

Fort Dalles in the Columbia Valley, shows a corresponding
record to Fort Defiance in New Mexico. Similar extremes of
cold are experienced at both places, although so far as the record
goes, the former manifests the greatest degree of cold earlier
than the latter. December here gives 5. as the lowest, whilst
at Fort Defiance it gives 6.. But in January, at Fort Dallas,
the thermometer has never been observed as low as at Fort De-

1859.] Climate to the Gmsum'ptive, dc. 811

fiance. Radically and abstractly considered, they have about
the same winter temperature condition. Finally, when consid-
ering the corresponding table in the other division of this coast,
we instituted comparisons of some of its data, with places on the
Atlantic slope ; if now we make another comparison of the latter,
with regard to the extreme range of the thermometer for the sea-
son and the individual months, with the two first stations in this
table, we will find equally good results. These comparisons
have a bearing upon the variability of the climate at the several
places, and therefore subserve a good purpose; for were it
not for the variability of the southern portion of the eastern
slope, there would be scarcely a need of further search for suita-
ble climates for the consumptive. A continuously cold climate
is not so objectionable, as a warmer one, with variability :
for changes of temperature, sudden and powerful, as they are
sometimes, to say nothing of their association with other altera-
tions in the condition of the atmosphere, are amongst the chief
of the dreaded exciting causes of pulmonary disease.

3rd. The General Range of the Mean Temperatures
for the Winter.

MEAN TEMPERATURES.

Mean
December. Jaxcary. | Febrcart. Range

for
High't Lowest Range High't Low's*. Range;High't Low'st Range Seas'n
Fort Orford, Oregon,.. 4S.i 44.lo J7a^l 48.72 :~' 40~47 27S3" ~2~.'5l

' Vancouver, " .. 4 : 66 6.89

" Dalles, Col. Valley 4iiQ.o7 24.95 15.1^ 4-*.-16 21.9> 1> -1" 42.Q.~.7 S7.-14 5. "43 12 g91

We observe in this table at the coast station, whose record
embraces a period of only two years' observation, a continua-
tion of that uniformity in the relative position of the monthly
mean temperatures, which was spoken of on the coast of Califor-
nia. With the change of position as to latitude, the degree or
the height of the thermometrical means, both of the months and
the season, has sensibly declined, yet for this latitude it indi-
cates comparatively a high temperature. It is probable that
with a longer series of observations, a greater range than 5.15
for the season, would be found, but it is doubtful whether it
would so far exceed it as to set aside the uniformity at present
foreshadowed. The mean position of the thermometer through-
out the season is between 44. 15, and 4(J.30 ; the first being the
y.B. vol. xv. no. xii. 57

812 Doughty. An Est,ay on the Adaptation of [December,

lowest mean, which occurred in December, and the second, the
highest, which was noted in February. December may almost
be taken as an index of the extreme range of the means for the
season, for the difference between its highest and lowest means
is nearly equal, to that of the same for the season. Compared
with the same month at San Francisco, it is much more varia-
ble, there being a difference in the range of two degrees in favor
of the latter. The other months of the season give no record of
a mean as low as that of December, and at the same time, dis-
play a degree of uniformity much in advance of it. Finally,
the mean range for the season amounts to only 2.51, which is
even 0.85 less than that of San Francisco. As contrasted
with that of the other posts of the table, it is about two and a
half times less than that of Fort Vancouver, and about one-
fifth that of Fort Dalles.

Examining now the record of Fort Vancouver, we find in
December twice the range that is recorded on the coast ; in Jan-
uary, there is seven times that of the latter ; and in February,
twice the latter. Here the highest monthly mean is 43.71,
nearly a degree less than the lowest on the coast in February,
and the lowest is 33.20, in December, which gives a resulting
range of 10,51 for the season. January and February show
advances in the positions of the means over December, and
give a material diminution in the extent of their general range.
It manifests greater variability than Fort Miller in California,
the mean ranges for the season, being as 6.39 to 5.00. At
this post, the record extends through five or more years, and
will compare favorably with those eastern stations, the records
of which were given in the first clause of the subject.

The interior post, Fort Dalles, presents an extreme record,
even in a period of four years, such in fact, as to need no ex-
tended remarks. It is more variable than Fort Defiance in New
Mexico, notwithstanding it has an advantage in altitude and in
its valley situation.

4th. Winds and Weather of Oregon, &o.

Irregularity is the marked feature of the atmospherical circu-
lation at this season throughout the entire section. Therefore,,
we shall content ourselves with a simple notice of those indi-

1859.]

Climate to the Consumptive, <c.

813

vidual winds, which appear to be the most prevalent. At Fort
Orford, during two years' observations, we observe a continua-
tion of the fall season, namely, a greater prevalence of the south-
east and north-west winds ; the former being very much stronger
and more frequent than all others.

At Fort Vancouver, in December, with five years' observa-
tions, no extraordinary prevalence can be accorded to any par-
ticular wind ; those however from the east, south-east, north,
and west were the principal ones ; and of these, the east and
south-east were strongest. In January and February, with
four years' observations, a similar record was noted.

At Fort Dalles for three years, throughout the season, the
east, south, and west were most frequent and forcible, and of
these, the west was the strongest.

Of the Weather, the following is a Summary :

DECEMBER.

JANUARY.

~ ''

- \

~ - -

FEBRUARY.

Fort Orford, Oregon, (1 year.)....i B
" Vancouver. " 4 " ....8
" Dalles, C. Valley, 2 " .... 1

1. 12

16.0
6.6

.0 11.0 17.01 5.0 0.

-
4.6 li. y

The respective means for the entire season are, as follows :
Ft. Orford, fair days 10.5 -crdy-19.5 -rainy 12.83-Sn'y 0.33
"Vancouver, 9.4-" -20.66- " 14.1 - " 2.06

" Dalles, " 9.86- " -20.06- " 6.16- " 4.73

December at Fort Orford, presents little or no variation from
November, these two months forming an important part
of the wet season here. The relative proportion of the various
divisions of the weather, remain at about the same figures : al-
though a record of snowy days is made in December. During
this month, the fair days are only one-half of the rainy days,
and about two and a half times less than the cloudy. The
rainy days occupy more than half the month, and the cloudy
constitute two-thirds of the same. In January, there is a slight
increase in the proportion of fair days, and as slight a diminu-
tion of the others. The only material difference that February
shows, is a diminution in the number of fair days, which is so
great that they form only one third of the cloudy, and one-half

814 Doughty. An Essay on the Adaptation of [December,

of the fair days. No record of snow was made during the sin-
gle year of observation at this post. If we may use this short
record in general comparisons with places along the coast, fur-
ther south, as San Francisco, we shall then be able to form
an idea of the wetness of the season.

In December, at San Francisco, there are 16.3 fair days, hero,
there are 8.5 ; of cloudy days at the first, there are 14 6, herey
there are 22.5. In January at San Francisco, there are 9.5 rainy
days, here there are 16.0. At San Francisco the fair days pre-
serve an ascendancy over all others, throughout the season,
whilst here they form only a fractional part.

At Fort Vancouver, the record of December corresponds with
that of Fort Orford, except in a slight decrease in the rainy
days, and a large increase in those upon which there was a fall
of snow. And the general characters of this month are pretty
well sustained throughout the other two ; the most material
difference between them, being the diminution in the snowy days.
There is also a general resemblance between these posts, and
the interior one, so far as the relative number of fair and cloudy
days is concerned, but a great dissimilarity in regard to the
other divisions. This last consists in the diminished number of
rainy days, and the largely increased number of snowy days.
The record here is in singular contrast with that at Fort Defi-
ance in the south of this basin region. A simple exhibition of
the various means for the season at the latter, is sufficient.
At Fort Defiance, the number of fair days is 22.33 ; of cloudy,
7.66; of rainy, 0.5 ; and of snowy, 4.5. The result of the com-
parison is the deduction, that no such wet season prevails at the
latter at this time, as is found at the former.

5th. Rain in Inches at Oregon, &c.

At Fort Orford in two years, the mean quantity for Decem-
ber was 11.64 inches; for January, 8.81 inches; and for Februa-
ry, 6.35 inches: the resulting mean for the season is 26,80 in-
ches. At Fort Vancouver, the mean of six years for December
was 6.69 ; of January, for five years, 9.62 inches ; and of
February, for six years, 3.38 : with a resulting mean of 19.69
inches for the season. At Fort Dalles in four years for Decem-
ber, there was a mean of 2.91 inches ; for January, 3.16 inches;

1859.] Climate to the Consumptive, &c. 815

and for February, 1.01 : with a resulting mean for the season of
7.11 inehes.

It will be observed that the amount of precipitation is
much more profuse upon the coast, and that it decreases
rapidly as you progress towards the interior, until having
reached the Columbia Valley, there is a diminution of nearly
three-fourths of the amount for the season. To the east of
Fort Dalles, and towards the centre and south of this region,
the average as indicated by the shading in the chart for the sea-
son, is only three inches.*

Besides the profuseness along the coast, its great and rapid
increase as we ascend from California, becomes a matter of
much interest. At San Diego, the mean quantity for the sea-
son is 5.90 inches; at San Francisco, it is 11.33 inches; whilst
at Fort Orford, it has increased to 26.80 inches. An increase of
nearly twenty-one inches in ten degrees in the one case, and of
fifteen and forty-two hundredths in nearly five degrees of lati-
tude in the other. The precise result of which is an increase of
two inches and one-tenth to a degree of latitude in. the first, and
three inches and eight hundredths in the latter.

Finally, in this connexion, we give the following quotation
from Mr. Blodget : "At Astoria, the quantity of winter rain is
much like that of Bergen, in Norway, which at 60 north lati-
tude, has a mean of 23.5 inches of rain in winter, for a period
often years. Points on the west coast of Ireland, and of Scot-
land, and parts of England, would not differ largely from these
measures. Bergen is considered as the most extremely rainy of
European positions in its winter climate, and it is probable that
the quantity placed on the chart for our immediate western,
coast thirty inches is too great to be sustained by the results
of a period of years. At Sitka, the mean of seven years is 23.8
inches, and at Steilacoom, that of six years is 22.6. The mean
for the most exposed points of the coast, cannot be less than 28
inches, and this quantity probably belongs to the whole coast,
at least as far as Sitka."f

Meteorological Summary for the Year at Oregon, &c.

The mean annual temperature of Fort Orford, is 53.62 ; that

* See Blodget's Climatologj', <fcc.

f See Blodget's Climatology of United States. Page 343.

816 Doughty. An Essay on the Adaptation of [December,

of Fort Astoria, is 52.c23 ; that of Fort Vancouver, is 52.65 ;
and that of Fort Dalles, is52.79.

The lowest monthly mean at Forts Orford and Astoria is found
in December ; and the period of increase continues to August,
which has the highest mean for the year at both places. The
whole range of the monthly means is at the first 14.92, and at the
second 13.10, The average rate of advance from the lowest to
the highest at Fort Orford, is l.92 per month; and that of the
decline of temperature is 3.73 per month. At Fort Vancouver,
December still has the lowest monthly mean, but July has the
highest, so that the period of an increase of temperature is one
month shorter than upon the coast. The mean of December is
36.ol, and that of July, 68.71, which gives a range in the
monthly means of 32. 20. The average rate of monthly in-
crease is 4.60 per month, and that of the decline 6.44 per
month.

At Fort Dalles, the periods of advance and decline of tem-
perature are equal, each occupying six months. January has
the lowest mean temperature, 33.09, and July the highest,
73.22 : the resulting range is 40.13. The average rates of in-
crease and decline are the same, 6.68 per month. The record
at this interior post is not quite so extreme in these various re-
gards, as that of Fort Defiance : the stations on the immediate
coast, however, differ from that of California, at San Francisco, by
having a greater increase in the range of the monthly means, a
more rapid increase and decline from month to month, and also
in the height of the means of the summer months. The extreme
range of the thermometer for the year is 47. at Fort Orford,
31. being the lowest recorded degree in two years, and 78.
the highest. At Fort Vancouver, the extreme range is 79.p
the lowest degree being 19., and the highest 98.. At Fort
Dalles, there may be an annual range of 120. ; the lowest re-
corded point being 15., and the highest 105..

Of the weather at these places, the record is so irregular and
defective, as to admit of no very accurate representation of it.
Thus, at Fort Orford, no continuous record, even for a single
year, is given ; but for the last six months of the year, 1854, it
was as follows : fair days 105, cloudy 79, rainy 39 ; and for the
last seven months of the year, 1852, there were 121 fair days,
93 cloudy, 70 rainy, and 2 snowy days. In the absence of

1859.] Climate to the Consumptive, <c. 817

positive records on this subject at this place, we think we are
warranted, in view of the various records of the seasons, which
were taken from disconnected periods, in stating that the cloudy
days probably greatly exceed the fair, and that the rainy con-
stitute perhaps two-thirds of the number of cloudy days. At
San Francisco, the proportion of the rainy days was a little
more than a third of the fair and cloudy days, which latter were
about equal to each other.

At Fort Vancouver, with two years' record, there was a mean
of 141 fair, 213 cloudy, 116 rainy, and 7 snowy days. At Fort
Steilacoom, on the extreme north, during three years' observa-
tion, there was a mean of 150 fair, 211 cloudy, 133 rainy, and
9 snowy days. At Fort Dalles, the record of one year was as
follows: 237 fair, 128 cloudy, 59 rainy, and 11 snowy days.

The mean annual quantity of rain at Fort Orford, is 68.52
inches; at Fort Vancouver, 45.50 inches; and at Fort Dalles,
14.32 inches. These data need no comment from us, a simple
mention of them being sufficient to convey an idea of their
great extremity, and the results of any comparison that might
be made with the southern section of this coast.

Finally, in reference to the atmospherical circulation, we refer
the reader to the various seasons, only adding, that upon the
coast, the south-east and north-west winds are perhaps the most
frequent ; whilst at Fort Vancouver, and in the interior, irregu-
larity of circulation is the rule. Winds from all quarters, at all
seasons are recorded, with the expression of no general controll-
ing circulation at any part of the entire section.

In conclusion, we have yet to enquire into the hygrometrical
condition of this section. We have purposely omitted any ref-
erence to this quality of the atmosphere heretofore, because of
the limited amount of information that we possess upon the
subject, and also that we might present at once or connectedly,
all that we have to say in regard to it. As we have elsewhere
stated, no direct exposition of the positive relative humidity of
the Pacific slope by instrumental means, has ever been attempt-
ed ; hence, in our remarks upon the climate of California, and
its contiguous interior, we were compelled to confine ourselves
entirely to general allusions to this condition, and by the best
arrangement possible of the scattered and few facts, known in
relation to it, to form some idea of its probable hygrometrical

818 Doughty. An Essay on the Adaptation of [December,

condition, at least so far as this pertains to our investigation.
Having been enabled to come to a conclusion in regard to the
relative humidity of this section, we propose to test or rather to
ascertain that of the other part, by the greater or less existence
of those circumstances and conditions, which influenced and de-
termined the dew-pont at the former. The two divisions of the
interior, namely the Columbia Valley and the Great Basin, and
its neighborhood, present conditions in no respect differing
greatly from each other ; each having similar degrees of protec-
tion from extraneous influences of every character, and present-
ing in its hydrographic systems, more the evidences of the sur-
plus condensations beyond their surface limits, than of actual
precipitation upon them.

They are alike as to aridity of soil and atmosphere, and give
analogous measurements of rain. At both places, the principal
measurements have been made in the neighborhood of the
mountains, where, as we have already stated, they are more the
results of those local condensations which take place on
their tops and sides, than of any general atmospherical precipi-
tation.

The chief point in the comparison of the coast sections, is that
of the relative amount of precipitation upon them. Taking this
as an index of their probable relative humidity, we soon per-
ceive the greater dampness of the coast of Oregon and Wash-
ington Territory. Every season of the year has a larger pro-
portion of atmospheric precipitation, than is noted on the coast
of California, and the rapidity with which this increases at some
seasons northward, is a matter of great astonishment. From a
comparatively small amount at all seasons at San Diego, and
the intervening coast to San Francisco, we have an extraordi-
nary profusion at Fort Orford, except in the summer season.
In the spring, the difference between the precipitation at Forts
Orford and San Francisco, as given in the charts of the Meteo-
rological Register, is 10.81 inches.* In other words, more
than twice as much falls on the coast of Oregon, as on that
of California at this season. The effect of this upon the divisions
of the weather, corresponds with it. For here, (Oregon) instead
of having a larger number of fair days than of cloudy and
rainy days, these latter actually transcend the other ; the fair

* Iu the Willamette Valley of Oregon, the differences, are not so large.

1859.] Climate to the Consumptive, &c. 619

days constituting only one-third of the month, while in Cali-
fornia they occupy more than half of it. There are double the
number of rainy days here, that there are in California.

In the summer season, the amount of precipitation also
differs, although it cannot be said that it here constitutes an ex-
ception to the climate, for in all probability, it is not sufficient
to influence injuriously the human system. The wet season is
not so completely obliterated as in California, and only seems
to undergo a temporary suspension, which ends very early in
the autumn.

There is one circumstance in which the summer climate of
Oregon, is probably superior to that of California on the imme-
diate coast. This is due to the absence of those extremely un-
like temperature conditions which exist over the sea and land,
and which beget both high winds and a cool, misty atmos-
phere. ^Ve have no evidence that the line of rolling mist which
exists on the southern coast, extends as high as the present
part under consideration : on the contrary, the absence of those
physical peculiarities which intensify the action of the other
agents, that are concerned in its production, warrants the pre-
sumption that it does not exist here.

In the fall season, which ma}7 be said in California still to
form a part of the dry season, the amount of precipitation
at Fort Orford, equals that of the spring, and during the pro-
gress of the season, the cloudy and rainy days steadily increase
to the winter, and greatly out-number those of San Francisco.

Finally, in the winter season, the principal part of which is taken
up in rainy and cloudy days, and during which an exceedingly
great amount of rain is noted at Oregon on the coast, there ex-
ists the most material differences. Those meteorological circum-
stances which produce a constant elevated dew-point are here
present to a controlling degree, and present a striking contrast
with those of California.

The dew-point here then, as indicated by these several con-
ditions, we conclude, is much higher than that of California, and
if we may be allowed to express their relationship in arbitrary
numbers, it would probably stand as 2 to 5.

Being now released from the tedium of statistical detail, the
only remaining feature that claims our notice, is the suitability
of this region,, as a resort for the Consumptive. And of the

820 Doughty. An Essay on the Adaptation of [December,

Columbia Valley we shall have nothing to say, having attached
it to a consideration of the coast, for the same purpose as averred
for the territories of Utah and New Mexico in the other section ;
and whose record, being in every respect identical, renders it
equally unadapted. Therefore, we shall only discuss the adap-
tedness of the coast, and this discussion shall be more in a com-
parative sense than otherwise. If the record embraced a longer
time, it would be unnecessary to resort to this method of ascer-
taining its merits or claims as a sanitarium ; or if its topographi-
cal relationships were as those of California are, such as to pre-
serve its features of climate at a single uniform state, this would
not be requisite. But in the absence of both, we are forced to
regard it only in a comparative light ; although the imperfect
nature of the present limited record, impairs somewhat the value
of such conclusions as may be drawn from the comparison. It
will be remembered, that we found the climate of the Califor-
nian coast so regulated by the circulating waters of the Pacific,
that its temperature was preserved throughout the year at a
relatively high and uniform condition : any great excesses of
the winter climate, being prevented by the prevalence of warm
masses of water at that season, which both elevated the tem-
perature, natural to the coast in their absence, and sustained
and supported it against those severe anti-periodic extremes,
which so largely affect the temperature condition and statistics
of the continent generally : and in the summer, opposite but
analogous extremes were prevented by the substitution of cold
masses of water for the warmer ones of winter. The approach to
anything like an extreme in any phase of the temperature dis-
tribution, being at such periods of the year as were occupied in
the shifting and substitution of these currents, each for the other.
No such conservative influence is found influencing and mould-
ing the climate of the coast of Oregon and Washington Territo-
ry ; moreover, if such was the case, the result would not be so
gratifying, for the altered and 'interrupted condition of the coast
mountains, which would permit a more extended diffusion of
the sea-influences into the interior, and give at the same time,
greater sweep and accessibility to the continental influences,
would of itself, alone and unassisted, destroy an approach to
that uniformity and mildness of temperature, found upon the
other coast. As it is, the waters of the ocean off this part of

1859.] Climate to the Consumptive, dr. 821

the coast, are of a uniform temperature all the year round, and
in all probability, form a part of the same current, of which mea-
surements of temperature, have been taken off the coast farther
south, in the winter season. But even the effect of this uniform
condition of the waters of the Pacific, is on the southern part of
the coast of Oregon, greatly modified in the dry season, by the
proximity of the cold line at sea to it. As a consequence of
the absence of the cold waters, or the substitution of waters of a
higher temperature here for the colder ones of California, not-
withstanding its more northern latitude, a higher summer tem-
perature is experienced upon the coast to the extreme northern
boundary, than at the other.

And this higher temperature appears to increase as we re-
cede from the proximate influence of the cold waters at the
south. Fort Orford has a mean summer temperatue of 59.95 ;
Fort Astoria, 61.58; and Fort Steilacoom, lat. 47.10' N.,
62.89.

And we may further add, that if the considerations of tem-
perature alone, and the features of summer climate, were all
that is required of us, those of the southern and middle parts of
this coast, would compare favorably enough with those of Cali-
fornia. The dreaded winter, however, too often full of gloomy
presage to the consumptive, has to be considered ; and al-
though similar or corresponding sea-temperatures are present at
both, yet, at Oregon, with a higher latitude, and less protection
by mountain rauges from the north winds, there is far less uni-
formity, greater variability," and greater excesses of cold.

Extreme degrees of cold may be experienced at any part of
this coast, and ice, frost, and snow, are recorded at every post
upon it. This season also approaches much sooner than in
California, and when present, affords greater vicissitudes. Spring
and autumn also show greater variability and changeableness,
than the same seasons at San Francisco.

If now we associate its humidity with its temperature condi-
tion, which we have already considered, and found objectiona-
ble, we think that no doubt can exist but that the climate here
is unadapted to the consumptive. The summer climate as a
temporary resort, may be perhaps, suited to the condition of
certain irritable constitutions, but as a permanent residence,
there is too much variability, a want of permanency in the

822 Battey. Vesico- Vaginal Fistula. [December,

climate of the winter and remaining seasons, and too great rela-
tive humidity. /

The requisite amount of exercise in the open air, could not
be taken, on account of the large proportion of rainy and damp
days ; and the irregularity of the circulation of the atmosphere,
rendering proper exercise precarious at all times, also contri-
butes to further the idea of its unadaptedness.

[To be concluded.]

ARTICLE XXVII.

Vesico- Vaginal Fistula Second Case. By Robert Battey, M.D.,
of Rome, Ga.

Adeline, servant of Wm. Holmes, of Cass County, set. 19 ; of
rather small stature mother of three children first is living,
and three years old ; second died at one month; third was de-
livered 6th of March last, by use of the perforator. She had a
bad getting up, with vaginitis and subsequent sloughing of
tissue. Stillicidium of urine made its appearance upon the 8th
day, in the act of lifting her child. The fistula is a large one in
the basfond of the bladder second class of Bozeman extend-
ing for the most part to the left of the median line, and directed
a little upwards; in length say one and quarter inches, breadth
three quarters of an inch ; mucous membrane of the bladder
considerably everted.

May 17th. Assisted by Drs. Lay ton and Cheney, the edges
of the fistula were freshened to the extent of a quarter inch in
breadth, carefully avoiding the prolapsed vesical membrane;
introduced six sutures of silvered iron wire, and adjusted an oval
button of one and a half inches length and three quarters inch
width, having two rows of six holes each, distant three-six-
teenths of an inch. The silver coating upon the iron wire, in
great part separated and fell off in the manipulation, while the
adjustment of the button was wholly unsatisfactory, inconse-
quence of its large size, completely obstructing all view of the
fistula, so soon as it entered the vaginal canal, so that in the
absence of any other means of determining the proper coapta-
tion of the edges, it was necessary to rely upon the sensations

1859.] BATTEY. Vesica- Vaginal Fistula. 823

communicated to the hand in drawing the wires. Having once
had a suture to cut out, from being too tightly drawn, care was
used to avoid this accident, and at the .same time such traction
made as was deemed necessary to close the opening. The
needle, in passing one of the sutures, penetrated a small vessel,
which caused slight hemorrhage. She had some febrile excite-
ment for the first three days, with moderate hemorrhage from
both vagina and bladder ; otherwise did well.

Upon the 9th day after the operation, the sutures were removed
and no good union of the surfaces discovered ; blood was still
oozing from the denuded part ; two of the wires had rusted off
completely, while all were considerably acted upon by the
secretions; there was no evidence of suppuration along the
track of the wires, and they had not cut into the tissues at all.
The length of the wires, when withdrawn, showed that the
edges had been very imperfectly approximated. The patient
was allowed a rest of two weeks upon a tonic of quinia and
iron.

Desiring to substitute in the case some more rational and re-
liable means of determining the due approximation of the de-
nuded surfaces to each other, it was determined to employ a
narrow leaden bar, in place of the Bozeman's button, which had
constituted the obstacle. Having prepared such a splint bar
as will be described as No. 1, in the concluding remarks,
he second operation was performed upon the 10th of Juner
aided by Drs. Layton and Ware. No benefit whatever had oc-
curred from the first. The fistula was as long as ever, and
gaping almost to a circular form, with the vesical membrane
everted as before. The vaginal surface was denuded as usual.
Six silver sutures introduced, and the narrow splint adjusted to
its place without difficulty, while ample opportunity was afford-
ed of inspecting the approximation of the edges, The entire
procedure was fuliy satisfactory, and confident expectation would
have been indulged of a complete union, but for the amount of
force required to bring the edges together, inducing a belief that
one or more of the central wires would cut out; in this however
wre were agreably disappointed.

The patient, annoyed by flies, was very restless, and delayed
the progress of the operation. Had she been furnished with
a pair of drawers, they would have materially added to her com*

824 Battel. Vesico- Vaginal Fistula. [December,

fort, and relieved her surgeon and attendants. The case pro-
gressed up to the 8th day, as favorably as could be desired,
when an attack of acute disease supervened, in no wise connect-
ed with the operation. Upon the 10th day the apparatus was
removed, and a thin layer of creamy pus found beneath the
splint; the cicatrix was smooth and perfect throughout; urine
was retained during the night and passed voluntarily this morn-
ing.

Kemarks. This patient had convalesced so slowly after her
labor, in consequence of vaginal and uterine inflammation, that
some hesitancy was felt in the absence of any recorded prece-
dent, as to the propriety of operating in so short a spade of time
after the accident. No difficulty, however, was encountered upon
this score.

The writer is duly sensible of the debt of gratitude imposed
upon suffering humanity through the labors of Drs. Sims and
Bozeman, and heartily unites with the general voice of the pro-
fession in the appreciation of their discoveries, and yet enter-
tains an honest conviction that perfection has not yet been
attained in the operation. While disclaiming, in toto, all desire
to occupy the position of a discoverer, or in any degree to par-
ticipate in the honors so properly awarded to the gentlemen
named, it may not be unprofitable to examine briefly, the objec-
tions to the apparatus which is now used by the various opera-
tors, and see if we cannot get one step nearer the desirable
standard.

First, let us understand that vesico-vaginal fistula, however
produced, is a solution of continuity of the vesico-vaginal septum,
in which the efforts of nature for repair are thwarted, by the
continual trickling of the urine over the denuded parts, and
frequently by extensive loss of substance, widely separating the
granulating surfaces. It will not probably be denied, that if
immediately upon the promotion of the fistula, its edges be
brought together, and a contrivance instituted say two small
silver tubes, to be inserted into the mouths of the ureters, for the
purpose of completely removing the urine without its entering
the bladder at all nature is fully competent, by adhesive inflam-
mation or by granulation, to close a breach in this situation as
well as in any other part of the body. We may then assume,

18o9.] Battey. la. 825

that the objects to be aimed at in the operation, after freshening
the edges, to place the parts in a suitable condition for healing,
are threefold. 1st., completion of the surfaces; 2nd., perfect
rest for the parts; 3rd., th al of the urine from contact

with the freshened aid this by means which shall not in

themselves be objectionable.

The clamp suture of Dr. Sims, fulfils these indications well,
inmost cases, if skilfully applied, but is subject to objections
which has caused it to be abandoned by Dr. Sims himself, and
need not therefore be further considered. Of Dr. Bozeman's
button, it may be said, that he has succeeded most admirably in
overcoming the dangers of sloughing; he has given us the op-
portunity of treating with the single apparatus, an opening of
any size or shape ; he has rendered the sutures independent of
each other, so that the failure of one shall not involve the rest ;
he has giv^n us a shield to protect the edges of the' fistula, also
a splint to keep them at rest, carefully avoiding, however, by
corrugating the button, any pressure upon the immediate line
of union, distributing it oft' to a distance, thus making the pres-
sure tend rather to gap open than to close the edges. Besides,
we have lost the opportunity afforded in the use of the clamp,
of inspecting the approximation of the edges, and in the case of
a large fistula, the button is clumsy and unwieldy.

Dr. Agnew, of Philadelphia, operated upon a case last year,
which had twice failed in the hands of another surgeon, and
attributes his success to the fact of his having overcome the diffi-
culty, by cutting a window upon each side of the button,
through which the parts beneath were distinctly visible. The
button of Agnew is an improvement upon Bozeman's, but still
objectionable, in that it is encumbered with the ring of metal
left upon the circumference, and which can answer no useful
purpose, but on the contrary adds to the difficulty of adjust-
ment, while it prevents a salutary pressure of the central bar
upon a line of approximation. He seems to ignore, with Dr.
Sims, of X. York, the advantages to be gained, first, by splinting
the parts, and secondly, by pressure upon the edges, ensuring
the complete exclusion of the urine, and suggests the future
employment of the simple silver wire, twisting the ends together,
as practised by Sims ; or the twisted suture, as in hair-lip, using
silver pins and protecting the ends with shot.

826 Battey. Vedco- Vaginal Fistula. [December,

It would seem most reasonable to hold, that there is no advan-
tage to be gained in abandoning the perforated shot for securing
the ligatures ; it is much more easily adjusted, and admits of
the wire being cut off and its ends turned down, thus relieving
the labia from irritation by the projecting wires; or if the latter
be cut off, protects the vagina more effectually from the points.
Again, if it be desirable to approximate the edges at all, the
more completely and uniformly this be done the better. It is
quite true, the complete coaptation may be effected by the su-
tures alone, if closely placed and evenly drawn. Equally true
is it, that the use of a compress admits of fewer sutures, and
obviates any gaping which might arise from the sutures being
a little too loose. The advantage which must acrue from splint-
ing the parts to keep them entirely at rest, and secure a smooth
and even cicatrix, needs no argument to commend it to an un-
biased mind, when simple and easily available means are at hand
for the purpose.

Believing that the true question at issue in this operation is
not how can the cure be effected without the use of the appli-
ances of any other operator, but rather, what is the simplest
and best means, available to all, for securing a satisfactory cure,
if possible, at the first sitting, the writer thinks that he has
succeeded in so modifying the apparatus of Sims and Bozeman,
as to materially divest them of objectionable points, and so
combining their valuable features as to ensure greater certainty
in the result, with very simple means. It is to be distinctly
understood, that no claim whatever is made upon the gratitude
of any body the proposed forms of splint are mere modifica-
tions, with the addition, perhaps, of the idea of a single compress
upon the line of union, which is believed to be new, but for
which nothing is asked.

The splint No. 1, consists of a narrow bar of sheet lead, { of
an inch in width and about -g^th of an inch in thickness, perfor-
ated with two rows of holes, distant say T\ th of an inch along
and very close to either edge of the bar, from which a splint is
to be cut of such length as will properly cover the fistula and
denuded surface.

[No.

1.]

o
o

o
o

o
o

o
o o

o

Q

o
o

o
o

o
o

o
o

1859.] Battey. Vesica- Vaginal Fistula. 827

). 2, differs from No. 1, only in the substitution of a row of
notches cut into one edge of the bar with a very thin saw, or
the blade of a case knife, in place of a row of the holes.

[Xo. 2.]

No. 3, is a simple, plain bar, without either holes or notches.

[Xo. 3.]

It is proposed, then, to proceed as heretofore up to the point
of inserting the sutures : Let there be as many little coils of
the silyer wire as the required number of sutures pass in the
free end of each wire, as usual, and out at the vulya. To adjust
splint Xo. 1, pass the ends of the wires through the perforations
upon the corresponding edge of the bar, slip a shot upon each,
compress it, and turn down the end of the wire. Now, with a
slender rod of wood, or whalebone, in one hand, as a pulley
over which the wire may slide with the other hand draw al-
ternately upon the coils of wire, and pull down the splint upon
the posterior edge of the fistula holding the wires firmly,
press upon the anterior edge in contact with its fellow, cut off
the wires at a length of -i to 6 inches, as may be conyenient,
and with a forcep pass the ends through the holes adjust the
shot and finish as usual.

No. 2, is applied in the same way precisely, save only that
the proximal ends of the sutures are much more conveniently
adjusted by simply pressing the wire into its notch, securing the
shot, cutting the wire afterwards just aboye it, when a slight
pressure with a blunt metallic rod upon the edge of the splint
will close the notch sufficiently to prevent the wire slipping out.
simple leaden bar, and is applied as follows :
Introduce the requisite number of wires, of say 12 to 18 inches
length, press up the front line of the fistula in even, but not too
forcible contact with its fellow, slip the two ends of the wire
through the eye of the needle and press it down as a suture ad-
juster pass down a shot and fasten it, cutting off the wires and
turning down the ends.

k. s. yoL. xv. xo. xii. 58

828 Battey. Vesico- Vaginal Fistula. [December,

This is the simplified operation of Sims, improved by the
restoration of his own shot, Now bend the bar longitudinally
to an arc of a circle, representing the vagiual orifice, grasp it
near the middle with forceps, and insinuate the end under each
successive suture, gradually straightening out to the natural
curve of the vaginal wall as it is introduced. The ends of this
bar may be turned up a little, or even folded over, if any appre-
hension be entertained of its slipping ; without this precaution
it will so far bury itself in the tissues as to leave little chance for
displacement

It is believed that no one form of splint will be likely to an-
swer every case, but the particular form must be chosen for each,
remembering that the desirable points in the apparatus are
these viz : the metallic suture (lead, silver, gold or platina not
iron). The splints and the compress. The splint No. 2, as de-
scribed, will usually prove the best and most convenient form,
with the further recommendation of consuming the smallest
amount of wire, only so much as actually forms the suture being
used in the process. With this splint gold wire could probably
be used to better advantage, on account of its greater softness
and pliability, while the expense of the very small amount con-
sumed could not be objected to.

The observation of two successful operations in which the
sutures were removed upon the 5th and 6th days, respectively,
leads to the inference, that so long a period as nine days is en-
tirely unnecessary to success. It has been remarked, in the case
reported, that a thin layer of pus was found beneath the splint ;
the fluid was purulent in appearance, but was not critically ex-
amined. Could it be due to the action of the compress ? Upon
this point, it may be said that the mucous membrane beneath it
was smooth and even nothing unhealthy about the tissue was
discoverable ; that the patient labored under granular inflamma-
tion of the cervical canal and os tincse, from which source the
supposed purulent fluid may well have emanated and become
lodged beneath the splint, and thus protected from the water
with, which the vagina was daily syringed. Its presence cannot
be used as an objection to the splint, since there were no evi-
dences of ulceration at all, and the splint had occupied its place
several days longer than was really necessary to the cure.

This form of splint and compress might be used, it would

1859.] Notes on the Phenomena of Frogs. 829

seem, with advantage, in closing the abdominal section in gas-
trotomy. The action of the compress in closing the gap firmly
and protecting the edges from every source of irritation by con-
tact of air or clothing, and of the splint, in keeping the parts at
perfect rest, must obviously favor early adhesion, which, with
the use of the silver or gold suture, would probably give us
every desirable advantage. In hare-lip, also, a similarly formed
splint to either ISfo. 1 or No. 2, of transparent horn, or a perfect
ly flattened section of goose-quill, perhaps presents some advan-
tages over any other expedient in use.

It is deemed wholly superfluous to argue at all the propriety
of bringing to our aid the valuable services of the compress in
favoring early adhesion ; any one who has cut his finger with a
knife, and quickly bound it up with his handkerchief, is familiar
with the fact that a surprisingly rapid union takes place.

Notes on the Phenomena which occur in the Tails of very young
embryo of Frogs, when they have been detached from the body.
By M. Vulpian.

Spallanzani has stated that when the tail of the tadpole is cut
off a process of regeneration takes place, after which the tail is
reproduced. This experiment has been often tested, and is con-
stantly successful. I have seen the new part form again after it
had been several times taken off. Until now, physiologists have
rarely made it a matter of research as to what became of the tail
after it was cut off. Moreover, no results can be obtained by
operating on well-developed tadpoles. In this condition the tail
loses all movement as soon as it is separated from the body, unless
the section have been made close to the base, because it may then
contain a very small portion of the spinal marrow, which in the
tadpole passes a little beyond the posterior portion of the body;
the tail, at all events, soon becomes decomposed. The case is not
similar when the experiment is made upon the very young embryo
of the frog, at the time when their gills be^in to form. The tail
detached from the body lives some time, and interesting phenome-
na occur in it. I discovered this when it was too late to procure
any more frogs' eggs, so that I was unable to vary the experiment
in many ways, which I intend to do next year. The tails de-
tached from the bodies frequently live several days, manifesting
their existence by the motions which they make when stimulated
or when they are exposed to contact with the air, which appears
to be a source of irritation. These motions consist in a series of
flections and a lifting up of the tail as in the act of swimming.

/

830 Notes on the Phenomena of Frogs. [December

But life is also manifested by yet more important and singular
phenomena. At the time when the experiment begins the tail
is formed of the central axis and of two membranous portions,
one inferior, the other superior, the whole constituting the caudal
fin. All the elements in these different portions are in their first
stage ; the epithelial cells, the muscular fibres, the nervous fibres,
the vessels, and the blood. Without entering into details, which
I shall enlarge upon in another publication, I may say that these
tissues, examined daily, gradually attain perfection ; they lose their
foetal character, the elements are multiplied, and, at the same time
the vitelline granulations which they inclose disappear completely.
A cicatrice is formed in the neighborhood of the section ; a new
portion is here added to the tail, and this portion which may be
about as one-eighth to the whole length of the tail, seems younger;
it is more transparent, and has no central axis, and the cells are
filled with a larger number of granulations. This growth of cells
takes place at the expense of the pre-existing cells ; there is no
intussusception. The tail flattens out without becoming larger.
The vessels are seen to ramify ; star-shaped cells give birth to
capillary blood-vessels and probably to lymphatics ; cutaneous
pigment cells appear. The groups of muscles which are separa-
ted by intersections, and which form a large portion of the axis,
are more clearly defined ; these intersections are crossed by dis-
tinct vessels which give rise to a net- work of membranous lamina ;
in these vessels are seen stationary blood-globules, which become
modified while the tail lives. In the only experiment which I
could extend to any length, a tail, cut upon the 9th of April, 1858,
was yet alive on the 27th ; that is to say, at the end of eighteen
days ; but it was then almost dead, and was sacrificed for more
complete examination. At the time the tail was cut off the blood-
globules were entirely round, almost colorless, and very granular.
During the last days of its existence the granulations had dimin-
ished in number, and were exceedingly fine ; several globules
were oval, and at the last they became of a marked yellowish tint.

I wished to make these experiments upon the embryos of the
triton, but I could not succeed. They offer less resistance,
and the cohesion of their elements is not so strong, so that they
fall rapidly into decay. Nevertheless, I preserved the tail of the
larva of the triton, which lived six days ; the section had separa-
ted from the body not only the tail, but also the posterior half of
the larva. No real scar was produced, but drawings, made every
day with the camera, showed considerable changes in the length
and shape of the caudal portion of the segment. The elements
of this portion underwent notable modifications ; but the length
of the experiment did not admit of their being as profound as those
in the elements of the tail of the embryo of the frog.

Thus the tail of the embryo of frogs, detached from the body,
may live twenty days, and be the seat of the most incontestable

1859.] Poisoning wi ;m Seed. 831

vital phenomena. This cicatrization which occurs, this new por-
tion which is reproduced, are tendencies to restoration. As in
animals still lower, lite, at this stage, undergoes segmentation, if
we may be allowed the use of such a phrase. But as the vital
force begins to resume its functions, the elements which it rend-
ers active are multiplied and perfected, and gradually attain to a
higher organization. Circulation thus becomes an imperious
necessitv, either to convey new materials or to carry away the
tissues alreadv broken down. Finally, a multitude of minute
molecules are deposited in the midst of the tissues, and life be-
comes excinct [Cornptes Rendus de la Socieie de Biologie, and
h Amer. Med. Chir. Revi.

Report of a Case of Poisoning with Stramonium Seed Laudanum,
the Antidote. By T. L. Maddix, M. D.

A little girl, at the Orphan Asylum, four years of age, had
eaten her dinner as usual, in apparent good health ; in an hour
afterwards was found in the yard, not able to stand, staggering,
falling, and striking about at random, talking incoherently, a
vacant bewildered expression, with the pupils dilated to the
full extent of the colored portion of the eye, and totally blind.
I saw the child in about half an hour afterwards, and found her
with all of the above symptoms in their extremest degree. The
face was of a scarlet hue, the conjunctiva of both eyes engorged
with blood ; the iris could not be seen, so great was its dilitation ;
the retina entirely insensible to light. An incoherent delirium,
imagining herself surrounded by objects that had no existence;
her vagaries were of a pleasant character, and created great
merriment with the other children present. Subsultus tendi-
num, picking about the bed-clothes, and grasping at random
around her ; the pulse imperceptible, and the extremities cold.

The matron of the establishment supposed the child had be-
come deranged. AlSsoou as I examined it, I told her it was poison-
ed with stramonium. She stated there had never been any of it
about the house. Upon inquiry if there was any Jamestown
weeds about the lot, she stated not one, for she had some days
previously had every one pulled up and thrown from the }*ard,
fearing the children might get them, having known of children
poisoned with them. I remarked that, whatever may have been
her precaution, the child had been eating the stramonium seed.

The first feature of the treatment consisted in the use of emet-
ics, but by no process could I induce vomiting, so insensible
had the stomach become. At first the child would swallow any
quantity of fluid, no matter how nauseating, warm or cold, all
indifferently, but without the slightest perceptible effect, the
train of symptoms remaining the same. The jaws, after a time,

832 Poisoning with Stramonium Seed. [December,

became so rigid, that it was impossible to give any thing, the
symptoms all the while assuming a graver character. The the-
rapeutic import of stramonium and belladonna being the same,
and as I have by repeated trials convinced myself of the certain
virtue of belladonna as the antidote for opium, vice versa, opium
should be the antidote of belladonna, and all therapeutic agents
that act on the same principle with it. This is true only with
that class of antidotes which act upon a therapeutic principle,
and not those which act chemically or mechanically. I ordered
an enema of half a drachm of laudanum in a tablespoonful of
water, having previously ordered a large stimulating enema,
which passed off without any fecal evacuation. The laudanum
enema was retained. In about half an hour a narrow portion
of the iris could be discovered. This injection was repeated five
times, and each time with good effect, with more contraction of
the iris, and returning consciousness, the child becoming more
composed, the delirium yielding, the expression more natural,
the sight returning, the scarlet flush gradually vanishing, the
circulation better, the extremities warmer, and recognizing and
answering questions correctly. She continued dozing pleasant-
ly for the next thirty-six hours. The pupil remained dilated
during this time about two-thirds the size of the colored portion
of the eye. I should mention that after the second laudanum
injection had been administered long enough to have effect, and
with the first symptoms of returning consciousness, the emetics
which had been taken six hours previously, produced considera-
ble nausea with some vomiting, but nothing more than a small
quantity of water was thrown up. A large dose of castor-oil
was administered, with specific directions to examine carefully
each evacuation for the stramonium seed. In the meantime,
the matron informed me that she had found quite a patch of
Jamestown weeds, which by oversight had been left in a portion
of the yard. Seed-pods, broken open, were discovered, and the
bushes seemed to be freshly broken. This was a partial en-
dorsement of my diagnosis, which was fully demonstrated by
-finding a very- large quantity of the seed in the fourth evacua-
tion. All unpleasant symptoms gradually disappeared, and in
forty-eight hours from the time the seed were eaten, the little
girl was able to be up and about the room.

I have deemed it advisable to report the above case, as a fur-
ther proof of the valuable fact, which I have on previous occa-
sions endeavored to impress upon the profession through the
pages of the Record, that opium occupies to belladonna and
its kindred drugs the relation of a therapeutic antithesis, and
that they furnish to each other, in any quantities, safe and relia-
ble antidotes, the pupil in all cases being a reliable index as to
how far we may with safety proceed in their use. [Nashville
Med. Record.

1859.] Treatment of Post-partum He-morrliage. 833

Is the Usual Treatment of Post-partum Hemorrhage Correct ? By
Dr. Lyall.

Amid the thousand and one expedients for the arrest of post-
partum uterine hemorrhage, there are a few of universal accep-
tation taught in the schools, prescribed in didactic works, and
employed in all emergencies demanding special interference.

3 seem to constitute a portion of the broad beaten track of
the obstetric source, from which no one may think for a moment
of turning aside, or even of entertaining a doubt that he walks
in the right way. It will readily suggest itself to the minds of
every one, that I here allude to the mechanical irritation of the
uterus to induce it to contract, and the removal of clots from its
interior, so as to get it to contract, upon itself. In this practice

I instructed, and in this faith for many years practised ; and
the instruction and practice are, in a great meausre, now what
they were when I was a pupil, thirty years ago.

: us take a case, and go over the ordinary mode of proce-
dure. After the removal of the placenta, which, perhaps, has
been somewhat tedious, the uterus contracts at longer intervals
and more feebly than usual ; at each contraction a quantity of
blood is thrown out ; the uterus is grasped through the external
walls of the abdomen, and urged by frictions and pinchings, to
contract and expel its contents, which are now found gradually
to increase : these means failing, and the woman getting more
and more prostrate, cold water is dashed over the belly, the
hand introduced within the cavity of the uterus, and the clots
removed. Brandy and opium are prescribed ; still the uterus
fails to contract so as to prevent hemorrhage, sinking continues,,
till, pulseless and exsanguined, the woman dies. This consumma-
tion I have never witnessed, and trust I never may ; but all
preceding the final issue has been to me a matter of experience ;
the grievous discomfort of the patient lying in a plash of cold
water, and the scarcely less grievous anxiety of the attendant
watching and waiting on.

Such is the usual course of a fatal case of post-partum hemorr-
hage, and the most common means employed in its treatment;
the chief object in view being to get the uterus to contract upon
itself, so as to arrest the vital flow. Many other means out of
the thousand and one to which I have alluded, are, no doubtr
often used galvanism, squeezing a lemon within the cavity of
the uterus, blowing up a caoutchouc or common bladder within
it. etc. etc., one or other of which has preceded a recovery " post
hoc ergo propter hoc,'7 the steeple preceding the sands. The
indication of cure is, no doubt, a right indication, as the contrac-
tion of the uterus is the means employed by nature to arrest the
hemorrhagic loss ; and it is usually because nature fails in the
performance of this natural act that we are called on to inter-

834 Treatment of Post- par turn Hemorrhage. [December,

fere. But do we act aright in the mode of our interference ?
If the uterus acts feebly, and fail to contract favorably, so as to
stop up the uterine vessels, will we aid its feeble powers by ex-
cessive stimulation or irritation ? We know that the stimula-
tion of other organs in a weakened or feeble condition may soon
exhaust, but cannot invigorate them ; and why may the uterus
be an exception to the ordinary physiological rule ? Moreover,
are we right in removing the clot from the interior of the organ ?
The uterus has been powerful enough by its contractions on the
child to expel it ; and will it now contract more powerfully on
nothing than on a contained clot? All muscular fibres, we
know, by contraction lose power that is, the more they are
shortened by action, the less power they have to continue short-
ening by continued action ; and why may the uterus be an ex-
ception to the ordinary rule? These questions, and questions
such as these, I put to myself, but fail to answer them favorably
to the ordinary practice ; and thus it came about that my mode
of procedure changed. I do not feel anxious although the uterus
contain a clot, and have long ceased to vex the organ by exter-
nal and internal manipulation. Is this or the usual practice
right ?

If we consider the ordinary and natural mode of arrest of
hemorrhage, we find that the blood coagulates within and around
the mouths of the bleeding vessels, and that this coagulation is
promoted by the sickness and fainting induced by the loss of
blood, in fact, is a chief means employed by nature in arresting
its further flow. In epistaxis, for instance, the bleeding nostril
gets plugged up with a clot, which in time restrains the further
flow ; and in ordinary wounds, unless an arterial trunk of con-
siderable size be injured, the same thing takes place. In epis-
taxis, we do not sedulously remove the clot, but rather aid its
formation by plugging the nostrils, and diminish, if need be,
the vis a tergo by venesection, and thus imitate nature in her
conservative efforts to check the hemorrhage. Why our prac-
tice in uterine hemorrhage should be different I cannot see.
The organ, having failed to secure its own vessels by its custom-
ary contraction, adopts the mode of coagulation to effect the
same purpose ; and we, forsooth, wiser than nature, would com-
pel her back again into her forsaken course, and say to the
uterus, You shall cease to bleed by contraction, and contraction
alone; a coagulum is not to be formed, or, if formed, must be
removed ; but removed at least once too often, the organ and
its possessor fail in the contest, and cease to strive forever.
While thus condemning the " meddlesome midwifery" of intra
and extra-uterine manipulation for the arrest of uterine hemor-
rhage, in which the very life-blood of the patient is squeezed out
of her by these ill-considered efforts, the casualty is by no means
one for non-interference ; something must be done, and that

On the A ration of Belladonna. 835

quickly ; but let it be in accordance with the principles and the
rules of art. When, in surgery, we fail to reach and ligature
a bleeding vessel, our next resource is pressure ; and as we can-
not tie the v the uterus, pressure is our chief and re-
maining stay. At the risk of apparent egotism, I shall go over
the mode of procedure I usually adopt, both for the prevention
and arrest of uterine hemorrhage. As soon as the placenta is
withdrawn. I place the patient on her back, put her hand over
the uterus, and cause her to keep it there until I have drawn a

^r-slip or similar bandage underneath her: feeling for the
uterus, I lay over it a folded flannel petticoat, or other large
compress, and fix it in its place with the circular roller as tight-
ly as it can well be drawn; a very considerable pressure is thus
applied to the uterus from the first, as the compress should be
sufficiently large to make the antero-posterior equal at least to
the lateral diameter. If hemorrhage do take place, the bandage

ill further tightened, and the compress enlarged; and if
there be escape to any extent of blood per vaginarn, then the
long bandage is also applied, as described in Lancet, 1850, vol.
i. p. 384. The patient is kept supine and motionless, so as to
promote coagulation and repress cardiac action. I permit no
shifting of clothes, or indeed anything demanding motion or
likely to excite arterial activity ; as pressure and quiet I con-
ceive to be quite adequate to prevent a fatal issue in uterine
hemorrhage, if properly and timeously applied. [Proceedings of
Obstetrical Society of Edinburgh . i h. Med. Journ, and Amer.

Jour, of Md. Sciences.

On tlxe Administration of Belladonna, and on certain Causes which
modify its Action.

A paper on this subject was read before the Roval Med. and
Ghirurg. Society (July 5) by Henry W. Fuller", M. D. The
author was led to the inquiries which form the subject of this
paper by observing the remarkable tolerance of belladonna ex-
hibited by a child, a patient in St. George's Hospital, to whom
he was administering it as a r r chorea. Fancying that

the tolerance of the drug observed in the case in question might
be attributable either to imperfection of the extract or to the
modifying influence of the choreic he obtained other ex-

ts of belladonna from Apothecaries' Hall, from Squire's, and
from Jacob Bell's, in Oxford Street, and administered it, dissolv-
ed in water, to ten other choreic patients in the hospital. In a
twelfth case, he administered atropine, obtained from Morson's
in Southampton Row. The result was in all cases the same
namely, extraordinary tolerance of the remedy, with a varying,
but not very satisfactory, effect as regards the subjugation of the

VOL. XV. xo. XII. 59

&86 On the Administration of Belladonna. [December

choreic spasm the tolerance of the drug being so great that one
girl, aged ten, took seventy grains of the extract of belladonna
daily, and a total amount of one thousand and nineteen grains,
or rather more than two ounces, in twenty-six days j while the
child aged fourteen, to whom the atropine was administered,,
took no less than thirty-seven grains in eighteen days. 1. The
patients were all pale whilst taking the larger doses of the drug
and in no instance, was there any feverish heat, or any rash or
erythematous blush on the skin. 2. There was great weakness
of the pulse in all the cases, and, in some, considerable quickness.
3. The urine was generally clear and acid, but scanty, and of
high specific gravity, varying from 1024 to 1086. In three cases
it frequently contained a copious deposit of crystallized lithic
acid ; and, in three other cases, it was usually loaded with
lithates. In one case, for the space of a few hours, whilst the
patient was under the toxical influence of the drug, it became ara-
monical almost as soon as voided. 4. In one case some difficulty
was experienced in voiding the urine \ but this was not observ-
ed in any other case. This difficulty passed off when the bel-
ladonna was omitted. 5. The tongue was always moist, but
usually red whilst the larger doses of belladonna were being
taken, and the redness passed off when the drug was omitted,
6. The remedy did not, in any instance, exert a constipating
effect ; on the contrary, it appeared to prove aperient. An oc-
casional purge was required only in three cases. 7. In five
cases it ultimately gave rise to sickness and diarrhoea ; but in
every instance, save one, the choreic spasms had almost wholly
ceased, and, in the exceptional case alluded to, had greatly sub-
sided before those symptoms were produced. Whenever bowel
symptoms occurred, mere omission of the medicine sufficed to
cause their cessation. Did the existence of spasm counteract
the influence of the drug and prevent their occurrence ? 8,
Dilatation of the pupils was very uncertain. In almost every
instance the pupils were large before the administration of the
medicine was commenced,, and they invariably became dilated
soon after a dose of the medicine was taken.. The dilatation, how-
ever, was not to the degree observed when a solution of bella-
donna is dropped into the eye, and, in most of the cases, it
passed off before another dose of the medicine was due. Its
ordinary duration was about two hours and a half. In one
case, excessive dilatation occurred for a few hours coincidently
with the occurrence of sickness and purging. In two cases
considerable dilatation was pretty constant ; in one case it was
seldom grert. &. In two instances only did the slightest indis-
tinctness of vision occur. In one of these it was observed only
on three occasions, and then only to a slight degree, and was
not accompanied by dryness of the throat, headache, or any im-
pairment of the mental faculties ; in the other, it took place

1859.] Or the Administration of Belladonna. 837

more frequently, and strange to say, was most complained of
when the pupils were of their natural size, and were contracting
freely under the stimulus of light. It was not attended by
delirium, nor by any indication of the action of belladonna, and
the administration of an additional quantity of the drug was
almost invariably followed by its removal. 10. The drug did
not, in any case, produce the slightest narcotic effect ; and, in
one case it failed utterly as an anodyne. 11. In no instance
was there any evidence of its accumulation in the system. 12.
The tolerance of the drug was not in proportion to the severity
of the choreic spasms. In Case 2, in which fourteen grains of
the extract, daily, occasioned sickness and purging, the spasms
were more severe than in case 11, in which seventy grains were
taken daily without disturbance of the stomach and bowels.
13. The curative effect of the drug was very uncertain. In seven
cases its action appeared to be decidedly curative, but in two
cases it failed to exercise the slightest control over the spasms ;
and in the other three cases, it is doubtful whether the improve-
ment ought to be attributed to its action. Being desirous of as-
certaining whether the tolerance of the drug was due to its de*
composition in the stomach, or to its non-absorption, the author
submitted to Dr. Marcet and Mr. Kesteven for examination
some of the urine voided by a patient in Rosberry Ward, who
at the time was taking sixty-four grains of the extract of bella-
donna daily. The former extracted atropine enough from three
ounces of the urine to kill two white mice, and narcotize several
others. The latter, from two ounces of the urine, obtained suf-
ficient to produce dilatation of a cat's eye, to afford the beauti-
ful filamentous crystals of atropine now laid before the Society,
and to give the reactions which atropine yields with iodine
water, tannic acid, chloride of gold and sulphuric acid, and bi-
chromate of potash. The feces also, on being analyzed by Dr.
Marcet, yielded abundance of atropine. Thus, then, up to this
point, five facts, appeared proved : 1st. That in cases of chorea
extraordinarily large doses of belladonna and atropine are tolera-
ted. 2d. That the drug is absorbed into the blood, and there-
fore, that the tolerance of it is not attributable to its non-absorp-
tion, nor to its being decomposed in the stomach. 3d. That it
does not accumulate in the blood, but passes out of the system
with the urine and feces, and probably with the other excretions.
4th. That it does not exercise that amount of control over the
choreic spasms which would have been expected from the readi-
ness with which it is tolerated by the system. 5th. That the
tolerance of the remedy is not in proportion to the severity of
the choreic symptoms. The question, therefore, arose as to
whether the existence of chorea had any part in producing toler-
ance of the drug, or whether that tolerance may not have been
due to some other circumstances? With the view of determin-

838 On the Administration of Belladonna. [December,

ing this point, the author administered the extract of belladon-
na to two convalescent children, whom he kept in the hospital
for the purpose. To the one. aged seven, he ultimately gave
thirteen grains of the extract daily, and to the other, aged ten,
twenty-eight grains daily, without producing dryness of the
tongue or fauces, or any symptom indicative of the action of
belladonna beyond some temporary dilatation of the pupils.
With the view of having the matter tested with children on a
larger scale than is possible at St. George's Hospital, the author
requested a friend, who is attached to a large public institution
for children, to administer it cautiously in gradually increasing
doses. Accordingly to eleven children, varying in age from
three to six, one-eighth of a grain of the extract in solution was
administered three times a day, and the dose was increased in
the course of six days to half a grain thrice daily. To four
other children, from eight to twelve years of age, a quarter of a
grain of the extract was given, and the dose was increased in
the course of six days up to one grain three times daily. These
children were all in good health ; the dose was gradually in-
creased, and dilatation of the pupil was the only effect produced.
To seven other children, between five and seven years of age,
he began by giving one-third of a grain twice a day, and con-
tinued it for three days without perceiving any effect from its
administration beyond slight dilatation of the pupil. He then
prescribed two-thirds of a grain twice a day ; but by mistake
one grain and a third was given at a dose. The result of this
large and sudden increase was that the children were all seized
with sickness and vomiting ; some of them had diarrhoea, and
one of them had the violent uncontrollable delirium characteris-
tic of belladonna. Stimulants were at once administered, the
belladonna was omitted, and on the following day the toxical
effects of the drug had passed off, and the children were perfect-
ly welL To adults, the author administered the drug in pills,
and in solution, and he found that, however given, very small
doses usually produce dryness of the tongue and fauces; that
two grains daily will often excite vertigo and dizziness, and that
it is not possible to establish a tolerance of the larger doses as
in children. He was thus led to the conclusion that; 1st. The
tolerance of belladonna is not attributable to the counteracting
influence of choreic spasms, but is in some way connected with
the age of the patient. 2dly. That a much larger dose than is
usually prescribed is well borne from the first by children of
tender years. 3dly. That in children, though not so in adults,
a tolerance of the remedy is speedily established, so that the
dose may be safely increased, rapidly, but gradually. 4thly.
That special care should be taken in apportioning the dose to
the age of the patient, and in not increasing the dose too rapid-
ly, inasmuch as the usual toxical effects of the drug will be pro-

1859.] Treatment of Syphilis with Mercury. 839

duced if too large a dose be given before a sufficient tolerance
of the drug has been established, otbly. That the milder toxi-
cal effects produced by the drug are of little importance, and
subside without remedies as soon as the administration of the
medicine is discontinued. 6thly. That adults cannot tolerate
the doses of the drug which can be taken with impunity by
children. The extraordinary difference in the tolerance of the
drug observed at different periods of life, the author remarks,
may be explicable by the medicine passing off with the urine, as
also, probably, with the other excretions, more rapidly in child-
hood than in adult life ; and he concludes his paper by the fol-
lowing suggestions: 1st. That inasmuch as belladonna is ad-
mitted to be productive of signal benefit in hooping-cough, even
in the minute doses in which it has been hitherto administered,
it is probable that a corresponding increase of benefit would re-
sult from large doses, which it is now proved may be safely pre-
scribed under certain restrictions. 2dly. That it deserves a trial
in epilepsy, laryngismus stridulus, and other spasmodic affections.
3dly. That combining as it does antispasmodic, sedative, and
slightly purgative properties, it may be productive of relief in
certain cases of dyspepsia connected with infra-mammary pain,
flatus, and spasms in the abdomen. 4tkly. That inasmuch as
it exercises a remarkable power in controlling spermatorrhoea
and incontinence of urine, and the experiments recorded in this
paper prove that it is excreted with the urine, it is highly pro-
bable that its curative action in such cases ma}7 be due in great
measure to its topical effect, and if so, that it might be applied
locally with advantage. [Med. Times and Gazette.

The Treatment of Syphilis with Mercury. By C. A. Hartman.

Dr. Von Baerensprung, physician of the department for syphi-
litic patients in the hospital Charite, at Berlin, Prussia, has, for
a number of years, studied the effects of mercury and its prepara-
tions on the human body, in order to deduct therefrom the indi-
cations for the employment of these remedies in the venereal dis-
ease. We condense the substance of his elaborate essay on this
subject, published in the " Annalender Berliner Charite."

Metallic quicksilver has been employed as medicine in three
forms: fluid, in fumigation, and in trituration, (gray ointment,
blue mass, Plenck's mucilage of mercury, murcurius saccharatus,
hydrargyrum cum creta, &c. ;) but in none of these forms does
the fluid mercury penetrate any of the tissues of the human body.

The pure metal, however, may be retained for sometime in the
intestinal tract, become partly oxydized, and attain in that way
the power to affect the organs of the body. Mercurial fumes
have only a local and external effect ; when inhaled, they are

8-iO Treatment of Syphilis icith Mercury. [December,

condensed into globules, which cause violent irritation of the air-
passages. Mercury extinguished by trituration is always partly
transformed into the sub-oxyde, which forms the only effectual
ingredient of the blue pills and similar preparations. In the Un-
guentum cinereum, this sub-oxyde of mercury is by far the great-
est part combined with adipous acid, and thereby enabled to pen-
etrate together with the free fatty matter, the skin and mucous
membranes diosmetically, and to reach the blood.

In regard to the oxyds of mercury, their combinations with
sulphur are no longer used, and need, consequently, no attention.
The black sub-oxyde is transformed, in the stomach, into calomel ;
the red precipitate into corrosive sublimate. The latter substance
has a strong affinity to all organic tissues, destroying their struc-
ture, by inflaming and corroding them. It enters into combina-
tions, not only with the contents, but also with the membranes
of the stomach, among which combinations the albuminates re-
quire a particular consideration. A solution of sublimate added
to a solution of albumen forms two albuminates of mercury ; one
solid, insoluble in water, but easily dissolved by the addition of
different acids and salts, such as acetic and muriatic acids,
muriate of soda, or ammonia, &c; is, according to Rose and
Elzner, oxyde of mercury with albumen ; the other, albuminate
appears in a fluid state. They are both readily absorbed by the
mucous membranes of the stomach and intestines ; so quick, in-
deed, that nothing of them reaches the lower two-thirds of the in-
testinal canal.

Among the other oxysalts of mercury, the cyanate is nearly
allied to sublimate, sharing with it the same degree of solubility,
and, consequently, forming the same combinations. Its effect
may, however, be modified or complicated to a certain degree,
by a small quantity of Prussic acid, set free during the changes
undergoing in the stomach. The acid nitrate of quicksilver ex-
hibits also a character similar to that of the bichloride, whilst the
biniodide differs by being almost insoluble in water. It requires
for its solution muriatic acid, or some combination of the same.
Adhering to the walls of the stomach, it operates more violently,
and on different places, corroding the membrane more intensely.

The oxydulated salts of mercury are all decomposed when con-
nected with organic substances, giving off metallic mercury, and
changing into oxydized salts. Those of their number which are
soluble in water, (the nitrous oxyde, for instance,) are thus trans-
formed more rapidly than the insoluble ones, (calomel, the simple
iodate and the bromate.) It is for this reason, that especially the
latter ones do not corrode the stomach, but, merely irritate it; a
large part of them go to the intestines and is there transformed,
so that the mucous membrane of the entire intestinal canal par-
ticipates in absorbing the albuminates formed. As a natural con-
sequence, greater doses of these insoluble preparations are requir-

1859.] Treatment of Sy pi tills ic itli Mercury. 8-ii

ed, but salivation is also more readily excited. Large doses in-
crease the secretion and the peristaltic movement of the intestines
so much that all, or most of the remedy is thrown out with the
copious discharges that foilow.

The unguentum cinereum is, therefore, the only preparation
which sends the mercury in a saponaceous combination to the
blood; all other preparations changing into albuminates, which
are always alike, neither the acid connected with the mercury,
nor the state of oxydation producing a difference. The only dif-
ference existing in the latter class is this : all preparations soluble
in water, or in the digestive fluids, are strong corroding poisons,
and must be exhibited in very small doses. Their effect is pro-
portional to the dose employed. Such are the red oxyde. the
chloride, the iodide, the cyanide, the nitro-suboxyde, and the nitric
oxv de.

The preparations almost insoluble in water, or by the digestive
organs, do not corrode, but irritate the mucous membrane of all
the intestines, and are in part discharged unchanged; consequent-
Iv their effect is never proportional to the dose. Large doses
generally produce diarrhoea and no salivation, which is more cer-
tainly brought on by small doses. The simple suboxyde, the sub-
muriate and the iodate belong to this class. The acids and salt-
radicals connected with the different preparations of mercury, and
set free in the stomach or intestines, may possibly modify some-
what the effect of the mercury itself. The preparations of each
of the two classes enumerated may be taken in general as per-
fectly alike, and scarcely differing in degree so far as their effect
on the organism is concerned. What further changes the quick-
silver goes through after it reaches the blood, how long it remains
in the organism, in what manner it is discharged again from the
body, are questions not yet settled, in spite of a great many ex-
periments. All we know on this point is the diminished coagu-
lability of the blood, in consequence of a continued use of mercu-
ry. But it has yet to be proved that metallic quicksilver is form-
ed out of the preparations taken, and that the globules can be
found in the bones, the urine, and the saliva. Probably, however,
the mercury remains for a certain length of time intimately con-
nected with the organic tissues, and is perhaps never entirely
separated again.

Turning now to clinical observations, we find that inunction
does not disturb the digestive organs, nor, properly managed, irri-
tate the skin ;. the insoluble preparations produce a moderate ir-
ritation of the gastric and intestinal mucous membrane, but the
soluble ones corrode the mucous membrane of the stomach. Given
in conjunction with sufficient quantities of albumen, these last
preparations will lose most of their corrosive quality. The com-
mon effect of all mercurial preparations reaching the blood is the
so-called mercurialism, of which an acute and a chronic form

842 Treatment of Syphilis with Mercury . [December,

may be distinguished. The former manifests itself by the well-
known affection of the gums and a copious salivation; the chronic
form is recognized from certain disturbances of the animal econ-
omy generally, and the nervous system especially the mercurial
cachexia. Which one of these forms will appear, depends upon
the quantity of mercury taken in a given time, upon the constitu-
tion of the patient, and upon certain chemical combinations.
The more mercury is taken in a short time, the quicker saliva-
tion will appear ; small doses given for a long time, will rather
produce chronic mercurialism. It is well known that children
are not easily affected with salivation; tall persons, with a firm,
muscular tissue are also not very liable to this affection. Certain
remedies, the preparations of iodine especially, counteract the
effects of quicksilver ; calomel produces salivation sooner than
iodate of mercury. Other agents seem to promote the salivating
property : the cyanide works more readily in that regard than the
chloride.

The anti-syphilitic power of mercury being entirely dependent
upon its transmission to the blood, those preparations ought of
course to be principally employed which disturb the least the di-
gestive organs, and these are calomel, the simple iodate and the
albuminate for internal use, the gray ointment for external appli-
cation. The last name is undoubtedly the most advisable wherev-
er a speedy general effect is wanted ; inunction will do in the short-
est time, and in the most perfect manner, what any preparation
of mercury can do. In many cases this form of exhibiting mer-
cury is quite indispensable, and cannot be replaced by any other.
The only objection to it is the salivation growing often, in spite
of all caution, more violent than is wished for. For internal use
calomel ought to be placed first, the general effect being most
rapidly produced by it; too violent operation of it can be check-
ed by cathartics. One grain twice a day, or, to hasten the effect,
half a grain five or six times a day, is a sufficient dose for a grown
person ; as soon as the gums begin to be affected, the remedy ought
to be dispensed with. The iodate is too preferred in persons
who are readily affected with violent salivation, but, being more
irritating than the calomel, smaller doses are advisable about
half a grain three or four times daily. The albuminate of mercu-
ry would be preferable to both the preparations named if it could
be given in pills, this being the most convenient form to almost
all patients. All other preparations can be disregarded in the
treatment of syphilis. The opinion entertained by many, that
some preparations of mercury possess a specific power against
certain localizationsof the syphilitic process, is not proved by ex-
perience; with any mercurial preparation one local affection will
disappear sooner, another later. The whole complex of symp-
toms is modified almost suddenly by a speedy appearance of mer-
curialism ; where this is produced gradually, the improvement
likewise takes a more protracted course.

1859.] Treatment c Mercury.

But is, then the mercury a specific remedy for the venereal
disease ? Most certainly it is not ; mercury does not cure syphi-
lis ; the disease is only put back by the appearing mercurial
and is always returning again as soon as the effect of the mercu-
ry ceases, assuming a form corresponding with the more or less
debilitated constitution of the patient. It is not merely an infec-
tion of the blood., but a disease affecting the whole organism, and
consequently can not be eradicated but by the gradual change of
all the materials composing that organism. The means to accom-
plish, or favor, this change, are not to be found in the druggist's
shop. A proper change in the mode of life, a strictly regulated
diet, will do more than all medicines. Sometimes no medicine
whatever is required ; cases have been observed, where, under
favorable circumstances, not onlv some of the symptoms, but
even the syphilitic diathesis itself disappeared without any medi-
cation. Everything which disturbs digestion, respiration, or
nervous activity, has a deteriorating effect in regard to the ven-
ereal disease ; too much mercury favors rather than cures even
the worst forms of it. It is now an established fact, that syphili-
tic caries and necrosis are not developed but in persons laboring
under mercurial cachexia. Tending to an amelioration of that
dreadful disease are, living in a warm climate with an even tem-
perature, a regular mode of life, avoiding all kinds of excess, a good
nourishing, easily digested diet, bathing, exercise, etc. Antiphlo-
gistic treatment, species lignorum. etc., may be employed as val-
uable assistants : sarsaparilla, guaiacum-wood, and other so-called
surrogates of quicksilver, have a more or less cathartic, diuretic
and diaphoretic effect; in other words, they promote the change
of the organic matters; hunger is serviceable inasmuch as it re-
tards a too speedy renovation of these matters, and keeps thereby
the organism in a state most favorable for the eradication of con-
stitutional disease.

In establishing these principles, mercury is not entirely reject-
ed, it is on the contrary recommended as the most important,
though not always indispensable medicine against syphilis. But
the basis of the whole treatment must always be formed by a
strictly regulated general regimen. The use of mercury, however,
is contra-indicated whenever the bodv is still suffering from the
effects of the same, which is apparent in an anaemic condition,
nervous irritability and diminished energv of the motorv actions.
The local manifestations of svphilis show under the influence of
such a condition, tuberculous forms, caseous and gangrenous exu-
dations (Rhypia, Ecthyma, Lupus,) affections of the bones, etc., with
great inclination to purulent decomposition. It is, in short, in
the so called tertiary syphilis, where mercury ought to be avoided
and iodine employed in its place, assisted by saline and sulphur-
ous baths. Mercury is also not required in the primary forms ;
the fresh chancre, not yet indurated, being a local affection, yield-

8-il Administration of Medicine to Children. [December,

ing to local treatment ; but the quicksilver is highly serviceable
against occult chancres located in the urinary passages or the
female parts of generation. Everything depends here upon a
speedy repulsion, and the mercury is exactly the remedy to effect
this. The same principle holds good in regard to open chancres
of an older date, or much irritated, where the general infection
is yet doubtful. The mercury is, lastly, quite indispensable in
all the secondary forms, and especially when important organs,
the iris, for instance, is endangered. Pregnancy, tuberculosis,
and hemoptysis, form no objection to mercurial treatment, and
again the hereditary syphilis appearing in children we have
scarcely another remedy of similar usefulness to resort to.

Salivation is not to be dreaded ; on the contrary, it is just the
thing wanted, and the sooner it is produced the better; of course
it has to be kept within reasonable limit. The usual increasing
and decreasing doses of mercurial preparations are, however,
objectionable; the pretended accomodation of the body to the
remedy given in this manner, is always a very doubtful affair, and
the general effect of all the preparations being essentially the
same, it is evidently the best plan to induce this effect in the
manner most convenient, that is, to begin with some suitable mer-
curial remedy in sufficient doses.

These propositions, based on physiological facts, a patient ob-
servation and the most logical reasoning, recommend them-
selves to the attention of every practitioner. It seems almost im-
possible to refute any part of them, and we may. therefore, con-
sider the old question, if syphilis ought to be treated with mercu-
ry or not, fairly settled forever. [Cleveland Med. Gazette.

On the Administration of Medicine to Children.

M. Wahu having much to do with the diseases of children,
wishes to impress upon practitioners the importance, in the case
of important medicinal substances, of having them administered,
whenever practicable, in their own presence. He also states
some of the means he adopts to enable certain medicines to be
more easily got down. Thus the sub-nitrate of bismuth, in large
doses, which is of such value in diarrhoea and the gastrointesti-
nal affections of children, often subsides to the bottom of the spoon
when given in broth or milk ; and it is much more readily taken
also by children of about, two years old when given in chocolate
prepared with water, and thickened with tapioca or crumbs of
bread. In this way seventy grains and more may be given night
and morning. In the same way iron can be very readily given.
Ratany and catechu, two precious drugs, the action of which,
when in small doses, is soon manifested in children, can also
very readily be given in this chocolate panada. Chocolate made

1859.] Influence of Sex on Diseasts of Children. S45

with either milk or water, and flavored with canella or vanilla, is
usually very readily taken by children, and its dark color facili-
tates the mixture of numerous colored medicinal substances,
which would be observed by the little patients were they given in
milk, broth, or any infusion. Katany and catechu may also be
well triturated and mixed with quince jelly, the flavor of which,
while masking that of other substances, is very agreeable to chil-
dren. Sulphate of soda and sulphate of magnesia are substances
very difficult to get even adults to take. The sulphate of soda
mav often be administered to children, by dissolving ten parts in
150 of unsalted beef-tea, and waiting until the child is sufficiently
thirsty to swallow a cup of liquid almost without tasting it. For
adults, the best means is to dissolve the sulphate of soda or mag-
nesia in exactly the quantity of hot water necessary for its com-
plete solution. This is allowed to get cold, and a glass of pretty
strong lemonade is prepared. Holding a glass in each hand, that
containing the salt is rapidly drunk, and then the lemonade is
slowly drunk masking the detestable taste of the purgative, and
supplying each fluid to prevent its proving too irritating. Cor-
sican moss is another substance which children take with difficul-
ty ; but if an infusion be made and strained, and then added to
unsalted beef-tea, it will be readily swallowed. Calomel is one of
the most difficult medicines to ive, when children are too young
to swallow pills, which is the case under six years of age. Incor-
porating it into honey is the best means rinsing the mouth after-
wards, to prevent any adhering to the gums. It should never be
given in currant, or any other jelly ; a death having occurred a
few years since from the conversion of the calomel given in cur-
rant jelly into a bichloride. It is safest to prohibit any acid drink
being taken on the day that calomel is given. Ipecac, may be
given either in the chocolate panada or in honey. When it is
impossible to give any medicinal substance by the mouth, it may
be administered by the rectum, taking care first to empty the gut
by tepid water or an emollient decoction, and that the bulk of the
medicated enema do not exceed from four to six ounces, so that
it may be retained and absorbed. [Druggists' Circular.

On the Influence of Sex on Diseases of Children. By Dr. Eobert
Kuttner, of Dresden.

That sex exercises a decided influence upon diseases and their
course long before the development of puberty, is well evinced
in early infancy. It is one of the important tasks of pathology
to study this phenomena more closely, to establish the facts
having relation to it by accurate statistics, and to find out, as
far as possible, the real cause of the same. Dr. Kiittners treatise
is a valuable contribution toward the solution of this question,

846 After Effects of Diphtheritic [December,

as his statements are founded upon the statistics often thousand
cases treated in the Children's Hospital of Dresden, duringa
period of over ten years. Eeferring our readers for particular
data to the treatise itself, we only give the conclusions
which the author lays down as the result of his statistical re-
searches. They are the following :

1. Boys are, particularly in the first year of their life, much
more liable to diseases of the digestive organs than girls; they
bear therefore an improper mode of feeding less easily, and die,
the relative mortality of both sexes being equal, in an absolute-
ly greater number of diseases of this kind.

2. Nervous and cerebral diseases are, especially from the fifth
year, nearly twice as frequent in bo}^s as in girls.

3. Boys are more disposed to umbilical and inguinal hernia
than girls.

4. Girls, after their third, and particularly after their fifth
year, are more inclined to diseases of the respiratory organs, and
die of them in greater number.

5. The same is the case in regard to diseases of the heart.

6. In acute diseases of the blood the difference of sex does not
seem to exercise any influence ; chronic anasmia, however, and
scorbutic cachexia, are much more frequent in girls than in boys,
especially after the eighth year of life, (in the proportion often
to one.) Scrofula and tuberculosis are, at the beginning, nearly
equal ; but from the fifth year pulmonary tuberculosis is more
frequently met with in girls. Bachitis occurs in equal number
in both sexes, but is often somewhat later developed in girls, and
is of longer duration in them than in boys.

7. Chronic diseases of the skin (particularly of the scalp) are,
after the ninth year, more frequent in girls than in boys.

8. The same is the case in regard to swellings of the thyroid
gland. [Journal fur Kinderkrankheiten, and North American
Med, Chir. Review.

After Effects of Diphtherine.

Dr. Faure, of Paris, has, in a series of cases collected from vari-
ous sources, directed attention to a peculiar sequela of diphthe-
ria, in which, some time after all trace of the original complaint
has completely disappeared, the patient becomes, without known
cause, pale and colorless, at times one portion of the frame and
sometimes another seems to suffer most. The legs can no long-
er carry the body; the arms lose their power; the soft palate
dangles like a dead curtain ; swallowing, and even breathing,
becomes almost impossible ; the pupils are dilated, and vision
much impaired ; sensation is diminished and sometimes entirely
lost, or replaced by formication. In some, sundry parts of the

1839.] Arsenic in CI ironic Bronchitis. 847

body become cedematous, in others gangrenous; others again
are subject to repeated huntings. General reaction is not ob-
servable, fever rare, the skin in a certain degree moist. Beason
flashes betimes through the gradually increasing dull stupidity,
or a wandering smile may now and then light up the vacant
countenance; and death finally closes the scene either by syn-
cope, or as the last stage of exhaustion, like a gradual extinction
of life. This affection has been referred to by Bretonneau,
Trousseau, Blache, and others. Breton neau regards these
symptoms as the effect of a diphtheritic blood-poisoning. The
most successful treatment has consisted in the administration of
quinine and iron. [Edinburgh Med. Journal.

Arsenic in Obstinate Chronic Bronchitis.

Dr. Wood, observed that his attention had long since been
attracted to the probable existence, in certain cases of obstinate
chronic inflammation, no matter in what part of the body it
might be situated, of the same state of system which gives ex-
treme obstinacy to some cutaneous eruptions, such as psoriasis
and lepra. This view is of practical importance; as arsenicT
having proved a most effectual remedy in the cutaneous affec-
tions alluded to, might be equally beneficial in obstinate chronic
inflammation elsewhere, if possessed of the same systemic char-
acter. The idea is not a new one. Professor Simpson, of Edin-
burgh, having been led to the supposition that a certain obsti-
nate affection of the bowels, not uncommon in that city, was of
a nature similar to cutaneous eruptions, employed arsenic in it
with very beneficial effect. The same remedy has been long
employed in obstinate periostitis, and with great asserted bene-
fit in chronic nodosities of the joints of a rheumatic charac-
ter. I have frequently thought of using it in chronic bronchitis,,
which had resisted ordinary treatment, but never carried the
idea into effect until, in a case of nine or ten years7 durationr
which came under my notice some time since, connected with
psoriasis of the face,- 1 had a fair opportunity of trying the reme-
dy. Under the use of Fowler's solution, in the dose of from
three to five drops, three times a day, continued for six or eight
weeks, the cutaneous eruption and chronic bronchitis were
both so much relieved that the remedy was discontinued. In-
deed, both affections had almost, if not quite, disappeared ; and
the patient had not been equally free from his bronchial
affection at any time for years before. In consequence, however,
of apprehension of injury to the stomach, not well founded, I
believe, he prematurely omitted the medicine; and three or
four months afterwards both affections began to reappear. I
am again using the solution in the case, and thus far with a
similar result. {Transactions of the College of Phys. of Philad.

8^8 Curability of Tubercular Meningitis. [December,

On the Curability of 'Tubercular Meningitis. By Dr. 0. Bang.

Although many physicians deny the curability of tubercular
meningitis, (hydrocephalus acutus,) as, for instance, Camper and
Trousseau, some others have proved from their own experience
that a cure may be sometimes obtained, though such cases be of
very rare occurrence. West saved, of thirty -four children, one ;
Guersant, of an hundred in the second stage, one; in the third
stage, however, none. Rilliet, who has collected and compared
all the cases of cure in the Arch. Generates, (December, 1853,)
doubts many of the favorable cases, and admits only eight cases
reported by others, and three observed by himself, to have been
real cases of tubercular meningitis. To these cases Liegard (sur
la nature et le traitement de la fievre cerebrate) adds a case of his
own, and six observed by his father ; the total number of cured
cases on record are thus eighteen.

Those who maintain the incurability of the affection suppose
that in the cases reported as cured, simple inflammation of the
brain, or remittent fever, worm-fever, hydrocephaloid, etc., had
been mistaken for tubercular meningitis. The author believes
that an exact differential diagnosis between simple and tubercu-
lar meningitis can hardly be established. Accordiug to his
opinion, meningitis consists in an active congestion, followed
by an inflammation which assumes a different character when
the blood is healthy, and when it is diseased ; in the former case
the disease is simple, in the latter it is complicated. The tuber-
cular meningitis is characterized by its occurrence in scrofulous
children ; the meningitis is here complicated with a disease of
the blood, and is thus to be treated according to the same rules
which are observed in the treatment of any inflammation accom-
panied by a morbid condition of the blood. A complete cure
is possible only when an amelioration of the crasis of the blood
can be effected, and this is very difficult after a localization of
the disease has taken place. Only if a meningitis appears sud-
denly without premonitory symptoms, and is accompanied by-
violent fever, abstraction of a considerable quantity of blood is
necessary; the use of this measure requires, however, great cau-
tion when the disease commences more slowly, and the child
bears the characters of the scrofulous cachexia.

A prophylactic treatment is indicated only in cases of the
latter kind; it consists in the use of anti-scrofulous remedies and
of derivatives, when the children have a disposition to conges-
tion of the brain ; at the same time all strong impressions upon
the brain should be carefully avoided.

The author has treated three children in this manner, who
had lost their brothers of tubercular meningitis, and in whom,
certain symptoms threatened an attack of the disease ; blisters
to the nape of the neck were of particular use in this instance.

1859.] New mode of relieving Retention of Urine. 8-iO

If the parents .are scrofulous, or if there is a hereditary tend
in the family, Dr. Bang subjects the women to an anti-scrofu-
lous treatment during their pregnancy, and has found this plan
very successful in one Id affusions upOn the head

while the child is sitting in a warm bath are rerj useful, not
only as prophylactic, but also as curative means: if. however,
the state of exudation has commenced, he uses, instead of themT
powerful derivatives upon the shaved head, such as blisters,
croton oil, ointment of tartar emetic, etc. In three cases in
which considerable exudation had already taken placeT the cure
was very much promoted by an ointment composed of unguen*
turn hydra rgyri, tartar emetic, and ol. tiglii. In simple as well
as in tubercular hydrocephalus, calomel, in doses of three to
eight grains, is the most useful laxative ; in chronic cases the
author gives it, however, in smaller doses in combination with
digitalis, as an antiphlogistic. As calomel seemed to promote
vomiting, the author prescribed frictions with mercurial oint-
ment on different parts of the body ; this application was em-
ployed in two cases, which were cured. Two cases were treated
with iodine in combination with other remedies, and also in
these a cure was obtained by the author; in other eases, in
which he used iodine alone, it seemed to diminish vomiting, but
did not effect a cure.

In accordance with this experience the author considers tuber-
cular meningitis curable, and is supported in his opinion by
cases reported by reliable observers, in which all the symptoms
of the disease wrere present, and which were, nevertheless, cured.
If the physician is called in earl}T enough, and followrs the plan
of treatment recommended above, there is, according to the
author, hope of the disease being cured. [Bibliothek fur Laegerr
and North American Med. Cftir. Review.

New Mode of Relieving Retention of Urine.

Langstox Parker, Esq., Surgeon to Queen's Hospital, Bir-
mingham, states {British Medical Journal, May 21, 1859) that
he has very recently succeeded, in two separate instances, in re-
lieving retention of urine in the following manner;

" A gentleman lately entered my consultation room in great
pain from retention of urine. He had not passed water for
many hours; the bladder was much distended. He stated that
ineffectual efforts bad been made to pass the catheter,, during
which operations he had lost a considerable quantity of blood,

1 attempted to relieve him by the catheter, but failed to- do so ; I
tried instruments of various sizes and various curves, but could
not succeed in passing one into the bladder. I then took a No.

2 wax bougie, and inserted a small portion of potassa fusa into

850 Treatment of Hooping Cough. [December,

the end of it, after the manner proposed by Mr. Whateley, and
practiced by Mr. Wade in the treatment of permanent stricture
of the urethra. I well moulded the wax over all but the extreme
point of the-caustic, and passed it rapidly down to the point of
obstruction ; by pressing against this for a short time it yielded,
and I had the satisfaction of finding the bougie easily enter the
bladder. I directed the patient to strain as I withdrew the in-
strument; a stream of urine followed, and the bladder was
emptied. The retention did not again occur, and very little
irritation accompanied or followed the proceeding. On the
next day the patient made water freely, but in a small stream.

" The second case was very similar. The patient had travel-
ed some distance by rail. The bladder was much distended, the
symptoms urgent, and a catheter could not be made to enter the
bladder. A small wax bougie was armed as in the last case,
passed down to the stricture, and firmly pressed against it. It
yielded very shortly; the instrument entered the bladder, and
a stream of urine followed its withdrawal. This patient had a
second attack of retention two days afterwards, which was com-
pletely relieved in the same manner.

" A modification of this plan might be attempted by inserting
a small piece of potassa fusa into the extreme point of a small
gum-elastic catheter, and using it without the stilette. I am
sanguine enough to hope that many cases of retention of urine
might be easily and quickly relieved by the simple means I have
suggested, and more formidable and dangerous operations thus
frequently avoided." [American Jour, of Med. Sciences.

On the Treatment of Hooping Cough.. By Dr. J. Whitehead.

It is too generally assumed that, except by change of air,
hooping-cough cannot be modified by any treatment to a per-
ceptible degree ; that it is, at least, possible to abbreviate its
course, is proved by the following statistics :

In thirty-five cases of hooping-cough, admitted to the hospital
clinics at Manchester, after an average duration of the disease of
more than three months, a cure was obtained in less than twen-
ty-five days at an average; and it is probable that not- much
more time would have been required, in order to obtain the
same result, if the children had entered the hospital six or eight
weeks sooner. That such would have been the case is proved
by the fact that in eighty-seven cases in which the treatment
was commenced after the second week of the disease, the aver-
age duration of the treatment was the same as in the first series
of patients ; the duration of the disease was thus reduced to
thirty-seven days. The average duration of the disease was
forty-two days in the totality of the cases, and one hundred and
eleven days in those cases which had been neglected.

1859.] Iinpotency treated by Electricity. 851

Among the eighty -seven cases of the second series, there were
thirty-two in whom" the average duration of the disease, at the
time of their admission, had been eleven days; and fifty -five in
whom it had been five days. In the former, the average dura-
tion of the whole disease was thirty-five days; in the latter, but
thirty-two days.

The treatment employed consisted, in simple cases and in
such in which the existing complications had been removed, in
the administration of Dover's powder, either alone or combined
with camphor, which was used either internally or in fumiga-
tions; in the use of emetics, belladonna, and of revulsives. In
all cases opium or belladonna served as the basis of the treat-
ment. [Third Report of the Clinical Hospital, Manchester, 185(J.
X. A. Medico- Chirurg. Review.

Impotency treated by Electricity.

J. Althaus, of London, narrates a case of Impotency success-
fully treated by Electricity (Deutsche Klinik, 1858, 1.) He con-
sidered the cause of entire absence of erections of the penis, in
an otherwise healthy man, a3t. 45, an idiopathic atonic condition
of the musculi-ischio and bulbo-cavernosi. These muscles by
their contraction, have the office to compress the vena dorsalis
penis and the crura of the corpora cavernosa, and thus impeding
the return of blood, to swell and erect the penis. He made use
of Faradization. The patient was placed in a position as for
lithotomy, the scrotum raised, and the electricity for ten minutes,
first slowly and lightly, and then strongly and directly commu-
nicated to the bodies of the before named muscles. The result
was very satisfactory. Two days after the first application the
patient had erections, and was capable to fulfil with vigor his
marital duties, which had not been the case for over a year. A
return of the paralytic condition of the muscles was afterwards
also entirely and radically cured by four applications. Dr. Al-
thaus claims no novelty for this proceeding, as he was well aware
that Schultz, of Vienna, had treated successfully eleven cases of
this sort by electricity. Also, Hassenstein and Duchenne pub-
lished cases where Faradization was attended with entire relief.
Organic changes of the urogenital system certainly contra-indi-
cate always this treatment. [Cleveland Med. Gazette.

On tJie Treatment of Spina Bifida by Injections of Iodine. By
Daniel Brainard, M. D., Professor of Surgery in the Kush
Medical College.

In this essay Dr. Brainard, after discussing the seat and patholo-

852 Treatment of Spina Bifida by Iodine. [December,

instituted for its relief, and gives the results of fifty-nine cases
treated by puncture, excision, ligature, and pressure. From
bis table, we find that of 35 cases in which punctures had been
made, 17 resulted in cures, 16 in death, 1 was palliated, and the
result of 1 was unknown : 11 cases were subjected to excision,
with 7 cures, 3 deaths, the result of one being unknown. Liga-
tion was instituted in 8 instances, 5 being cured, and 3 termi-
nating fatally. In 5 cases, pressure gave the result of 3 cures,
1 death, and 1 palliation.

The treatment of spina bifida by injections of iodine was first
instituted by the author, and he illustrates his paper by ten cases
treated in this manner, five occurring in his own practice, two
in that of Dr. Crawford; Chassaignac, Velpeau, and Nelaton,
having each had one case. The oldest patient was thirteen, the
youngest a new-born child, and in four there also existed chronic
hydrocephalus.

Of the ten cases thus treated, five were cured, three died, and
in two the results are uncertain, having occurred in the practice
of MM. Nelaton and Velpeau. It is proper to state, however,
that in one of the fatal cases hydrocephalus coexisted, and was
the probable cause of this termination, as the spinal canal was
found closed, and there was no irritation about the tumor to ac-
count for death. In another fatal case the spina bifida was
cured, and the child died seven months afterwards from hydro-
cephalus. The result cannot, therefore, be attributed to the in-
jections of iodine.

Dr. Brainard deems interference improper when the tumor is
small, and the patient is somewhat advanced in years and in
good health. Also in children affected with acute disease, espe-
cially of the brain and spinal cord.

The rules adopted by the author in making these injections
are as follows :

1. Make the puncture in the sound skin at the side of the
tumor.

2. Inject the solution of iodine and iodide of potassium, com-
mencing with one-fourth of a grain of the former to three-fourths
of a grain of the latter, and retain it by slight pressure.

3. Evacuate no more of the liquid than the quantity of injec-
tion about to be thrown in.

4. If convulsions supervene, the fluid may be drawn out and
its place filled with distilled water.

5. Lay the patient on the face, and if there be heat, apply
evaporating lotions to the tumor and to the head.

6. When the tumor becomes flaccid, apply collodion or other
means of contracting the skin. This should be continued for
some months after the swelling has disappeared.

7. After the effect of an injection is past, repeat it as many

<

1859.] Secondary Syphilis Contagious. 853

times as may be necessary, and gradually increase the strength
according to the effect produced. [Chicago Med. Journal.

Secondary Syphilis Contagious.

The Academy of Medicine of Paris, at its sitting of the 31st
May, witnessed a scene which the editor of the Revue de Thera-
peutique calls an event. It was a partial renunciation on the
part of M. Ricord of one of the articles of his medical faith, for
which he lias long contended against the greatest odds. M. Ru
cord has always been a firm supporter of the views of Hunter,
rri relation to the non-contagiousness of secondary syphilis, but
the event of the academy referred to shows that his views in this
respect have undergone a change.

In October last, a letter from the minister of public works,
&c, submitted to the Academy the following questions :

1. Are the symptoms of secondary syphilis contagious?

2% Regarded as contagious, are the effects in infants at the
brea'st different from those observable in the adult?

These questions were referred to a committee, composed of
MM. Gilbert, Velpeau, Ricord, Devergie, and Depaul, who re-
ported through M. Gilbert, at the session of May 31 that

1. There are secondary or constitutional symptoms ol'syphilis
manifestly contagious. At the head of these it is necessary to
place the mucous papule or flat tubercle.

2. This proposition applies to^the nurse and the infant at the
breast as well as to other subjects, and there is no reason to sup-
pose that in infants at the breast the results of these symptoms
have properties different from those observed in the adult.

Answered so categorical ly, and enclosing in its terms so com-
plete a denial of the Hunterian doctrine of non-contagion, it
was necessary for the great expounder of Hunter to qualify his
renunciation, which he did in a long address from the tribune
of the Academy, closing as follows :

Therefore, I conclude that the report which should be sent to
the minister, in reply to his demand, should be cautiously ex-
pressed, admitting, if you will, the possibility of the contagion
of the secondary svmptoms, but without specifying anything
more at present Fiat Lux. [ Virginia Med. Jour.

Prophylactic Treatment of Hie Sequelw of Measles and Scarlet Fever.
By Prof. Scoutettex.

M. Scoutetten", chief physician of the Military Hospital of
Metz, advises frictions with warm sweet-oil all over the bodv,
the face included, when the redness is gone. After this friction
the patient is replaced in bed, where he should remain about

854: Premature Labor by Uterine Catheterism. [December,

two hours. The next day he should take a warm bath, and re-
main in it one hour. After the bath he is replaced in bed, and
two or three hours afterwards, when the skin is quite dry, another
friction is made similar to the first. This is generally sufficient
to ward off the unpleasant and well-known sequela? of the two
above-named exanthematous fevers ; but when the attack has
been violent, and the dead epidermis has not completely fallen
off, these means should be resumed until the dermis has regain-
ed its functions. M. Scoutetten has rarely gone beyond four
frictions and two baths. These precautions being taken, the pa-
tients can, according to the author's experience, go out with impu-
nity. \Gaz. Hebdomadaire, and North Amer. Med. Chir. Review.

On the Induction of Premature Labor by Uterine Catheterism. By
Prof. Braun, of Vienna.

Professor Braun, of Vienna, states that he has for several
years given a preference to this mode of inducing premature
labor ; inasmuch as it is very certain, operates rapidly and safe-
ly, brings on the pains with gradual energy, gives rise to no ill
consequence, such as congestion or injury of the uterus, or de-
tachment of the placenta, and is performed by the single appli-
cation of a simple instrument. One disadvantage of the proce-
dure is, that the membranes may become somewhat easily ruptur-
ed, especially in primiparse. In order to prevent this accidental
rupture, the author softens in hot water the end of a well-oiled
catgut bougie, a foot long, and^from two to three lines thick,
and passes it along the index finger with a twisting movement
into the uterine cavity, until only a portion, equal to too fingers'
breadths, remains in the vagina. The bougie so passed always
excites pains in from six to twenty hours, does no injury to the
membranes, and is to be removed only just before the discharge
of the waters, or the birth of the child. The employment of a
gum catheter, having a very thin, flexible stilette, is usually
also attended with good effect. Its application is difficult, how-
ever, when the vagina is narrow, and deviates from the pelvic
axis. During the session 1857 and 1858, Professor Braun em-
ployed catheterism twelve times, nine children being born alive,
and six dead three being twin-births. Of the mothers eight
recovered, and four died during the puerperal state, pneumonia,
tubercle, and Bright's disease having been respectively the
causes of death. The labor was terminated at an average period
of twelve hours after the introduction of the catheter. Brief
accounts of these twelve cases are subjoined. [ Wien medizine.
Wochenschrift, and North Amer. Med. Chir. Review.

On the Treatment of Chorea by Cauterization. By Dr. Hamon.
Dr. Hamon has treated two cases of chorea with the potential

1859.] Treatment of Chorea by Croterization. 855

cautery ; in one of them the affection had assumed a very j-eri-
ous form, the convulsions involving nearly the whole body, and
continuing unabated even during the night. The use of sulphur-
baths, and the systematic administration of tartar-emetic," accord-
ing to the method of Gillette and Bonfils, having produced no
amelioration in the condition of the patient. Dr. Hamon applied
amianth, soaked in concentrated nitric acid, to the side of the
dorsal and lumber parts of the spinal column, in such a manner
that sixty small punctiform burns were produced at a distance
of about one centimetre from each other, which healed in eight
to twelve days without leaving any distinct cicatrix. On the
evening of the same day the patient could already speak with
greater ease, passed a comparatively quiet night, and the convul-
sions had lost much of their intensity. The operation was re-
peated twice, at intervals of several days, and effected a com-
plete cure within three weeks, the disease having existed one
month before the treatment was commenced.

In the second case, the disease presented a milder form, and
affected only one side. After using sulphur-baths, without any
benefit whatever, the patient, a girl sixteen }^ears of age, was
subjected to the treatment by cauterization ; the cautery was
applied only once, at eighty different points, and as in the former
case, the symptoms were decidedly ameliorated the same evening.

The pain attending the operation is said to be very slight and
transient ; the oedema occurring in the commencement disap-
pears very soon, and no suppuration takes place if the applica-
tion is made but superficial. [L1 Union Mcdicale, and X. A.
Med. CJiir. Review.

Iodide of Potassium as an Antigalactic. By Professor Kousset.

The troublesome milk-knots which tend to appear especially
at the commencement of lactation, giving rise to fever, inflamma-
tion of the breast, and abscesses, indicate a diminution of the
secretion of milk by therapeutic means. As the usual measures
(emollient cataplasms, dieting, and laxatives) had frequently
proved insufficient, the author tried the iodide of potassium.
The results were as follows : The iodide of potassium occasions
a considerable decrease of the milk, and in consequence prevents
and removes milk-knots, particularly if at the same time the
child is not put to the breast. The milk returns quickly, if the
medicine is not used any longer than two to three days; its
effect is more decided if the dose does not exceed forty to fifty
centigrammes daily. The secretion of milk can be prevented
almost completely if the iodide of potassium is given on the first
or second day after delivery. The author gives a full report of
seven cases to confirm the above statements. [Jour, de Bour-
deaux, and North Am. Med. Chir. Rev.

856 Edlioriah [December,

EDITORIAL AND MISCELLANEOUS.

End of, the Fifteenth Volume. The present number closes the
Ffteenth Volume of the new series of the Southern Medical and Surgical
Journal. Established originally in the year 1836, this work lias continu-
ed, with but a brief interrupton, to exercise an elevating and improving
influence on the Medical Profession of the South, and during the last
fifteen years, one unbroken series of fifteen volumes, freighted with the
best treasures that both Contributors and Editors could supply, have
ranged themselves on the bookshelves of its subscribers. In age, there-
fore, we hold an honorable position, and among the medical periodicals
of the South, we think we can claim the distinction of being the first
enterprise of the kind.

While we are disposed to congratulate ourselves on the advanced age
we have attained, we still feel and profess the vigor of an annually re-
newed, youth. With the aid of those able collaborators who have here-
tofore assisted in sustaining the influence and increasing the usefulness
of the Southern Medical and Surgical Journal, the present Editors hope
still to labor in the arduous work, during the approaching year. We
have therefore no "parting words" for those who have been our read-
ers during the past season, but in the beginning of another volume, hope
again to present our salutations and our renewed vows of continued
faithfulness for the coming year.

Sixteenth Volume of the Southern Medical and Surgical Jour-
nal. In consequence of the absence of the parties from the city,
arrangements for the publication of the 16th Volume were completed
too late for the putting forth of a regular Prospectus, of that volume.
This will probably accompany the January Number.

Business Letters relating to the next volume of the Journal, will be
addressed to Dr. William S. Jones, Pablwher, Augusta, Ga. Contribu-
tions will be directed as heretofore, to the present Editors.

To Our Readers. For reasons personal to himself, our present
Publisher declines the publication of the Journal for the coming year.
Arrangements have been made which will secure the continuance of the
work, with little or no interruption. The delay in the present number,
is caused by the time which the Editors have unavoidably occupied in
arranging the unusually lengthy Index, necessary for the great variety
presented by this Fifteenth Volume.

In closing the relations of Editor and Publisher, with our esteemed
friend, Mr. Morris, we must, in justice to our own feelings, express our
satisfaction at the indefatigable care and skill with which he has exe-

1859.] Editorial 857

cuted the arduous labor assigned him, in the publication of the Journal
and at the uniformly kindly relations ever existing between us.

To those of our Subscribers, who are yet in arrears for the last and
previous volumes of the Journal, we now present the earnest request,
that they transmit the several amounts at their earliest convenience,
directly to Mr. J. Morris, Augusta, Ga. An early compliance with this
request, will prevent much confusion and trouble to the future Publisher,
and will, at the same time, be doing no more than simple justice to
one, who has labored diligently, faithfully, and ably in a work, which,
it must be recollected, if it does not pay him money, can never now,
pay him anything.

Lectures on Surgical Pathology, delivered at the Royal College of Svr-
gcons of England. By James Paget, F. R. S., <fec. 2nd American
edition. Philadelphia: Lindsay <fc Blakiston. 1859. 8vo., pp. 700.

The demand for a second edition of a work of this character speaks well
for the intelligence of the American Medical Profession, for it is not such.
a book as the active practitioner may pick up and hurry through in
quest of some new prescriptions, or short road to success ; but it is one
of deep philosophy, which will repay only those who subject it to careful
study, in order more fully to appreciate the changes in the intimate
textures of the body under the influence of various morbid actions.
Without sound pathology there can be no correct practice, and it is
gratifying to see that the profession is awake to the importance of keep-
ing pace with the advances in this department of knowledge. The
Lectures of Prof. Paget comprehend the subjects of Nutrition, Hypertro-
phy, Atrophy, Repair, Inflammation, Specific Diseases, Tumors, Cancers,
<fcc, and are delivered in a happy style, eminently calculated to
impart interest and to facilitate comprehension. The illustrations, with
which the book abound, are well done and add very much to its value.

D.

A Treatise on Gonorrhoea and Syphilis. By Silas Durkee, M. D., &c,
<fec with 8 colored Plates. Boston: J. P. Jewett&Co. 1859. 8vo^
pp. 435.

The importance of the diseases here treated of will secure for any new
work upon them a careful perusal ; and the fact that this is an entirely
American production gives it additional interest in our eyes. Dr.
Durkee has faithfully executed his task in summing up the doctrines and
practice of the best authorities, and has added to them the advantages
of his own extensive experience. D.

858 Miscellaneous. [December,

Messrs. Editors :

Allow me, through your journal, to correct an error I have just ob-
served in the "System of Surgery" recently published by Professor
Gross. At page 158 of the second volume, and under the head of
Fractures of the Clavicle, it is said that " Dr. Dugas, of Georgia, is in
the habit of treating fractures of this bone with a pad and with a trian-
gular piece of thick unbleached muslin," &c. /am, on the contrary, in
the habit of treating these fractures without a pad. This is evidently a
mere typographical error ; but inasmuch as I abandoned the use of the
axillary pad, as unphilosophical and injurious, upwards of twenty years
ago, and have had no cause to regret it, I desire not to be misunderstood
by the readers of the valuable work in question.

Yours, very Respectfully,

Augusta, Ga., 25th Nov., 1859. L. A. DUGAS.

Letters for Advice. We present the following to our readers with
the single comment that, we see no good reason why an opulent patient
should not pay a consultation fee for a service which is often more
onerous and involves far greater responsibility than any personal con-
ference in regard to his case. The attending physician should plainly
state to his patient, that he desires the opinion of a distant adviser for
his benefit, and that the established charge for such a letter is equal to
a consultation fee. Were this done, we think that few patients would
refuse to pay, most cheerfully, the reasonable and just charge. [Edts.
Southern Med. and Surg. Journal.

It has been our lot, during the last twenty years, to receive an amount
of letters of this kind enough to fill the mouth of the crater of Vesu-
vius, and all the money we have obtained for our answers would not, all
told, we are sure, enable us to buy a first-rate horse and buggy. If the
time thus spent could be correctly estimated it could not possibly be
found to be less than six or eight months, involving a vast amount of
toil and inconvenience, to say nothing of expense, which, in the aggre-
gate, must have been very great. We recollect paving for one letter,
when the postage was twenty-five cents, half a dollar. It covered nearly
ten pages of foolscap, giving the most minute and circumstantial details
of a case that was not of the slightest interest to us in anyway. Of
course, that letter was sent to Gehenna long before one-half of it was
read. To have done otherwise would have been impossible. If only
our friends knew how these letters annoy and worry us, they would not,
we are sure, so constantly inflict them upon us. What are their patients
to us, that we should be compelled to read the tedious accounts of their
cases, and, worse than all, answer their selfish lucubrations? Do they
suppose that we have no other business? Verily, verily, gentlemen, we
say unto you that such messengers are tolerable only when they inclose
a proper fee. In England, and indeed throughout all decent Christen-
dom, that fee is never less than five dollars, from which it ranges, in

1859.] Miscellaneous. 859

many cases, as high as twenty-five. The sight of a bank-note is always
agreeable to one who is compelled to earn his living by the sweat of his
brow; but especially is it cheering to him whose eyes and hands are
weary and aching with the labor of writing books and furnishing mate-
rials for the pages of a medical journal. Besides, how can a man possi-
bly discern the strong points in such a letter if he is not properly
remunerated for his services ? The expectation of a fee always wonder-
fully quickens a physician's sympathy and clearness of perception. We
never answer these charity-letters without a feeling of distrust that our
advice may be anything but salutary. If we had a benevolence as dif-
fusive as that of a Howard, we should rebel at labor and annoyance so
ungenerously and so inconsiderately imposed upon us by the profession.
A physician has no more right to ask such services gratuitously for his
patients than he has to send for his professional brother in a case of or-
dinary consultation without the prospect of reward, when the patient is
amply able to pay. A reasonable fee should always accompany the let-
ter. The only exception to this rule is where a practitioner solicits
advice for himself or some member of his family, or for a very destitute
person. \N. A. Medico-Chir. Review.

Narcotic Injections in Neuralgia. Charles Hunter, Esq., House Sur-
geon to St. George's Hospital, at the close of a paper on this subject, in
the Medical Times and Gazette, oriel's the following conclusions:

"In consideriug the results of the trial of the local treatment in the
two cases, the advantages obtained appear to me to be

" 1. That much less constitutional (nervous) irritation attends the local
introduction of the narcotic than when it is given by the stomach.

4* 2. That the effect of the narcotic is more immediately produced.

"3. The action of the narcotic appears more sure when injected. The
exact amount taken into the circulation can be more readily seen, and
the risk of contamination or alteration which it is exposed to, given by
the stomach, is avoided.

"4. It appears to exert more benefit on the local affection when it
has to be absorbed from the part affected itself, probably from being
brought more directly into contact with the nerves involved in the disease.

44 On the other hand, there are the disadvantages": these are, chiefly

" 1. The pain occasioned by the introduction of the fine canula.

" 2. The chance of the fluid escaping from the wound or puncture.

u 3. The production of local inflammation, effusion of blood, abscess."

[Dental Cosmos.

Test for Sugar in Urine. V Union Medicale has given its readers
long scientific details respecting the best method which the practition-
er can use for the purpose of ascertaining the presence of sugar in the
urine in diabetic patients ; and this conclusion is satisfactory, as it
shows that the method in ordinary use is the best of all methods : " Ii
is evident," the report says, in conclusion, " that for the ordinary use of
practitioners, the test by the aid of caustic potash, or by lime, is. suffi-
cient. A glass tube, a spirit-lamp, caustic potash, or a bottle containing
milk of lime, (lait de chaux,) are all the articles necessary for the pur-
pose." [American Med. Monthly.

860 Miscellaneous. [December,

Syrup of Proto- Carbonate of Iron.- In place of all the complicated
recipes furnished for syrups of unchangeable protoxide, et id genus omne,
we give the following as a simple and excellent preparation:

R. Sodae bicarbonatis (crystalized, if to be had) - - 1 drachm.

Ferri proto-sulphatis (crystalized,) l drachms.

Powder coarsely and shake up, without applica-
tion of heat, with

Syrup simplicis, -"" ---6 ounces.

One ounce of the syrup contains six grains of the proto-carbonate of
iron. Journal Materia Medica.

The Endermic Application of Medicines, will soon, in all probability,
supersede their internal administration, at least in a great measure.

Mix 3j. of laudanum, with 3ij. of olive oil, and rub into the epigas-
trium ; in half an hour your patient may be asleep.

Belladonna applied to the forehead for neuralgia has been known to
produce delirium and dilatation of the pupils. The same result followed
its application to the pit of the stomach.

Opium applied to the epigastrium will also produce a narcotic effect.
Thirty drops of laudanum, rubbed into the epigastrium, has produced
quiet sleep, when the liquor morphia?, administered internally, failed to
produce the slightest effect.

For intestinal spasms, apply over the abdomen, hot cloths, sprinkled
with tincture of opium, or tr. hyoseyami.

After in friction of half a teaspoonful of tr. opii into the epigastrium,
the pulse rises, the ideas increase in activity, incoherence and confusion
ensue, a sense of fullness in the head, perspiration, and sleep in twenty
or twenty-five minutes after the application.

With choleric ether, sulphuric ether, and chloroform, very similar
effects follow.

The epigastrium more rapidly absorbs than any other part of the
body. [Mr. J. B. Thompson, in Edinburgh Med. Journal.

Antidote to Strychnine. Dr. Bewley, wishing to kill a mangy cur,
and having read in Magendie's "Report on Strychnia," that the sixteenth
of a grain will kill the largest dog, determined to make sure of this very
little animal by giving it about half a grain. But either Magendie's
statement was incorrect, or the drug was adulterated, for at the end of
ten minutes the dog, though suffering frightfully, was not dead. Dr.
Bewly resolved to put him out of his misery at once, and accordingly
mixed half a drachm of prussic acid with a little milk, and put it under
the dog's snout, he lapped the milk with avidity, and in less than a min-
ute vomited, got upon his legs, ran away, and recovered. [Literary Gaz.

Ascarides. A writer in the Medical Times and Gazette asserts, that
the introduction of mercurial ointment into the rectum, has never failed
to destroy these animals, in all the cases in which he has tried it. The
ointment should be introduced into the rectum on the finger, as high up
as possible. All itching and other unpleasant symptoms, are said at
once to cease, but it is advisable to repeat the application three or four
times. [St. Louis Med. Journal.

INDEX TO VOLUME XV.

PAGE.

Abortion, attempted death from air

ID veins 756

Abdominal Typhus, 41

Abuse of Mercury in Ophthalmic

Diseases, 196

Action of Mercury on Secretion of

Bile,.. 767

Action of Vegetable Diuretics 256

Action of Quinine, 569

Acupuncturation, 327

A case of Epilepsy cured, 784

Administration of Medicine to chil-
dren, 844

Advice, Letters for 857

African Intermittent Fevers, W. H.

Clark, M. D, 172

After treatment of Extracted Cata-
ract 779

Albuminous Anasarca, Tannin in . . 628

Allanthus Glandulosa 716

American Medical Association, 216, 426
429, 488
Amputation, plan for supporting

Stumps, 713

Amussat's Operation for Artificial

Anus, 272

American Medicine in Great Bri-
tain, 645

American Medical Association

Transactions, Vol. XI 279, 281

Aui, Prolapsus in Children 632

Annual Report of the Dean of Medi-
cal College of Georgia, 210

Antiquity of Metallic Sutures, 548

Autigalactic Iodide of Potassium. . 855

A uew Hysterotome, 640

Aneurism of Ischiatic Artery, L A.

Dugas, M. D 651

An Essay on adaptation of Climate
to the Consumptive. W. H.
Doughty, M. D, 279, 363, 435, 507
723, 795
An Essay on Nature and Treat-
ment of Cholera Infantum. 11.

W. D. Ford, M. D 525

Anodyne Liniment in Otitis 722

Anthelmintics, 677

Anthrax 789

Anus, Itching of 720

Apocyanum Cannabinum for Inter-
mittents. Peterfield Trent, M.D. 6

Appointment of Dr. McCaw 74

Appointments of Facultv in Paris. 290
" " L. Hirschfeld, ... 434

PAGE.

Artificial pupil and inclination, 215, 689
" Production of Bone, . ... 419
Are Babies to be taught to walk I .

Arnica Montana 692

Arsenic in Chronic Bronchitis,. . . . 847

Ascarides, treatment of 433, 860

Asthma,. . .209, 214, 2S9, 433, 617, 638
Lectures on. ISO, 251, 324, 395

Atropine in Epilepsy 62, 717, 764

" Tetanus 721

Attempted abortion, death from air
in vessels, 756

Baker, P. D'L. M. D.,Veratrum Vi-

ride in convulsive diseases 579

Belladonna, administration of. ... . 835

Binding of 14th Volume, 68

Bicarbonate of Ammonia in Scarla-
tina, <fcc 72

Bismuth, with Copaiba and Cubebs, 720

Bisulphuret of Carbon, 71

Black Coloration round Eyelids of

Women 136

Bottles to prevent accidental Poi-
soning 505

Brodie, Sir Benjamin 290, 484

Broth and Beef-tea, apparatus. . . . 138
Bradycote treatment of Yellow

Fever 266

Buffalo Medical and Surgical Jour. 572

Cathetevism, accidents of 707

Campbell. Robert M. D., Action of
Quinine 567

Campbell, H. F. M. D., new Instru-
ment for Vesico Vaginal Fistula. 576

Campbell, H. F. M. D., Dysmenor-
rhea 639

Campbell, II. F. M. 1)., American
Medicine in Great Britain 645

Campbell, H. F. M. D, Scraps of
Practice 214, 283, 358

Campbell, 11. F. M. D, Diarrhoea. . 358
" " " " Headache and
its Remedies 283

Campbell, H. F. M. D., Sick Head-
ache

Campbell, H. F. M.D., Diuretics.. 285
" " H Tartrate of
Iron and Potash in Ulcers 285

Campbell, IL F. M. D, Remedy for
Spasmodic Asthma 214

Campbell. H. F. M. D., Iodine and
Glycerine in Ozoena 214

862

INDEX.

PAGE.

Campbell, H. F. M. D.t Turpentine
Externally applied in Puerperal

Peritoneal Tenderness 215

Campbell, H. F. M. D., Lime-water

for Boils 215

Cancerous Tumor treated by Chlo-
ride of Zinc 350

Cancerous Uulcer close to Inner

Canthus of Eye 771

Cancerous Ulcer, Sulphate of Zinc

Paste in 771

Cancer Labial 563

Cancer, Remarks on 533

Case of Lithotomy, D. W. Ham-
mond, M. D 246

Case of Uterine Polypus, Z. P. Lan-

drum, M. D 316

Carbonic Acid, a safe Anaesthetic. . 198
Caustic Zinc and Sulphuric Acid. . 636
Caustic Glyceriae for Lupus. . . .73 64

Cataract 557

Cerebral Fever 745

Cervix Uteri in latter months of

Pregnancy 37

Citrate of Iron and Strychnia 576

Chloride of Zinc Paste 72

Chlorine as a Disinfectant 74

Chlorate of Soda injection in Croup 74
Chloroform in Delirium Tremens. . 139
Chlorosis, treatment of, by Sugar 551
Cholera, Hygrometric Theory of. . 552
Chorea, treated by Cauterization. . 854
Changes in blood-vessels of Spleen 141

Charity of Speech 146

Changes in blood corpuscles by Cod

Liver Oil 345

Changes of the Urine in Disease. . . 565

Chicago Medical Journal 573

Clinical Lecture on Cerebral Fever 745

" Tetanus 477

" Dropsy and Al-
buminous Urine 610

Cod Liver Oil various formula.. 330

Cold water in Intermittents 63

Colleges, Convention of 421

Constipation 434

" of Infants 70

Coe's Concentrated Organic Medi-
cines 218

Congenital Hernia 780

Convulsions, Puerperal 675, 547

Condylomata 722

Conjunctivitis, Iodide of Zinc in. . . 780
Compression of Aorta in Uterine

Hemorrhage 559

Conviction of an Abortionist 578

Counter-extension with Adhesive

Plaster 672

Combination of Iodine and Sulphur

with Oil 720

Consumption, antagonism to Ague. 705
" Diagnosis of 31

PAGE.

Croup, Chlorate of Soda in 74

" Membranous, Glycerine in. 64

Cui Bono 497

Croup, Treatment of 650

*

Deaf and Dumb Printing 575

Death of Prof. G. M. Newton 142

" " S. S. Browne 413

Defective Assimilation in Infants. . . 768

Delirium Tremens 721, 648

Delegates from Colleges 281

Diagnosis of Dropsy 190

Diarrhoea 413

" in Children 52 765

" Sulphate of Copper and

Opium in 684

Diphtheritis, its Treatment, <fec. . . 213
" Augina of Children . . 562

Diphtheria 35, 718 761

Diphtherine, after effects of 846

Different Methods of Lithotomy ... 711
Dislocation of Cervical Vertebrae . . 133

Diuretics 285

Dr. Thomas Watson 218

" L. P. Yandell 287

" S. D. Gross 716

Dropsy and Albuminous Urine. ... 610

" after Typhoid Fever 634

" Tannin in 676

Doughty, W. H. M. D., Adaptation
of Climate to the Consumptive. . 279
363, 435, 507, 723, 795
Dugas, L. A. M. D., Ligature of ls-

chiatic Artery 651

Dugas, L, A. M. D., Ligature of In-
ternal Illiac 651

Dugas, L. A. M. D., Fracture of Fe-
mur below the Neck 176

Dugas, L. A. M. D., Fracture of

ISeck of Scapula 741

Dugas, L. A. M. D., Correction of

Gross' Surgery . t 858

Durk-ee on Gonorrhoea 857

Dysmenorrhoea 639

Dyspepsia, new Treatment of 695

Dysentery, Ipecacuanha in 14

Ears, Discharge from young Chil-
dren 542

Early Diagnosis of Consumption . . 31

Effects of Cold on Human Body. . 273

" " Ligature of (Esophagus. 691

Electricity in Neuralgia 55

Elixir of Cinchona. 216

" Calisava Bark 216

End of Fifteenth Volume 856

English Medical Education. R. H.

Nisbet, M. D 10

Epidemic sore throat in Albany, N Y 35

Epilepsy. Castration in 261

" Succeeding Menstrual Sup-
pression 771

INDEX.

863

PACK.

Epilepsy, Atropine in 62, 717, 764

Epistaxis 433

Erysipelas and Scarlet Fever. .403, 783
Ergot and the Tampon in Placenta

Praevia. W. A. Mathews, M. D. 595

Ergot in Eye Diseases 54, 335, 785

Escharotic, Sulphate of Zinc and

Sulphuric Acid 636

Excitement from Fast Travelling. . 793

Erichsen's Surgery, Notice of 144

Errors in Typography 502

Ether, extensive use in Midwifery. 134

Extirpation of Parotid Gland 202

Extracting the Eye-ball, Dickson's

Method 200

Eye Diseases, Ergot in 54, 335

Eyelashes, Pityriasis of 637

Eye, Foreign Bodies in 576

Facial Neuralgia 556

Facile Mode of Cupping 432

Faeces 264

Fifteenth Volume of Southern Medi-
cal and Surgical Journal 65

Fistula in Perineo 402

Forthcoming Medical Work By J.

S. Wilson, M. D 570

Ford, H. W. D. M. D., Cholera In-
fantum 525

Fracture Apparatus, Welch 790

Fracture of Femur below the Neck.

L. A. Dugas, M. D 176

Fracture of Fore-arm. W. S. Light-
foot, M. D 100

Fraenum Lingua* 339

Fracture of ^eck of Scapula, L. A.

Dugas, M. D 741

Frog Tails, Notes on changes in . . . 829
Fungus Haematodes, Gallic Acid in . 197

Gallic Acid in Fungus Haematodes. 197

Gallows Confession 794

Gaaton, G. McF. M. D., Counter Ex-
tension 672

Glycerine, Caustic 64

" in Membranous Croup,. . 64
Glycogenic Bodies in Umbilical

Membrane of Birds 600, 606

Gonorrhoea and Leucorrhoea 722

" Injections in 687

" Yellow Jessamine in.. 71
Green, W. A. M. D., Vienna Paste
in Varicose Ulcers 322

Hemorrhage from Fraenum Linguae 339

Post Partum 146

Haemoptysis, Tincture of Iron in . . 40
" Diagnostical and Prog-

nostical value of 203

Harelip Operation Correction... 216
Hammond, D. W. M. D., case of Li-
thotomy 246

PAGE.

Hautle or Animal Bread of Mexi-
cans 269

Headache and its Remedies, H. F.

Campbell, M. D 61, 283

Heart, Palpitation of 61

Disease, Treatment of 627

Hemorrhage, Post Partum, Ipecac

in. 505 833

"Here a Little and There a Little." 375
Hernia, Wutzer's Operation. .206, 719
Hereditary Influences in Insanity. 719
Hooping Cough, Treatment . 61 , 484, 850
" Syrup of Coffee in 717

Homoeopath}- not* a Science 577

Hydrocele cured 549

Hydrochlorate of Ammoniain Neu-
ralgia 561

Hydrochlorate of ammonia in Hoop-
ing Cough 187

Hvdrophobia from bite of Polecat

R. De Jernett, M. D 3

Hypophosphate of Quinine 558

Hysteric Condition of Joints 340

Hysteria, the Link between Mental
and Bodily Disease 701

Impermeable Stricture 326

Impotency, Electricity in 851

Improvement in Harelip Operation.

Correction 216

Inhalation Carbonic Acid an Anaes-
thetic 200

Inhalation of Cinchonia and its Salts 286

Inflammation, Theory of 112

" Fallopian Tubes, cause

of Peritonitis 267

Inflnence of Hunger on Poisoning. 649

Ingenious Device 716

Incision in Anthrax 789

Inductive Electricity in Lead Colic 792

Insanity among Negroes 718

Intermittent Fever 61, 254

Iodine and Glvcerine in Scrofulous

Ozena. H. F. Campbell, M. D. . 214
Iodine, new Mode of Giving. .332, 550
Iodide of Zinc in Chronic Conjunc-
tivitis 780

Iodide of Sodium 473

" " Iron, value of 59

Ipecacuanha in Delirium Tremens. 721
" Postpartum Hem-
orrhage 505

Iron, Syrup of Proto-Carbonate . . . 860
Irritable Bladder, Belladonna in.. 709
Itching of Anus 720

Journal de la Physiologie de l'Hom-
me et des Animaux 67

Jones, Joseph, A. M. M. D., Mala-
rial Fever 75, 147, 219

Jones, W. B. M. D., Retroversion
of Uterus 248

86

INDEX.

King fetching a Doctor 578

Labor, duration Of 688

turning in 703

Labial Cancer 568

Lachrimal Sac, diseases 3-16

La Charite 720

Landrum, Z. P., M.D. Polypus Uteri 316

Laryngeal Operation in Paris 361

Laryngismus Stridulus 782

Laryngoscopy 696

Lead Colic, electricity in 792

Lectures on Asthma.. 180, 251, 324, 395

Leniceps in place of Forceps 721

Lepra Inveterata 722

Leucorrhcea and Gonorrhoea 722

L'llotel Dieu of Paris 362

Life Insurance Companies 420

Ligature of the Extremities in In-
termittent Fever 254

" of Ischiatic Artery. L. A.

Dugas, M. D 651

" of lllirc Artery. L. A. Du-

gas, M. D 651

" CEsophagus 691

Light, the cause of Infantile Puru-
lent Ophthalmia 650

Lightfoot, W. S., M.D. Fracture of

Forearm 100

Lime-water for Boils. II. F. Camp-
bell, M.D 215

List of Graduates Med. Col. of Ga. 210

Louisville Medical Gazette 574

Lupus Exedens, Cod-liver oil in. 72, 73

" Caustic Glycerine for 64

" Sulph. of Zinc and Sulphuric

Acid 636

Maine Med. and Surg. Reporter. . . 573
Mathews, W. A., M. D. Placenta

Prsevia 595

Mal-assimilation in Children 721

Malarial Fever. Jos. Jones, A. M.,

M.D 75, 147, 219

Matters discharged by vomiting. .. 268

Marking papers not illegal 57 8

Means of eliminating grains of pow-
der from the skin 625

Measles, Hemorrhagic form 648

" and Scarlatina, affinity... 696
Measles and Scarlatina, Sequelae of 853
Medical College of Georgia. . .210, 714

" California 434

" Statistics for 1858-59 501
Medical Formulary, adopted in Ly-
ons 61

Medical Association of the State of

Georgia 211, 277, 352

Medical Association, American. . . . 421

Medical and Literary Weekly 574

Medicine in America 646

Mentnl Influence on Conception. . . 784

r-AGE*

Mentngra, remedy for 717

MezeroQ, Alcoholic extract of 717

Miasmata 781

Milk, Suppression of. 855

Mode of growth of muscular fibre. . 218

Montreal Medical Chronicle 573

Moreland on Urinary Organs no-
tice 212

Muriate of Ammonia in Neuralgia, 141

Muscular Fibre, mode of growth. . . 218

Nfflvus of Cheek, Tannic acid in. . . 201
Narcotic Injection in Neuralgia. . . 128

Nashville Monthly Record. 573

Nature and Art in disease 68

Necrology '. 791

New Vienna Caustic 73

New work on Gonorrhoea and Sy-
philis 575

New Instrument in Vesico- Vaccinal

Fistula. H. F. Campbell, MfD. . 576
New Poison from the interior of

China 681

New-born Children, Ophthalmia in 343
New York Academy of Medicine. . 426

Nervous Diseases of Syphilis 631

Nervous System, physiology and

pathology of ." 698

Neuralgia, Facial easy cure 556

" Muriate of Ammonia in. 141

" Narcotic injections in.55, 128, 859

" Nil Desperandum" 574

Nisbet, R. H, M.D. English Medi-
cal Education 10

Nitrate of Silver, abortive in Par-
onychia 73

Nitric Acid in Hooping Cough. . . . 484

Nothing Impossible 606

No American Surgeons at seat of

war 577

Nocturnal Incontinence of Urine.. 793
Notes on Changes in Frog's tails. . 829

Observations on Malarial Fever.

Joseph Jones, A.M., M.D. 75, 147, 219
Ophthalmia of New-born children,

treatment 343

Ophthalmia, Chloride of Zinc in. . . 343

Operation for cure of Hernia 206

Otonmcea of young children .... 54*2
Ozcena, Iodine and Glycerine in.

H. F. Campbell, M.D 214

Ozone, nature's great disinfectant. 217
Ozonometer 289

Paget's Surgical Pathology, notice

of 856

Pathology of Rheumatism 131

Pancreas, function of 408

Parotid Gland, extirpation of 202

Paronichia, Nitrate of Silver in. . . 73
Payments 145

INDEX.

865

TACK.

78, 7J

419

770

ifiron

ipbell,

38*

:,7i
360
687

Pepsi no, Elixir of 72,

Periosteum, transplantation of.. .

Perineal Section in Stricture

Pungndenic Ulcers, tartrate of

and potash in. II. F. Cam

M.D

Pharmaceutical Education for Btu

dents. Robert Battey, M.D

Philadelphia Med. and Surg. Re-
porter r>~-J,

Phosphorus for Phthisis.

Pityriasis of Eye-lashes.

Pig, fed on dejections. 3:57

Pine Sap in Phthisis. 71

Placenta Praevia, C. v. Howard,

M.D, 600

Placenta Previa 595

Plants, origin of 715

Poisoning by mercurial vapor. . . . 722
" Stramonium 831

*' hunger in 619

Poison, South American Arrow . . . 679 j
Polypus Uteri. Z. P. Laadrum,

M.D 316

Polypus Uteri 331

Popliteal Aneurism 54 1

Port-wine Enemata in Postpartum

Hemorrhage 140

Preservation of Dead Bodies 4 32

Pregnant women, Syphilis in. . .
Premature Labor, Induction of.
Prizes Academy of Medicine.. .

" Medical Students 714

Proto-iodide of Iron 720

Prof. E. R. Peaslee 664

Prolapsus Ani of children 632

ostate Gland, diseases of 21

Pierperal Couvulsions 547, 075

Tierperal Disease, turpentine and

opium in i 700

Purpura Hemorrhagica, treatment, 685

Quinine, action on. Blood-vessels.

R.Campbell, M.D 569

Quinic ./Ether 772

336
854
290

Radical cure for Femoral H*n
Raw meat for Diarrhoea in chrWen
Removals, changes and demises'

Retention of Urine

Retroversion of Uterus. W. B.

Jones, M.D

Rheumatism 61, 131,

Santonine in Verminous diseases.
W. Farell, M.D

Savannah Journal of Medicine. . . .

Scraps of Practice. H. F. Camp-
bell, M.D 214, 283,

Scarlatina 72, 140, 193,

' and Measles, affinity between

719

705
572

24 P

,,

471
572

358
403
626
696

PAGE.

Scarlatina, Scsquichloride of Iron in 140
Seeale Cornutum in Asthenopia. . . 54

" " for accommodation

power of the eye 785

Seton, metallic 274

Sex, in Diseases of Children 845

Sir Benjamin Brodie 290, 434

Sixteenth Volume of the Southern

Medical and Surgical Journal . . . 856

Skoda of Vienna 69

Sodium, Iodide of 473

Soluble Glass, use of

South American Arrow Poison. . . . 679

Southern Field and Fireside 503

Smith, Dr. F. G 506

Spina Bifida, Iodine injections in. . 851

Spontaneous Hydrophobia 27 1

Stereoscope, New Application of. . 433

Strychnia in Chronic Intermittent^. 785

" " Alcoholic Liquors... 503

Strychnine, Antidote for 860

Stricture of Urethra 770, 326

Stille, Prof. A 578

Subscribers 67

Sugar in Diseases of Infants 52

" " Chlorosis 551

Sulphate of Zinc and Sulphuric

Acid Caustic 636

Suppression of Urine 774

Sydenham Society 431, 794

Sympathetic Nerve 33

Syphilis, Nervous Affections of . . . . 631
Mercurial Treatment of. . 839

Treatment of 348

" in Pregnant Women 336

" Primary Ulcer of 45

Syphilid, Secondary, Contagious. . 853

Syphilitic Inoculation 712

" \ Iritis, Depletion in 337

Syrup ofCoffee in Hooping Cough . 717

Tannin in Dropsy 670, 576

Tartrate of Iron and Potash in
Phagedenic Ulcer II. F. Camp-
bell, M.D 285

Tendons, Reparation of 787

Tenia Salium 677

Test for Sugar in Urine 859

Tetanus, Atropine in 721

" Clinical Lecture on 477

The Semi-Monthly Medical News.. 357

" Nights versus the Days 425

" Pathologist and the Physician. 434
" Woman who lived without eat-
ing 577

he Workhouse 794

onics and their Administration. . 415

our Readers 856

cheotomy 504

Translation of Medical Works into

Chinese 650

Tubercular Meningitis 848

866

INDEX.

PAGE.

Turpentine and Opium in Puerpe-
ral Affections

Ulcers of Leg, Iodide of Potassium
iu 33:1.

Urine, Incontinence of 793

" Sediments of 621

" Healthy of Man 693

Uterine Hemorrhage, Compress
Aorta in 5')9

Uterus, Flexions of 560

Uva Ursi, an Obstetrical Agent. . . 72

Vaccination in fJ^rmany 72

Value of Scientific Services 793

Valerianate of Ammonia, its prepa-
ration 74

Varicocele, Clinical Lecture on... 554
Vcratrum Viride in Conrulsive Dis-
easesP. D'L. Baker, M. D 579

Veratrum Viride in Yellow Fever. 485

Vegetations, Cromic Acid in 773

Vesico-vaginal Fistula R. Battey,
M. D 822

PAGE.

Veterinary Surgery 362

Virch-w's Cellular Pathology.... 629
Vienna Paste for Varicose Ulcers
and Varieose Veins W. A

Green, M. D 322

Vital Point 56

s Venereal Chromic Acid in 773
Whitney Case. H. F. Campbell,

426

Will, <tran?e provisions of a 722

Wilson. .1. S. ,r. D. Woman's Hand

Book of Ilea^h 570

Wilson, J. S. M. T> Treatment of

Ulceration ofOs I'tori 691

I, G. B. M I). Relation of 546
Wutzer's Operation for Hernin. . , . 504

Yellow Jessamine in Gonorrhoea. . Tl]
J Yellow Fever, Bradycote treat-
ment of 266

Zinc Caustic Paste 73

" Chloride of, in Ophthalmia. 343

Date Due

11 IK, ...l>Q

JJJN i

u isw

mov n ro

'MAY 4 ]c

Library Bureau Cat. No. 1137

&7