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, 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 - 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, . 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 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 . 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 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 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 59he 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 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, ~-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, 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