SOUTHERN

KDITED BY

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

rCOrEPSOE OF SPECIAL AND COMPARATIVE ANATOMT IN' THE MF.DICAL COLLEGE 07 GEORGIA

AND

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

DEMOXSTRATOR OF ANATOMT IN THE MEDICAL COLLEGE OF GEORGIA.

Medical College of Georgia.

Je prends le bien ou je le frame"

VOLUME XVI. NEW SERIES.
AUGUSTA, GEORGIA:

DR. WILLIAM S. JONES, PUBLISHER.
Chronicle & Sentinel Steam Pre*3.

1860.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(new series.)

Vol. XL AUGUSTA, CEQECIA, J1SVASY, 186ft. NO. 1

ORIGINAL AND ECLECTIC.

ARTICLE I.

Stomatitis Materna What is its Pathology? Treatment
with Turpentine. By D. S. Beandok, M. D., of Thomas-

ville, Geo.

The frequency of this Disease as it is met with in certain
localities at times, and the uncertainty of its pathology together
with the obstinacy with which it sometimes resists treat-
ment, should have given it more importance than has been
claimed for it by Medical writers. Most of the old writers
have given it no attention. Perhaps about a dozen, have
noticed the subject under different heads.

In 1853, Dr. J. C. Hubbard, I believe, was the first to
direct the Profession to the Pathology of Stomatitis Materna
derived from the dead subject. They consist, he says, in
" ulceration of the mucous follicesof the intestines which, he
asserts, exists in all marked cases." He witnessed as many as
five of these ulcers in the case referred to without any other
marked appearance to account for the fatal result.

Shortly after this, in 1854, I believe, Dr. David Hutchinson,
after giving an extensive history of the symptoms, progress,
and termination of a case of Stomatitis Materna of four years
standing, gives the post mortem appearances, seventeen hours
after death, as follows :

2 Brandon. On Stomatitis Matema. [January,

" The Peritoneum exhibited evidences of inflammation ; gen-
eral appearance, pink color; blood vessels injected, adhesions
of pancreas throughout the whole extent to duodenum. Struc-
ture of Kidneys softened, congested, and pus in Pelvis of;
greatest quantity in right one. Want of integrity of colon ;
mucous membrane wanting in many places the ulcerative
process being so complete. Cecum as well as the colon, small
intestines and stomach for the most part normal. Spleen com-
pletely softened but for its serous coat would barely hold,
together ; small collections of pus throughout its interior. Liver
enlarged, softened in the inferior portion of the right lobe,
which was also congested, and showed signs of recent inflam-
mation. A melanotic tumor three fourths of an inch in diam-
eter was found on its convex surface. Gall-bladder filled with
black greenish material about a gill in quantity. Weight of
Liver, four pounds and two ounce-."

In the transactions of the Indiana State Medical Society for
1856, Dr. Hutchison says that " Dr. McLean relate- the post
mortem of a case in which the mouth and fauces were entirely
denuded of their mucous coat, with numerous patches of ulcer-
ation extending throughout the (esophagus. The stomach was
also almost completely denuded of its mucous coat, with nu-
merous patches of ulceration extending deep into its muscular
tissue. A small patch around the pylonic orifice of the
stomach was the only healthy portion. The duodenum was
healthy. There were a few inflammafo >ry patches in the colon.
The Bladder had traces of inflammation about the neck ; and
a few patches of ulceration existed in the Vagina.*"

So far as the writer knows, the three cases above noticed
contain all that post mortem examinations have shown, that
go to throw light upon the pathology of the disease in ques1-
tion.

From examination of the wreck alone, can we come to am
thing like correct conclusions of what has been the character
of the storm ; and so it is in Pathology. Dr. Hutchinson, as
I think, has done this work most admirably so well that the
Fisk Fund Society of "Rhode Island awarded him a premium

I860.] Treatment with Turpentine. 3

of one hundred dollars as an evidence of their appreciation of

his justly meritorious paper.

Prof. M. M. Pallen in the St. Louis Medical & Surgical Jour-
nal for March, when speaking of the disease in question, uses
the following language : " In all these cases, I have seen in-
flammation of the Cervix Uteri and of the superior portion of
the Vagina." lie further adds, " from the uniformity with
which I have met with disease of the Uterus in Stomatitis
Materna, L have concluded that it plays an important part in
like production of the disease ; and supposes that the affection
exists prior to the sore mouth ; and that pregnancy or lacta-
tion, as the case may be, increases it to such an extent that the
gastric derangement results ; and this is followed by the trou-
ble in the mouth.'' Dr. Pallen draws his conclusions, as it
seems, from the condition of his patients at the time he saw
them without the advantage of a post mortem examination,
and explains the phenomenon as one of sympathy, for he adds
" Diseases of the Womb very often produce severe gastric
derangement, often too. stomatitis is produced by gastric
derangement, both in children and adults." All that Dr. Pallen
has said of the symptoms in the cases he refers to, may be
true, but that these lesions are primary, or have much or any-
thing to do in the " production'* of the disease, is, I suspect,
very doubtful. It is true that these lesions often exist though
not in a majority of cases certainly not in the cases that have
fallen under my notice. Dr. Hutchinson is of opinion that the
starting point in this disease, is inflammation, " sui generis"
set up by pregnancy and kept tip by lactation, and this posi-
tion is ably maintained in his essay to which the reader is
referred. See Am. Jour. Med. Sciences, Oct. No. 1857.

In the Diagnosis of Stomatitis Materna there is nothing diffi-
cult as a general rule, especially if the Physician will take
the trouble to go back to the first, or starting point in the case.
Protracted and aggravated cases may be taken for typhoid
fever ; though this is rare. The first symptom is burning in the
mouth of a scalding nature, aggravated generally by hot drinks.
The tongue and mouth will be found red and inflamed, which

4 Bhaxdox. SLomatiMs Mdtema. [January,

is soon followed by apthae and ulceration of the buccal cavity.
In some cases there are no ulcers, but simply a diffuse redness
of the mucous surface of the tongue and mouth. To these
may be added, burning in the stomach with occasional vomit-
ings, constipation or diarrhoea, more or less obstinate, attends.
Inflammation of the vaginal mucous membrane, together with
painful micturation is somewhat common. The transient or
migratory character of the symptoms, Dr. Hutchinson thinks,
are quite characteristic.

There is a difference of opinion in the profession as to
whether the male subject is ever affected with this or an
anologous disease.

Treatment. It is to Prof. Wood, of Philadelphia, that the
profession is indebted for much that is valuable in the applica-
tion of the oil of Turpentine to diseases of the alimentary
mucous membrane. In the treatment of enteric fever at this
day. we have a remedy in the oil of Turpentine that disarms
disease of its terrors ; and in the same agent we have a remedy
equally applicable to that more distressing though not so fatal
disease, Stomatitis Materna, and it is to call the attention of
the profession to its use in this disease, that I have prepared
this brief essay. From being greatly amazed and many times
disappointed with the treatment of the authorities on the sub-
ject, I was led by the analogy of the cases, in which the oil of
Turpentine had a merited reputation, to try it in Stomatitis
Jfate/'/ia. and the result was everything that I or the patient
could desire. I have used it and caused it to be used, in quite
a number of cases since the first of last year, when I began its
use, and in no instance that I know, or have heard of, has it
failed. If the bowels are constipated I premise a dose of Cas-
tor Oil then give the Turpentine say twelve drops three or
four times a day on a little loaf sugar, h' there be diarrhoea
present, I use equal parts of Laudanum with the Turpentine as
above. For the inflammation of the uterine organs, if there
beany, I use simply warm milk-and-water injections; as
general rule I think these symptoms are sympathetic and will
subside if the alimentary canal is restored to health. If ulcers

I860.] Gaston. Strychnine.

exist, caustic will be necessary in some cases, perhaps. I do
nor kiu\v that the use of Turpentine will cure ulcers of the
uterus or its appendages when used as a constitutional remedy,
perhaps it may, I think it likely. The cure is usually
effected in from live to eight days ; very bad cases may require
more time. I would here earnestly call the attention of the
Profession to the value of so simple and efficient a remedial
agent as the oil of Turpentine has proved in my hands.

ARTICLE II.

Strychnine^ as aremedial Ag< nt By J. McF. Gaston, M. D.,
ok Columbia, S. C.

In a recent issue of the Southern Medical and Surgical
Journal it is said: " AYe are confident that the remedial
powers of Strychnia are not yet fully brought out," and as my
experience with this article has developed its influence in some
atfections to which it has not usually been applied, I purpose
to give a brief notice of its effects in my hands.

In the administration of Strychnine, it is a matter of much
consequence to keep the quantity below that which manifests
its toxical influence ; and inattention to this particular has
brought it into discredit with some experienced Physicians.
It is like many of the neurotics adopted to impart vigor and
force to the muscular organization in minute portions, but
calculated to disturb its harmonious performance when given in
doses not proportionate to the state of the system.

That Strychnine is injurious when given in portions not
suited to the susceptibility of the subject is a condition of its
potency ; and if we would test its efficiency it must be accurately
graduated to the energy of the nerve-center. In the doses
usually prescribed, it is very generally hurtful, and my early
experience was thus unfavorable to it as a remedial agent ; but
on a thorough consideration pf the quality of its action, I have
fixed limits to the quantity administered which harmonise its
effects on the various portions of the physical and vital struc-
ture of man. To secure this it must be kept short of the

6 Gaston. Strychnine, [January,

influence on the excito-motory system which is manifested by
irregular and involuntary contractions of the muscles. I am
well aware that a different view has been advocated in para-
lytic cases, but I am yet to see the first instance of any benefit
from such disturbing effects, and most assuredly I have seen
instances of harm from carrying the article to this extent. It
may be employed in some conditions in much larger quanti-
ties without producing this effect, than would be practicable
in a different state of the nerve and muscle organization ; and
its adaptation to the particular case requires care and discrim-
ination on the part of the Physician. The practice of begin
ning with a small dose and gradually increasing until muscu-
lar twitchings are perceived is not commendable ; as it even-
tuates in a disorder of the nervous system more detrimental
than the condition for which the article has been prescribed.
Such a tentative use of Strychnine is rarely if ever warrantable
in any condition of the system ; and within my experience, its
most salutary influence is procured by being introduced so as
to avoid all liability to such results. The rule by which we
may be guided, is, never to exceed one-half of the quantity
which in any case would be likely to be attended with these
specific effects. In illustration, a patient is supposed to be so
susceptible as to show this effect from the 1-16 grain, repeat-
ed three times a day ; then, in such case, never exceed the 1-32
grain three times a day, and there is an efficient influence of
the medicine without any possibility of the disturbing and
obnoxual effect which is to be guarded against.

Thus, by making the maximum only one-half of the recog-
nized dose, we may attain the best results in using this very
energetic article ; and my habit is to commence with the 1-50
grain, gradually increasing until double the quantity is given
at a dose, and repeated as often as the circumstances may
demand it. I have no apprehension from continuing the use of
Strychnine in these doses for any time it may be required, as
they cannot, by any process of influence, become taxical.

Prior to any application of the above views, let me submit
the mode in which Strychnine may be most conveniently

18(50.] Wilson. Veratrum Viride. 7

administered. It had been my custom for several years to
employ a solution of 1 grain to 1 f diluted Acetic Acid, giving
from 5 to 10 drops as the standard dose, but now Dr. Green in
his prescriptions of American practice, has given us the formula
for solution of Strychnia, as follows, viz : Strychniae gr. xn.
Acidi Acetic qt. ix. Alchohol f . Aq. font, f xi m. dose
from ten to thirty drops twice or thrice daily. This is kept
in our office ; and as it contains the same proportion as that
which I formerly used, it is employed in corresponding doses,
viz : from five to ten drops, and very rarely as much as fifteen
drops, three times a day.

As to the particular cases in which Strychnine has been
resorted to by me, no detailed account is requisite to illustrate
the quality of its influence, but I may state that in atonic con-
ditions of the organization, from various causes, and under
different circumstances, it has been attended with benefit in
the minute portions above mentioned.

The application of Strychnine in the adynamic class of
nervous disorders is a point to which special consideration has
been directed, and by imparting tenacity to tiie nervous
system it seems to be corroborant of the entire organization.

In that deplorable condition attended with involuntary
seminal emissions, I have tested it fully and satisfactorily during
a series of years, and it really has served my wishes so com-
pletely in these cases that Lnow use no other course of treat-
ment. With a view to secure the best effects from it, a
proper regimen should accompany its use, and such a course it
may almost be regarded as a specific in spermatorrhea.

ARTICLE III.

Veratrum Viride In Nervous Affections By John Stain-
back Wilson, M. D., of Columbus, Ga.

I have read with great interest the article in the September
number ef the Southern Medical and Surgical Journal, on " Ve-
ra* rum Viride" in Chorea and other convulsive diseases. Dr.

8 Wilson. Veratrvm Vmde. [January,

Baker's views as to the modus operandi of this remedy are
doubtless Correct; and it is strange that the truth so ably

enforced by him should have been overlooked 1 >y the mass of the
profession, and even by those who have most extensively used,
and warmly advocated the great sedative. It would seem
that a knowledge of the controlling power of Veratrum Viride
over the circulation, would, almost inevitably lead to its use in
convulsive affections originating in exaltation of nervous sen-
sibility ; yet, as already intimated, this practice appears to be
almost unknown to the profession. Still Dr. Baker's declara-
tion is not strictly correct, that, " all that has been published,
either in the United States Dispensatory or elsewhere, con-
cerning the remedial powers of this agent, was written in
reference to its value in the treatment of febrile and inflamma-
tory diseases." In an article published in this Journal in July
1853, under the head of "A brief Summary of my experience
with the Veratrum Viride" may be found among a number
of others, a case of epilepti form convulsions which was suc-
cessfully treated principally with Veratrum VI rich. The fol-
lowing is an extract from the above article : " The subject of
the convulsions was an anaemic boy of 10 or 12 years of age ;
the spasms were frequent and extremely severe, every paroxysm
apparently putting the life of the patient in imminent
danger: the Veratrum, to reduce the frequency of the pulse,
and Ether inhalations to quiet the spasms, were the remedies
almost exclusively relied upon ; and these indications were
fulfilled in the happiest possible manner, snatching the little
sufferer from the very jaws of death.'' This quotation, while
it may render some qualitication of Dr. Baker's remark neces-
sary, shows very plainly that the writer did not, at that time,
fully apprehend the controlling power of the Veratrum over
the nervous system ; and as this important truth has taken a
more definite form in his mind since that time, his object in
writing now is not so much to criticise and find fault, as to re-
turn thanks to Dr. Baker for the jiractietd demonstrations so
forcibly presented in his article. I believe that the discovery
of the sedative powers of Vercdrum Virid- in febrile and in-

I860.] Therapeutic Application of Electricity. 9

flammatory diseases is among the greatest, if not the g
boon of modern therapeutics ; and it' it should be found
sess equal power over nervous affections, its virtues cannot well
be over-estimated. My experience with it in the latter class
of disorders is quite limited, but in the former, not inconsider-
able, and I can truly repeat the declaration made in the above
quoted article published by me in 1S53, and based upon the
result of twenty-live cases of various disorders: UJ have
neve, seen it fall in r< during the frequency of the pulse, while
then was generally an improveriunt in its volume"

My experience fully corroborates Dr. Baker as to the size
of the dose. When there is no urgent necessity for a prompt
effect, I generally begin with only three or four drops for an
adult, every three hours, increasing one drop each dose, until
pulse is sufficiently reduced. By pursuing this plan I have
almost always succeeded in accomplishing the desired effect
and without a single unpleasant symptom ; without even the
slightest nausea : indeed, in many cases patients could not tell
from their feelings that they were taking anything more than
so much water ; and yet the pulse may thus be pleasantly and
gently reduced from 140 to 60, or even lower. When nausea
and vomiting do occur they are very distressing and peculiar
but I have never had any difficulty in giving relief by dimin-
ishing the dose, or by giving a little brandy or ether, or mor-
phine, or something of that kind. I trust that Dr. Baker will
continue to push his investigations in the line marked out by
him, and that others will follow his example until the control-
ling power of Veratrum Virideis as fully demonstated in ner-
vous as it is in vascular disorders.

ARTICLE IV.

ral View of the Therapeutic Application of Electricity,
being an Outline of Lectures delivered upon this subject
before the Class of 1859 and 1860, in the Medical College of
Georgia, at Augusta. By Joseph Jones, M. D., Professor
of Medical Chemistry and Pharmacy.

Published by Request of the Class.

Gentlemen : These lectures are designed, not merely to
furnish you with valuable knowledge and practical rules, but

^_____ -Jones. General View of the [January,

also to point out the sources of knowledge, the labors and
records of the best investigators of the Physiological and
Therapeutic effects of Electricity.

Your minds have been prepared for the consideration
of the Therapeutic Application of Electricty, by the care-
ful study of the various phenomena of Electricity, by the
study of its relations with all the other modes of force, and of
its relations to the nervous and muscular forces.

That we may, at the outset, form some idea of the impor.
tance and extent of this subject, we will glance, for a moment,
afcffce

History of the Therapeutic Application of Electricity.

Centuries before the developement of the science of Elec-
tricity, the ancients were acquainted with the effects of
the Torpedo, which, as we have before shown you, is a
living voltaic battery. Thus Pliny,* in his Natural History
published A. D. 77, says : "The Torpedo is very well aware
of the extent of its own powers, and that, too, although it ex-
periences no "benumbing effects from them itself.

Lying concealed in the mud, it awaits the approach of the
fish, and at the moment they are swimming above in supposed
security, communicates the shock, and instantly darts upon
them." Galen not only noticed the power of the Torpedo to
communicate its shock through a spear and paralyze the
hand of the fisherman, but also compared this phenomenon with
the action of the Heaclean stone, called the magnet, and
affirmed that he had applied the living Torpedo to the cure of
head-ache, and found that its application to the aching head
allayed pain in a manner similiar to the action of other things
which obtund sensation.

^Etius also affirmed, that the living Torpedo will cure
chronic head-ache, and cause the prolapsed anus to return ?
whilst the dead fish is incapable of producing these effects .
and Scribonius Largus, who wrote in the age of Claudian,
states that the most inveterate and intolerable head-ache may
be removed immediately and permanently, by placing a live

* The Natural History of Pliny, translated by John Bostock, M. D..and H. T.
Riley, published by H- G. Bohn." London, 1S55 : vol. 11., pp. 451 452.

I860.] Therapeutic Application of Electricity. 11

Torpedo on the painful part, till the part becomes benumbed ;
.and that in both species of the gout, if a live black Torpedo
be placed under the feet of the patient standing on the sea-
shore, when the whole foot and leg is benumbed up to the
knees, the pain will be immediately and permanently
removed.

The magnet was used for the cure of tooth-ache and other
disorders, at an early period. ^Etius, who lived so early as
the year 500, says : a We are assured that those who aro
troubled with the gout in their hands or their feet, or with
convulsions, h'nd relief when they hold a magnet in their
hands." Marcellus, who lived in the fifteenth century,
affirms that it cures tooth-ache : "Wecker, in the sixteenth
century, says that the magnet applied to the head cures head-
ache : Paracelsus recommended the magnet in a number of
diseases as fluxes and hemorrhages : Kircher states that it
was worn about the neck as a preventative against convulsions
and affections of the nerves : and at the end of the 17th cen-
tury magnetic tooth-picks and ear-pickers were made and
extolled as a secret preventative against pains in the teeth,
eyes, and ears.

The magnet was also employed at an early period on
account of its true magnetic properties : Kirkringius, Fabricius
llildanus, and Morgagni used it to remove particles of iron
which had, by accident, fallen into the eyes ; Kircher employed
it in the treatment of hernia ; and in the latter part of the 16th
and in the early part of the 17th century, the magnet was
employed in two cases in which knives had been swallowed,
to attract their points to the surface of the stomach, so that
they could be removed by incision. f

The Generalization of Electrical Phenomena, by Dr.
Gilbert, an English Physician, in 1600. The invention
of the Electrical Machine by Otto Guericke, the philo-
sophical Burgomaster of Magdeburg ; the discovery of the
Leyden phial, by Yon Kleist and the Dutch philosophers
in 17-15 ; and the experiments of Yon Kleist, Cunaeus,
Muschenbroek, Watson, Smeaton, Bevis, Wilson and Canton,

f Beckman's History of Inventions. London, H. G. Bonn, 1846 : vol. 1., p. 43.

12 .Tones. General.View of the [January,

were followed by the extensive employment of Static Elec-
tricity in the treatment of disease.

Jallabert, of Geneva, in 1748, studied carefully the physio-
logical action of electricity, and affirmed that this agent was
capable of accelerating the circulation of the blood, of aug-
menting the heat of the body, of awakening sensation, of
recalling movement to paralysed limbs, and of producing
involuntary, convulsive movements. He reports the cure of
paralysis and wasting of the right arm of a man, which was
greatly benefitted by machine Electricity.

The Abbe Sans, in 1772 and 1773, published a work on the
employment of Electricity in Paralysis, and reports eight
cases of paralysis cured, and several others ameliorated.

In 1778 and 1781, Mauduyt published observations upon
the effects of electricity in 6'2 cases of paralysis, Rheumatism?
Rheumatic Gout, Deafness, Amarosis, and Amenorrhea from
which he concluded that positive electricity accelerated the
pulse, whilst negative retarded it ; that electricity augments
the insensible transpiration, increases the perspiration, occa-
sions evacuations, removes chronic complaints, restores sensa-
tion and movement to paralyzed limbs, and establishes
critical evacuations which have been suppressed, and is favor,
able in paralysis, and in all cases where it is necessary to
fluidify the liquids and strengthen the solids, and is injuri-
ous when there is an excess of sensibility and nervous irritation.
In his treatment of disease, he generally employed the Electric
Bath, (the patient was placed on an insulated stool, and con.
nected with the Prime Conductor of the Electrical Machine,)
and in many cases drew sparks from various parts of the
body.

The Abbe Beetholon, 1780, Mazars de Cazelles, 1780, 1782,
1788, 1792, Sigaud de la Fonde 1781, 1802,Cavallo 1785, and
others, published observations and works upon the Physiolo-
gical and Therapeutic effects of Static Electricity.

The discovery by Galvani, in the year 1786, of the contract
tion of the frogs leg, when electrified, and when touched with
dissimiliar metals, and of the electricity inherent in the nerves
and muscles, and the publication, in 1791, of his celebrated

I860.] Therapeutic Application of Electricity. 13

works "De Viribus Electricitatis in motu musculari Com-
mentarius," excited a deep and wide spread interest amongst
the philosophers and physicians of Europe.

The physiologists beleived that they had at length obtained
an insight into the hidden nature of the nervous, muscular,
and vital forces ; and the Physicians began to believe that
they had found the great therapeutic agent for all diseases,
and that no cure, even of the most inveterate paralysis, was
impossible. Excited by the experiments of Galvani, the
Italian philosopher Volta, who united in an eminent degree,
boldness and fertility, of invention, with soundness of judg-
ment, careful execution, and untiring and unremitting atten-
tion, discovered near the close of 1799, the Voltaic pile, which
was destined to become for a time the great source of Elec-
tricity in the treatment of disease.

Alexander Humboldt, published in 1799 his experiments
upon- the effects of Galvanic currents upon the nerves and mus-
cles, which not only demonstrated the possibility of producing
contractions in the muscles of frogs by a perfectly homogeneous
metallic arch, and reconciled in a correct manner the experi-
ments of Galvani. and" Volta, but also suggested the idea of
applying the electricity generated by chemical actions to
therapeutics. Aldini, the nephew and pupil of Galvani, was
the first, however, to occupy himself with the application of
Dynamic Electricity, (electricity generated by chemical
charges, as in the Voltaic pile and Galvanic battery,) to the
treatment of diseases ; and in 1801, he published a Theoretical
and Experimental Essay on Galvanism, which contains a great
number of curious observations upon the effects of electricity
in numerous pathological cases.

Sarlandiere, Fabre Palprat, Labaume, Andral and Eatier,
Andrieux, Coudret, M. Guerard, Bayer, Magendie, Becquerel,
Trousseau, Pidoux, James, Puysaye, Regnault, Graefe, Koenig,
W. Wright, Charles T. Favell, Welch, Pravay, M. Marianinij
Matteucci, M. Bouisson, Tytler and others, published between
the years 1804 and 1838, numerous, observations and treatises
upon the application of Galvanism in the cure of almost every
known disease.

14 Jones. General View of the [January,

The investigations of Faraday, in 1831, upon the inductive
influence of Electric currents, led to the formation of electro-
magnetic machines, which gave a succession of induced cur-
rents, capable of acting powerfully upon living animals.

The discovery by Faraday, 1831, of magneto-electric car-
rents (a magnet by induction excites in an unelectrified closed
conductor, a current both on being brought near to, and on
being removed from the latter,) simultaneously with the disco-
very of the secondary currents induced by Voltaic currents,
was immediately followed by the construction of magneto-
electric machines, by this celebrated philosopher, andbyPixii
Clarke, Saxton, Dove, Breton, Duchenne and others.

These electro-magnetic, and magneto-electric machines,
have since the year 183S, in which they were improved and
adapted to medical use, been extensively employed in the
treatment of Disease, in almost every Hospital on the Euro-
pean and American Continents, and have almost entirely su-
perceded the use of the magnet, the Electrical Machine and
Leyden Jar, and the continuous Galvanic Current.

From 1810 to the present time, hundreds of cases treated
with these machines have been reported in this country and
in Europe ; and the attempt to give you even the most general
idea of the contents of these works and articles, , upon the
Therapeutic application of Electricity, would not only con-
sume far more time than can be devoted to a condensed his-
torical introduction, but would cause needless repetition by
anticipating the consideration of the results of the various
labours, which will be presented at the appropriate time under
the different divisions of the subject.

lilectrical Machines and Aj)j)aratvs Emjyloyed in the Thera-
peutic Amplication of Electricity.
During the study of the phenomena of Electricity, of its
agencies in nature, and of its applications in the arts of civil-
ized life, you have become familiar with the structure and
mode of action of all the various Electrical Machines and
apparatus and in the description of the electrical machines and
apparatus used in the treatment of disease, it will be simply
necessary to give you such a condensed view as shall be far

I860.] Therapeutic Application of Electricity. 15

more useful to you in future as practitioners of medicine, than i
a tedious description of minute details with which you are
familiar.

1. Static Electrical Machines, in ivhich the Electricity is
generated by Friction Ordinary Electrical Machine
Apparatus for the accumulation and condensation of Static
Electricity Leyden Jar and Electric Battery.

Electricity generated by friction is called Static, to distin-
guish it from electricity generated by chemical action, (Gal-
vanism,) which is called Dynamic Electricity.

Whilst the* ideas conveyed by these terms Static and Dy-
namic, are not accurate, and are in a great measure arbitrary,
still we use them for purposes of nomenclature. It would be
more exact to call electricity generated by friction, electricity
of intensity, for it possesses in a high degree the properties of
attraction and repulsion, and is capable of exercising great
mechanical power, as we have so often witnessed in the effects
of lightning, and of the discharge of the Leyden Jar, and even
of the sparks which fly from the excited prime conductor of
the Electrical Machine; and Galvanism, (electricity generated
during chemical charges.) electricity of quantity, for whilst
it has little tension, and can accomplish but feeble mechanical
effects (you have seen that the terminals of the Galvanic Bat-
tery must be placed in contact before the electrical excitement
will manifest itself,) on the other hand it is capable of develop-
ing intense heat, sufficient to melt the hardest metals, and also
of producing rapid and energetic chemical changes, such as
the decomposition of water and salts, and of all compound
bodies, inorganic and organic.

The Electrical Machine consists of three principal parts :

1. A Non- conductor, upon the surface of which electricity
is excited by friction ; this is generally a glass plate or cylin-
der^ so arranged that it may be continually rotated about a
fixed horizontal axis.

2. The Rubber, composed of a soft elastic substance as
leather, of low conducting power, and placed in close contact
with the surface of the non-conducting glass plate or cylinder.
During the revolution of the glass plate or cylinder, electricity

16 Jones. General View of the January,

is developed by the friction of its surface upon the surface of
the rubber. The surface of the non-conductor is always in an
opposite state of electrical excitement to that of the rubber ; if
the non-conducting glass be positively excited, the rubber will
be negatively excited, and vice versa, and the amount of posi.
live electricity will be equal to the amount of negative elec-
tricity.

3. The Prime Conductor ; one or more metallic cylinders,
supported by insulated pillars of glass, or of well baked, dry
wood, situated behind the glass plate or cylinder, parallel to
its axis prolonged, and at the same height as this #xis.

The end of this prime conductor nearest the non-conducting
glass surface upon which the electricity is excited by frictiou
is furnished with metal points which approach as closely as
possible to the plate, without, however, being in contact with
it ; these points serve to draw off from all parts of the glass
surface which are successively presented to them, the electri-
city acquired by the friction against the rubber, and to trans-
mit the electrical excitement to the insulated prime conductor.

Static Electricity, thus generated by friction maybe admin-
istered in three modes.

1. Spai'ks from the excited Prime Conductor of the Elec-
trical Machine.

The patient, upon whom we wish the electrical excitement
to act, is brought near to, but not touching the prime conduc-
tor; the sparks pass from the prime conductor through the
intervening air, to the nearest part of the patient, and the
electrical excitement passes immediately over the superficial
parts of the body, into the ground. We may thus act upon a
paralyzed arm or tumor or diseased structure of any kind, with
sparks, simply by approaching it to the prime conductor of
the Electrical Machine in action. Sparks produce sharp,
pungent, unpleasant sensations, and slight fibrillary contrac-
tions of the superficial muscles of the parts where they are
received. When prolonged, this mode of electrization aug-
ments the cutaneous sensibility, and excites the capillary cir-
culation of the skin, and produces slight rubefaciant swelling,
and some tenderness to the touch ; it mav therefore be

I860.] Treatment of Cardiac. Disea 17

employed, as a gentle excitant in torpid states of the skin,
when we wish to produce a gentle excitement of the capillary
circulation, and as a mild revulsive in sluggish chronic inflam-
mations, external and internal, of no great seventy.
, 2. Insulation Electric Bath. If the patient is placed
upon a stool insulated with glass legs, and then connected with
the prime conductor, he forms, in fact, a part of the prime
conductor, and will manifest during the revolution of the glass
plate or cylinder, similar electrical excitement, and give off
sparks in a similar manner. We may in this manner electrify
the patient positively or negatively at will, according as he is
connected with the prime conductor or with the rubber.

A portion of the electricity is spread over the surface of
the body, whilst another portion escapes incessantly and
silently into the surrounding air ; this slow escape of the
electricity is attended with slight sensations in the skin. The
effects of this mode of electrization, are those of a very gentle
cutaneous stimulant, not intense enough however to render it
valuable as a therapeutic means. A more efficient means of
acting upon the skin and superficial muscles, is to combine
this mode with the sparks in the following manner. If the
hand of a person, or a metallic body in communication with
the floor or ground be brought near to the insulated, electrically
excited patient, sparks will fly off to the hand or metallic
body, and excitement of the skin of the insulated electrically '
excited patient, will be produced at the points from which the
sparks have been drawn. We may thus draw sparks from a
single point, or from the whole surface of a paralyzed limb, or
from a diseased structure of any kind. The sparks may be
drawn by the hand of the operator, or by metallic conductors,
or by brushes formed of numerous metallic threads.

(To be continued.)

ARTICLE V-

The Pathology and Treatment of Cardiac Disease By Ber-
nard Kelly, M. D., Physician to the New York Dispen-
sary.

Disease more frequently attacks the left chambers of the

18 Kelly. The Patholocjy and [January,

heart than those. of the right, particularly among the young ;
as we advance in life, however, the reverse obtains, valvular
disease of the right side being more common, as a primary
affection, than that of the left. The most usual forms of en-
docardiac disease we meet with are: insufficiency of the
valves ; contraction of the orifices, with or without insufficiency.;
and, pediculated, adventitious, and atheromatous growths
and deposits, adhering to the valves, and obstructing more
or less completely the cardiac orifices, according to the dif-
ferent degrees of magnitude which they may have attained,
or the particular location they may occupy. Each of these
forms may be situated in the several openings, but more
generally in those of the left side. Disease, involving the
sigmoid valves of the pulmonary artery, is very rare. This
is owing in part to the unstimulating quality of the venous
blood, the carbonic acid which it holds in solution calming
irritation by its anaesthetic action ; and partly to their facile
function, requiring, as it does, very little effort to prevent the
blood regurgitating into the ventricle.

The most common cause of valvular disease is endocardi-
tis. This may be primary, that is, may affect the endocar-
dium idiopathically ; it is, however, more frequently the re-
sult of other diseases, such as acute articular rheumatism,
gout, syphilis, and perhaps, occasionally, from the abuse of
mercury, (the well-known symptom of ercthismus often at-
tending the injudicious employment of that agent.) The
disease, when it depends upon gout and rheumatism, is
called metastatic. We do not treat here of cyanosis, the re-
sult of permanent patency of the interauricular or interven-
tricular orifices ; this condition being rather a fault of the
progressive development of the organization than a veritable
disease. Endocarditis frequently accompanies inflamma-
ionofthe pleurae and lungs ; also, typhus, small pox, and
other eruptive fevers, whether it be the consequence of
these affections or merely produced by the causes which
excite them, is difficult to determine. We know that the
blood, in the diseases mentioned, is highly charged with fib-
rin, stimulating and inflammatory ; it would not at all, then,
seem repugnant to admit that so delicate a membrane as the
endocardium, bathed continually in the normal state of
things by a bland, unirritating liquid, so highly susceptible
of being influenced by agents injurious or foreign to the
economy should take on diseased action from the inflamma-
tory condition of the blood alone. It is no doubt in this way
that the disease with which we are engaged in so frequently

I860.] Treatment of Cardiac Disease. 19

seen in persons addicted to the intemperate use of alcoholic
liquors, which arc promptly absorbed, carried along in the
torrent of the circulation, enter the chambers of the heart,
and then produce those deplorable ravages which embitter
the existence of the unhappy sufferer, and infallibly mark
him out as the victim of an early grave. It is no doubt in
this way, too, thattheabuse of mercury occasionally produces
the disease ; for we know that this substance is readily
absorbed, and doubtless equally capable of irritating, and
finally inflaming, the lining membrane of the heart, as any
of the agents already mentioned.

Before speaking of the symptoms of the various forms of
valvular disease, it may not be inappropriate to note a few of
the more prominent ones of its almost universal forerunner
endocarditis.

This affection, in its early, acute stage, is readily recog-
nized by an examination of the heart and precordial region.
The action of the organ is increased in force; its pulsations
augmented in number; they are very peculiar in character;
so much so, indeed, as to be denominated, by Bouillaud,
acute palpitations ; they strike loudly and sharply beneath the
ear ; a vibratory movement is distinctly felt in the precor-
dial region by the cheek of the auscultator, or on applying
the hand to it. The healthy sounds of the heart are changed
or modified. We get, on auscultation, a bruit de souffle, or a
bruit de rape, varying in intensity and distinctness with the
greater or less violent pulsations of the heart, or according
to the ravages which the disease has already made. A me-
tallic tinkling is also not unfrequently heard accompanying the
ventricular contraction. Percussion gives a larger field of
dullness than is usually met with in the healthy state. This
is owing to the tumefaction of the heart when not complica-
ted with the pleurisy, or pericarditis. The bellows and rasp-
ing sounds, together with the greater distinctness of the car-
diac pulsations, serve to distinguish endocarditis from in-
flammation affecting the pericardium. The dullness and
bulging of the precordial region are common to both diseas-
es, but more extensive and better marked in pericarditis.
Pain is by no means a common symptom of endocarditis ; on
the contrary, it scarcely ever manifests itself when the disease
is simple and uncomplicated. The patient generally expe-
riences feelings of uneasiness, anxiety, and oppression about
the region of the heart; there is great dyspnoea and appre-
hension, with a tendency to faintness and syncOpe. The
pulse is rapid, remarkably small, intermittent, and irregular.

20 Kelly. The Pathology and [January,

This curious discrepancy between the feeble state of the pulse,
and the violent, energetic action of the heart, is generally at-
tributed to the collection of fibrinous concretions in the left
ventricle, greatly diminishing its normal capacity, and con-
sequently the volume of blood destined to traverse it in a
healthy state. The thickened and altered condition of the
valves, the contraction of the aortic orifice, contribute, to
some extent, in producing the almost impalpable pulse.
When the obstruction to the circulation is very considerable,
congestion of the lungs and brain supervenes ; the counte-
nance is tumefied and purple, and sometimes the patient ex-
hibits all the usual symptoms of apoplexy, such as sudden loss
of sensation and voluntary motion, stertorous breathing,
frothing at the mouth, and convulsions. In similar cases the
lower extremeties become cedematous. There is abundant
mucous or bloody expectoration. The orthopncea is well
marked ; the wretched sufferer being constantly harassed by
the fear of impending suffocation.

Such are the prominent symptoms of the gravest form of
acute endocarditis ; the disease sometimes passes into the
chronic state, which produces lesions of the structure it in-
vades, to be accompanied or followed by phenomena of ano-
ther order. The structural changes which are wrought by
this form are chiefly confined to the valves and cardiac orifi-
ces. Induration and thickening of the substance of the
valves; vegetations springing from the latter, or attached
to the lining membrane of the heart ; adherence of the
valves, and constriction of orifices, false membranes, fibrous,
cartilaginous, osseous, or calcareous formations, such are the
anatomical characters presented by the chronic form of the dis-
ease. Although atheromatous and calcareous deposits are
very commonly attributed to endocarditis alone, they are, on
the contrary, rarely the result of that disease, but are generally
produced as a necessary consequence of the modifications of
nutrition which the heart, as well as all other tissues of slight
vascularity, undergo from old age. They are also very
frequently met with in the hearts and principal arteries of con-
firmed drunkards. In such cases it is difficult to account
for their true mode of formation : whether due to contin-
ual irritation, or to changes wrought in the physiological
constitution of the blood in all probability to both.

The symptoms of valvular disease of the pulmonary
artery will vary with its degree and form. Thus, for instance,
should there be merely constriction of the orifice, we get a
bruit de souffle, more or less intense during the ventricular

I860.] Treatmentqf Cardiac Diseas . -1\

systole. This is heard most distinctly towards the junction
of the second and third ribs with the sternum. If there be
valvular insufficiency at the same time with contraction,
the bruit exists during the first and second sounds. If in-
sufficiency of the pulmonary valves alone presents itself,
the valves remaining in a normal condition, the bell<
murmur, or that o\' regurgitation, is heard during the ven-
tricular diastole the pulmonary second-sound in this e
is entirely wanting. It is very difficult to distinguish pure
constriction of the irifice of the pulmonary artery from
vegetations affecting the same or its valves. It is distin-
guishe I from the contraction of the right auriculo-ventricu-
[ar op< ning, by the murmur attending the latter being
heard most audibly at the right apex, extending behind the
sternum, at the point where the cartilages of the fourth
ribs join that hone, and synchronous with the ventricular
diastole, or second-sound; from contraction of the aortic
orifice, by the bruit accompanying the latter being louder,
more prolonged, and heard over a greater extent of surface;
the latter, too. is infinitely more common. The state of the
pulse is also an excellent guide to enable us to discriminate
between both affections. When the orifice of the pulmo-
nary artery alone is constricted, the pulse of the individual
preserves its usual force, fullness, and regularity : when
when the aortic opening is diminished in calibre, the pulse
is remarkably small, miserable, frequently intermittent ami
irregular.

The auriculo-vcntricular orifice of the right side is more
frequently affected by disease than that of the pulmonary
artery. Th be either constriction from chronic in-

flammation, or obstruction from vegetations situated in the
opening, or attached to its valves, or the valves themselves
may be thickened and bound down by false membranous
bands; or all these different forms may present themselves
simultaneously.

The symptoms revealed to us, both physically and ration-
ally, are as follows : In simple contractioii vf the right auri-
culo-ventricular orifice, a form, like the antecedent, exceed-
ingly rare, and consequently very seldom met with, a dias-
tolic murmur heard behind the centre of the sternum,
about the point where the cartilages of the fourth ribs arti-
culate with it, and extending to the right apex. In the ob-
structive form, from vegetations, which is yet rare, but still
more common than the preceding, the murmur, heard at
the same point, and extending in the same direction, is more

22 Kelly. The Pathology and [January,

intense, and may present the bellows or [filing eharacters ; in
both cases there is dilated auricular hypertrophy.

Tricuspid insufficiency from thickening of the valves, or
the latter being bound down by false inembranous adhe-
sions, the orifice remaining in a healthy,* normal condition,
gives a systolic murmur heard at the right apex, and ex-
tending to the sternum, the point corresponding to the arti-
culation of the cartilage of the fourth rib. If contraction of
the orifice and valvular Insufficiency exist simultaneously, the
regurgitant and obstructive murmurs will be heard over the
same space successively, synchronous with the first and sec-
ond sounds, whose distinctness they will tend more or less
to mask and modify. In the regurgitant form, or that re-
sulting from tricuspid insufficiency, there is often manifest
pulsation, and distension of the external jugulars ; the right
ventricle, as well as its corresponding auricle, are dilated
and hypertrophied ; there is congestion (as in all the forms
of tricuspid disease) of the venous system throughout, with
anasarca. In grave cases this congestion may induce cere-
bral apoplexy. The breathing is usually slow and cautious,
the lungs not receiving their full supply of blood this after
several ventricular contractions ; there is neither cough,
dispncea, mucous nor bloody expectoration, at the begin-
ning ; it is only when the disease has existed a considerable
time that symptoms of pulmonary congestion manifest them-
selves.

The lesions met with in the left side of the heart are pre-
cisely similar to those of the right ; the physical signs are
also the same, with some slight modifications ; the rational
symptoms assume an inverse order in the course of their de-
velopment, as compared with those supervening on disease
of the right side.

Obstructive disease of the left auriculo-ventricular orifice,
or mitral contraction, furnishes the following signs :
a diastolic murmur heard a little to the left of the sternum,
beneath the cartilage of the fourth rib, and extending to
the left apex of the heart (this sound has been compared
we believe, by Dr. Hope, to that elicited by pronouncing
ichoo in a whisper;) dilated hypertrophy of the auricle ;
pulmonary congestion a very prominent and precocious
sign, revealed by cough; abundant mucous and bloody
expectoration; great diminution in the clearness and force
of the aortic second-sound; the pulse small, weak, and
unequal. Irregularity of the pulse, accompanying the
characters just mentioned, indicates co-existing cardiac

I860.] Treatment of 'Cardiac Disease \ 23

(dilatation. A bruit cataire, or purring murmur, is some-
times heard at the apex. Consecutive dilatation of the right
chambers of the heart is an almost inevitable result of this,
as well as all other forms of obstructive or regurgitant
disease affecting the left side, especially if the subject sur-
vive any considerable length of time. General venous
congestion and anasarca appear towards the end. It is in
this form particularly, as well as in the regurgitant, that we
are so liable to have1 what is called pulmonary apoplexy; that
of the brain following directly cardiac disease of the right
side.

Mitral insufficiency, the most common, perhaps, of allforms
of valvular disease, presents us with the following physical
and rational signs : a systolic murmur, propagated from the
left apex to the point corresponding with the cartilage of the
fourth rib, and a little to the left of the sternum ; an accen-
tuation of the pulmonary second-sound ; feebleness of the
aortic second-sound; pulmonary congestion and haemop-
tysis; a small, miserable, unequal pulse, which contrasts
singularly with the energetic character of the heart's action ;
general venous congestion and dropsical effusion ultimately
follow this disease. Mitral regurgitation is, in some very
rare instances, unaccompanied with a systolic murmur ; the
cause of this strange anomaly is not well known. In this
case the diagnosis, unless aided by the other physical ami
rational signs, is necessarily obscure.

Contraction, or obstructive disease of the aortic orifice, is
attended with these symptoms ; a systolic murmur, heard
with greatest intensity behind the left margin of the ster-
num, where the cartilage of the third rib joins it, the sound
being transmitted upward, following the curve of the aortic
arch; the bruit is heard, .though sometimes feebly, at the
left apex ; dilated hypertrophy of the left ventricle ; the
aortic second-sound feeble ; the pulse is generally small and
wiry, particularly when the orifice is much constricted, the
artery shrinking to accommodate itself to the scanty volume
of blood thrown into it. Similar symptoms to those enu-
merated have been found to arise from other conditions,
affecting the free circulation of the blood through the aorta,
as the pressure of a tumor or condensed lung upon the
vessel, the roughness of the lining membrane of the artery,
aneurism, or abnormal dilation of its arch or thoracic por-
tion. Systolic murmurs heard with greatest intensity over
the aortic orifice, are by no means always symptomatic of or-
ganic disease. A bruit de souffle or bruit dediable} extending

24 Kelly. The Pathology and [January,

from the sign Loid valves up th e carol ids, is one of the most com-
mon symptoms of chlorosis and anaemia. Theyare often pre-
sent in typhoid, puerperal, and exanthematous fevers. Ab-
domnal tumors, whether morbid or physiological, calculated
from their size or location to impede more or less effectually
the free circulation through the aorta, sometimes give rise
to sounds so entirely similar, as to mislead the physician to
suspect organic trouble of the sigmoid valves and orifice
where all, in the mean time, is perfectly healthy and intact.
Valvular insufficiency of the aortic opening furnishes the
following symptoms : diastolic murmur at the left apex, and
extending to the sigmoid valves, most intense around the
latter point; the aortic second-sound often completely
absent, or so modified by the regurgitant murmur as to be
scarcely appreciable ; accentuation of the pulmonary second-
sound. A vibrating fremitus not unfrequently accompanies
the regurgitant current. The pulse is soft, weak, and
undulating, and sinks beneath the finger with extraordinary
rapidity. There is, on this account, a remarkably long
interval between the systolic impulse of the heart and the
period when the pulse is felt at the wrist. General venous
congestion and anasarca do not usually attend the early
stage of this and the preceding form of disease ; however,
they are not slow in manifesting themselves, for pulmonary
embarrassment, indicated by cough and haemoptysis, is
among the foremost complications of aortic contraction and
valvular insufficiency.

While dwelling upon the physical signs of the various
forms of endocardiac disease, we have had occasion to allude
more than once to hypertrophy as a result. It may not be
out of place here to describe more fully the different kinds
of enlargement, and the peculiar organic lesions upon
which they depend.

Hypertrophy, then, may be either eccentric or concentric.
Eccentric or dilated hypertrophy supervenes when the cur-
rent of the blood flows unimpeded into the auricle or ven-
tricle, but has to be expelled from either chamber with
difficulty, owing to a contraction of the orifice through
which the blood has to pass in the natural state of things.
Thus we have this form of hypertrophy in the left ventricle,
for instance, when there is great constriction of the aortic
opening, the left auriculo-ventricular orifice remaining in *
a normal, healthy condition. ISTot only are the walls double
and triple their usual size, but the ventricular cavit3T also is
greatly dilated. Eccentric hypertrophy does not always

I860.] Treatment of Cardiac Disease. 25

depend upon organic disease of the side enlarged. Thus
obstruction to the circulation, originating in the left side

of the heart, will produce dilatation of the right auricle
and ventricle, although the valves and orifices of both pre-
serve their normal integrity. Atrophy of the left cardiac

parietes is generally, if not always, the necessary conse-
quence of obstructive disease pf the right side. General
atrophy of the organ may be induced by any of the causes
which tend to debilitate the powers of life, as organic or
cancerous disease of the stomach, copious and long-con-
tinued hemorrhages, insufficiency of nutritious and stimu-
lating food; certain cachectic conditions of the system, as
marasmus, anaemia, and chlorosis. Pressure from serous,
sanguinolent, and purulent effusions into the pericardiac
cavity is a powerful means of producing atrophy of the
heart. Concentric hypertrophy results when the current is
obstructed in its ingress and egresss. This is easily
accounted for. The ventricle, for instance, in this case,
receives but a very scanty supply of blood, its walls are
consequently not distended to their full capacity, its chamber
contracts by degrees to adapt itself to the small quantity of
fluid poured into it from the auricle ; but an impediment
being presented to its free egress by constriction of the
aortic orifice, for example, it requires a considerable degree
of muscular force to overcome the resistance, and hence the
variety of hypertrophy of which we speak.

The only disease with which acute, uncomplicated endo-
carditis is likely to be confounded, is acute inflammation of
the pericardium, but in both diseases there are some very
marked distinctive symptoms. Thus, in pericarditis, pain
is very constant ; the patient frequently complains of an
insupportable burning sensation in the anterior and left
portion of the chest, winch he endeavors to assuage by
swallowing cold drinks with great avidity, and seeking the
fresh, open air, while the surface of his body, in the mean
time, is often cold and livid. The precordial region is quite
prominent, and gives dullness, on percussion, over an
extensive surface. The sounds, communicated by auscul-
tation, are most decisive, and are usually as follows : o
rubbing, rasping, belloios sound, compared to that produced by
stretching or crumpling new leather. This is heard during
the ventricular systole and diastole ; it has been designated,
on this account, the to-and-fro sound. The normal cardiac
murmurs resound indistinctly in the distance ; they present
a dull, muffled tone. Pain, as heretofore stated, very rarely,

26 Kelly. The Pathology and [January,.

or never, accompanies acute, uncomplicated endocarditis ;
the skin is usually hot, and bathed with a profuse perspira-
tion ; the bruit de rape or souffle is almost universally single ;
the heart's impulse is sharp, loud, and distinct, a circum-
stance which induced the illustrious Bouillaud to denom-
inate, in his happy style, the sounds elicited " acute palpi-
tations. ' ' The arching of the precordial region and dullness
on percussion are never so prominent and extensive in the
latter as in the former disease. The diagnosis of the chronic
form of endycarditis is sometimes difficult and obscure ; the
physical and rational signs are often precisely similar to
those we meet with in other conditions of the system
chlorosis and anaemia, for instance. Thus, the bruit de souffle
and bruit de diaUle of these affections often perfectly simulate
the rasping and bellows sounds of organic disease of the
cardiac orihces and valves. Haemoptysis, however, and
hypertrophy of the heart seldom, or never, attend pure
forms of chlorosis or anamiia, as direct and necessary
consequences ; whereas they are inevitable in chronic
endocarditis. These distinctions, together with the antece-
dent history of the case, will, in the majority of instances,
serve effectually to dispel any obscurity which may hang
around our diagnosis.

The dropsy, dependent upon valvular disease, can only
be confounded with the anasarca following Bright's disease.
An examination of the heart and urine will at once reveal
the true source of the dropsical effusion, save in those cases
where both organic affections exist simultaneously. In the
dropsy supervening upon cardiac disease, albumen is scarcely
ever detected in the urine, while in granular degeneration
of the kidneys it is scarcely ever absent. As regards the
comparative gravity of the two affections, both are equally
serious to the poor patient; with this slight difference,
however, that Bright's disease is often amenable to judicious
treatment, while valvular disease, once established, can only
terminate in the premature death of its victim. It is
scarcely possible to mistake a$r->fc$, the result of cirrhosis of
the liver, with that following the last stage of heart disease.
Both dropsies follow an inverse order in their respective
manifestation and development. (Edema of the lower
extremities is among the first rational signs of cardiac
trouble ; ascites, from the same cause, among the last.
Abdominal dropsy, on the contrary, which depends for its
existence upon cirrhosis and other organic diseases of the
liver, succeeds directly and immediately the hepatic

I860.] Treatment of ( ardidc DiseA

obstruction to the portal circulation : oedema of tin4 lii
being a rare and secondary complication.

The course, duration, and prognosis of endocardial disease
will depend upon its form and extent. The course of acute
endocarditis, when left to the resources of nature, is usually
very rapid, and may induce death in a few days. Boiiillaud
lias limited this periojito eight days ; but the standard is an
uncertain and arbitrary one, inasmuch as his cases were
complicated with articular rheumatism, pericarditis, pneu-
monia, and pleurisy. The simple, uncomplicated form
would, no doubt, continue much longer before the fatal
termination. The abundant fibrinous concretions which
collect in the chambers of the heart, and adhere to its lining
membrane, opposing seriously the free circulation of the
blood, seem to be the direct cause of death. The chronic
form may. and generally does, continue for a long, indefinite
period, and ultimately destroys the patient by dropsical
effusions into the thoracic and abdominal cavities, and by
fatal congestions of important organs of the economy. The
disease sometimes proves suddenly fatal in another way.
The little polypoid excrescences or tumors, of which we
have already spoken, as growing from the orifices and
valves, occasionally become detached from their pedicles,
are swept along in the torrents of the circulation till they
arrive at some arterial branch, whose unequal calibre arrests
their further progress, become firmly impacted by the
ceaseless vis a h. rgo, infallibly cutting off all supply of arterial
blood from the part to which the vessel is distributed, thus
producing gangrene of the part, unless relieved by commu-
nicating branches, or even death of the individual in instan-
ces where such organs as the lungs and brain are concerned.

It would be well, then, to seek for such accidents in all
cases of sudden death from organic disease of the heart.
Our prognosis must not always be influenced by the appa-
rent gravity of the cardiac lesions, as manifested by the
frightful murmurs which so often grate so harshly on our
ears. As long as the tuneful rhythm of the heart's action
remains intact, as long as the comparative prolongation and
dullness of the first-sound, followed by the brisk, sharp-
clacking stroke of the second is heard, so long may our
prognosis of the case be favorable, no matter how formida-
ble may be the physiognomy of the other stethoscopic signs,
the heart is performing its all-important function healthily
and well. But if the harmony or rhythm of the organ be
impaired, if the natural cardiac murmurs be confused, or

28 Kelly. The Pathology and [January,

entirely silenced and superseded by obstructive and regur-
gitant sounds; if, with these untoward symptoms, we have
pulmonary congestion and haemoptysis, distention of the
general venous system and anasarca, the case becomes then .
one of serious gravity, and consequently, our prognosis
highly unfavorable.

Few diseases, within the broad domain of pathology,
require so much vigilance and decision on the part of the
medical practitioner, as the one which at present engrosses
our attention. The treatment of acute endocarditis, to be at
all satisfactory and efficacious, must be seasonably resorted
to. Hence the urgent, imperative duty of the physician to
examine carefully the condition of the heart in all acute
rheumatic affections, particularly if the patient be young
and of a robust constitution. This precaution is all the
more necessary, since metastatic endocardiac disease is very
often hidden and insidious in its early development. If we
rely upon subjective symptoms alone in such cases, the great
chances are we give such a point d'appw to the formidable
enemy, that the whole arsenal of our remedies will prove
fr<>;upletely inadequate in the subsequent contest to dislodge
,/.m its ill-gotten stronghold. Local and general deple-
tion, thn, should be pushed to the utmost limits warranted
by the severity of the inflammation and the patient's consti-
tution to bear it. This should not be restricted to one or
two venesections, hut must be repeated till a decided
impression is made upon the circulatory system. It is at
this stage of the disease, particularly, that the heroic treat-
ment of Bouillaud, his terrific depletion, so widely known
by the famous expression coup^sur-coup, is so eminently
successful. Calomel and opium should then be given. <ay
'{ or 2 grs. of the first, with J or J- gr. of the latter every two
or three hours, until the specific effects of the mercurial are
manifested, when the dose may be gradually diminished in
quantity, and the interval of administration lengthened.
At this period, blisters, repeatedly applied to the precordial
region, are signally efficacious. Bouillaud is accustomed
to sprinkle 6 or 8 grs. of powdered digitalis over the raw
surface at each dressing, and vaunts to have derived excel-
lent effects from its use. Diluent and demulcent drinks,
containing the nitrate of potash, should be freely given.
Colchicum and hyoscyamtts, in equal proportions, are often
followed by beneficiaf results, particularly when we have to
combat the rheumatic element. Veratrine is considered by
some of the French physicians, of whom I may particularly

I860.] Treatment of < hrdiac Diseast . 29

mention Becquerel and Trousseau, almost a specific for all
acute rheumatic inflammations. When this fells, as it often
does, they resort to quinine, which they give in large dose-,

frequently repeated, SO as to amount to several scruples in
the twenty-four hours. This treatment, according to the
reliable assertions of those two eminent pathologists
faUswhen employed in season.

Another remedy, highly vaunted in disease of the heart,,
is digitalis. This must be given in large doses, say a grain
in the form of powder or infusion every two or three hours,
at the very outbreak of the malady, in order to produce the
full sedative effects of the drug. The same remedy is given
in the latter stages of the disease, as a diuretic, when
anasarca appears. It is then never given more frequently
than two or three times in the twenty-four hours, due pre-
caution being taken to guard against its powerful sedative
action, which, owing to its peculiar cumulative property,
sometimes unexpectedly explodes. The muriated tincture
of iron, either separately, or in union with the digitalis, is a
valuable adjuvant to our treatment at this particular stage.
It not only seems to act as a diuretic, but also to give tone
to the vessels and plasticity to the blood; thus counter-
acting, to a great degree, the tendency to dropsical accumu-
lations. Its beneficial effects are strikingly manifest when
the cardiac disease is accompanied with anaemia. The iodide
of potassium, with chinchona, hyoscyamus, digitalis, and
colchicum, is a valuable resource in chronic endocarditis.
When the lower extremities are loaded with serosity,,
numerous punctures, made with a large needle, give great
relief, by drawing off a larger quantity of fluid than one
would, at first sight, anticipate. This is far preferable to
bandaging the limbs, a process which only hastens the
appearance of dropsies in other parts, as the abdomen and
body. When ascites is developed, we may have recourse
to paracentesis, or the administration of elatefium, according
to the circumstances of the case. When organic disease of
the heart is complicated with general sanguineous plethora,
blood-letting and hydrogogue cathartics are prominently
indicated. The effects of a copious venesection, in such a
case, are often truly magical. The distressing and tumul-
tuous action of the heart, the turgid and apoplectic hue of
the countenanee, the enormously distended condition of the
limbs and entire body, vanish with the rapidity of lightning,
to the great relief and comfort of the unhappy sufferer.
Elaterium aets well, in such a case, after blood-letting, par-

30 Bastick. The Chemistry [January,

ticularly wlien the bowels are loaded with fa?culent matter,
or obstinately constipated. But if plethora and anaemia be
the most favorable, inasmuch as being most amenable to
judicious treatment, whether antiphlogistic or tonic, they
are, unfortunately, the rarest complications of heart disease.
Gastric derangement, torpidity and enlargement of the liver,
constipation of the bowels, and congestion of the kidneys,
are several conditions which frequently accompany and
aggravate the cardiac trouble. The medium through which
they react upon the diseased organ is doubtless the blood.
This fluid, under such circumstances, is surcharged with all
kinds of impurities, as bile, urea, uric acid, pus, and various
other principles, which, in a healthy state, are either not
formed, or, being formed, are eliminated from the economy,
after having served the role allotted to them in it. It is in
such cases that we see remedies, administered with the view
of restoring the healthy functions of the digestive organs,
folloAved by such cheering and salutary results. So very
obvious and flattering are those benefits sometimes, that we
are almost willingly deceived into the belief that the de-
rangement of the abdominal viscera is the sole cause and
mainspring of the cardiac trouble. This fact, however, so
far from being true, only forms a rare exception to a very
general rule. Functional disorders, frequently becoming
organic, of the lungs, stomach, liver and kidneys, are the
most common results of obstructed systemic circulation,
and also, as .must be confessed, the most stubborn and
serious complications of cardiac disease.

The Chemistry of Caustics. By William Bastick. Of

all the applications of chemistry to the sciences of medicine
and surgery, there is not one which has been so little studied
or written upon as the chemistry of caustics. Having re-
cently had my attention called to this fact, while making
some investigations into the nature of caustics, and especially
their mode of action, I propose to lay briefly before those
interested in this subject, the conclusions arrived at, however
fallacious the labors of future and abler investigators may
prove them to be.

" It seems to me that caustics, with reference to their ac-
tion, may be divided into two great classes, namely: one
which comprises those which merely kill or destroy the vi-
tality of the living tissue: and the other, which includes

I860.] Of Caustics. 81

those which not only destroy the vitality of the living tissue,
but decompose or dissolve the tissue, whether dead or living.

"As example's of the former class, may be enumerated
chloride of zinc, sulphate of copper and zinc, bichloride of
mercury, etc. ; and, as examples of the latter class, maybe
mentioned caustic potash, nitrate of silver, manganese cum
potassa chromic acid, etc.

"Another distinctive featur^e of these two classes is, that
while the latter destroys and decomposes the living or dead
tissue, the former, having killed the living tissue, acts after-
wards as a powerful antiseptic or preservative of it.

"It is not within my province to point out to those exten-
ly employing caustics, to whom these facts may be new,
the importance of bearing in mind this distinctive feature
between the two classes of caustics-, when selecting the des-
cription of caustic to be employed in any given case.

"Although caustics may he conveniently divided in the
manner described into two principal classes, these clat
can be further sub-divided into many others, because the
mode of action is frequently distinct in each individual case,
whatever the final result may be on the living tissue.

'To illustrate this point, the modes of action of caustic
potash and chromic acid may be cited. When the living
tissue is placed in contact with caustic potash, tlie destruc-
tion of its vitality ensues by the potash dissolving its albumi-
nous and fibrinous components ; in fact, acting in the man-
ner described by chemists for obtaining the various protein
substances from organic matter. Of course I only allude to
the leading features of the action of caustics in this instance,
as well as in others. When the same tissue is treated, chro-
mic acid, instead of obtaining a solution of the protein com-
pounds of the tissue, and thus destroying its organized struc-
ture, the tissue is destroyed by a slow process of combus-
tion ; or, in other words, it is oxydized at the expense of the
oxygen of chromic acid, by Reason of the facility with which
that acid parts with its abundant oxygen when in contact
with organic bodies. The manganese with potash acts in a
similar way as a caustic to chromic acid, but in consequence
of the permanganic and manganic acids which it contains
being in combination with the base potash, its action is more
controllable and persistent. It may not he here out of place
to mention, what appears to me to be a practical advantage,
that the destructive caustics, if I may so term them, possess
over the conservative ones. In doing so, I beg to state, once
for all, that I offer my opinion on such points with great dif-

32 Bastick. The Chemistry of Caustics. [January,

fidence, knowing that chemistry is not medicine or surgery,
but onl}T one of their instruments. The practical advantage
is this : When the surgeon desires the removal of the dis-
eased tissue by caustics, if he uses a conservative caustic, he
kills the tissue, but has to effect its separation by a further
process of supination, etc. ; whereas, if he employs a de-
structive caustic, the processes are in simultaneous action,
and the desired result is, consequently, more speedily
accomplished.

"Nitrate of silver is essentially an oxydizing caustic, but
its action is much slower than that of chromic acid or man-
ganese with potassa, from the circumstance that it does not
so readily part with its oxygen ; and it forms an insoluble
compound with organic structures, which acts as a preven-
tive to its continuous power as a caustic, by forming a sort
of impermeable coating on the tissue to be removed. I am
aware that this action is an advantage where haemorrhage is
to be feared.

" The exsiccated sulphate of zinc and copper, when em-
ployed as caustics, act like chloride of zinc by their power-
ful affinity for watei*. But when the vis vitse is destroyed by
such affinity, their further action is that of strong antisep-
tics, thereby greatly, if not entirely, retarding the natural
disruption of tissues which have ceased to possess vitality.
Bichloride of mercury, and, in fact, all mercurial caustics,
possess a conservative aetion, by their strong affinity for the
albuminous components of organic structures, with which
they form compounds of definite character.

"Nitric and sulphuric acids belong to the class of destruc-
tive caustics; the action of the former is that of the oxyda-
tion of the tissues, Avhile the latter owes its power as a caus-
tic to its power of extracting the elements of water from
organizedbodies, behaving like the exsiccated salts previous-
ly mentioned, with which it is sometimes judiciously com-
bined to prevent the spreading of the acid beyond the parts
to be destroyed by reason of its fluidity when combined.

" Chloride of gold has been extensively employed, geno-
i ally in combination with other caustics, in some of the con-
tinental hospitals. When placed in contact with organic
matter, this sail is reduced to a metallic state similar to the
action of nitrate of silver; but as far as my experience goes,
it is inferior as a caustic to the silver salt, because of the
large quantity of oxydizing material which is setiree when
the organic matter is treated with nitrate of silver. Among
the conservative caustics, arsenic audits compounds will find

I860.] Smith. Stricture of Urethra 33

its propoi" class ; for although arsenic, is poisonous to living
tissues, it is a powerful antiseptic agent. It forms no com-
binations with dead or living tissue, and only a feeble one
with albuminous matter; and from tins cause it must be re-
garded, in a chemical point oi' view, as a very inefficient
caustic.

" Chlorides of antimony and iron, which have been used
as caustics, exhibit a mode of action similar to chloride of
zinc. The very feeble action of the latter must, in some
cases, he its principal recommendation.

" It will be evident from the previous statements, that
chemistry will supply us with an indefinite number of caus-
tics; for it is clear that whatever decomposes or combines
with living tissue sufficiently to kill it, is to all intents and
purposes, a caustic. It is equally manifest that, while it is
the essential condition of every substance professing to be
a caustic, that it should kill the living tissue, it by no means
follows that all caustics performing this condition should
destroy or dissolve away, as it were, the tissue, when no
longer possessing life, for this latter property belongs to a
distinct class of caustics.

" I am aware that I have not noticed the so-called irritant
action of caustics; but, in explanation, I reply, that the con-
sideration of this action is foreign to the purpose of this
communication, and, moreover, a subject not within the
province of the die mist, Med. Times and Gazette and Scien-
tific An m nit.

On some of the Difficulties Attending upon the treatment of
Stricture of the Urethra. By Hexky Smith, F.R.C.S.

In the Medical Times and Gazette for August 21, of last
year, I detailed at length a case of obstinate stricture of the
urethra, which was remedied by dilatation, and careful
general treatment, after the patient had been condemned
to undergo the operation of external division of the canal
by a Surgeon of large experience, under the idea that there
was not any other method of relief. At that time I made
some observations referring chiefly to a feature of difficulty
which the case detailed particularly illustrated, namely, the
almost insuperable rebelliousness to dilatation, which is
every now ami then met with in certain instances of this
affection. I was enabled to show that a case of the most
obstinate and unpromising nature might, by careful treat-

34 Smith Treatment of [January,

ment, be made to yield, without recourse being had to the
knife, although both the patient and his Surgeon were con-
vinced that it was the only remedy. This incapacity of
certain kinds of stricture to admit of progressive and satis-
factory dilatation, is a feature well known to all those who
have seen much of the disease in question; hut there is one
feature in particular to which I shall refer to in these obser-
vations, and which I do not find much allusion to in the
ordinary works on stricture, and this is the absence of
improvement in the power of passing the urine, although
dilatation has been carried on in a satisfactory manner.
This is a difficulty which is exceedingly annoying and
distressing, because, in the first place, the patient naturally
expects that relief will be given so soon as an instrument of
at least a moderate size can be introduced into the urethra,
and the Surgeon knows that he has to deal with a feature
in the complaint which may depend upon circumstances
over which he has little control, and which will render the
treatment of the case more troublesome. Mere density or
tightness in a stricture acting as a bar to progressive dila-
tation, is a condition much less likely to hinder a satisfactory
termination than the one alluded \o; for in the one case,
although the dilatation may advance but slowly, the im-
provement in the stream of urine is generally commensurate
with the mechanical progress, and satisfactory both to
patient and attendant, while in the other it will happen that
the exercise of the utmost skill and endurance is but faintly
rewarded,

Xext to extreme irritability of the urethra, this one feature
of absence of improvement in the stream, has been a source
of greater difficulty and .annoyance than anything else.
Among a considerable number of very severe cases of
stricture which have lately been under my care, my atten-
tion has therefore been much directed towards ascertaining
its cause, and removing the symptom, if it may be so
termed. In some cases it has not been difficult to account
for it, as where one or more fistulous sinuses exist : when
such is the case the bladder may be healthy and the urethra
be fairly dilated, yet the patent condition of the artificial
openings, which take so long to close, allows the greater
portion of the urine to percolate through them, little comes
through the urethra, and that little in any volume. In
instances of this kind the patients may be assured that the
stream of urine will increase as the sinuses close up. slowly
as that event is too often known to take place.

I860.] Stricture <>/ the Urethra.

There are, however, other eases of severe stricture,
uncomplicated with fistulous openings in the perinseum,
where the Surgeon has been able to carry on dilatation in
satisfactory manner, and to such an extent that a good-sized

catheter may pass, and vet there is either no improvement
at all in the stream, or. if any, it i-> so slight as to be almost
inappreciable. This obtains also not only in instances of
stricture in persons of advanced aire and of debilitated
power, hut it is occasionally met with in patients either in
the very prime of life, or in those not much above adult
age. It is in some of these latter eases that it is extremely
difficult to understand the meaning of this symptom. It is
considered by some men of Large experience that it is the
Madder alone which is in fault; that it has become weak-
ened and dilated by the persistence of the obstruction in
front; and that, even when this latter has been removed,
the viscus does not recover its tone sufficiently to expel its
contents in an effectual manner. That this is the true
solution of the question, in some instances, there cannot he
much doubt; but I am induced, by careful observation, to
believe that in a considerable number of these cases the loss
of power in the bladder is more apparent than real, and that
the impediment to the volume and now of the urine is in
the urethra itself, notwithstanding that dilatation has been
carried on to a measure with which the passing of urine in
a small stream, or in drops even, seems almost incompatible.
I have noticed that this very distressing feature has existed
both in instances where the stricture has been exceedingly
difficult to penetrate, the canal not being especially irritable,
and in those cases where there has not been very much
difficulty in overcoming the obstruction; but the urethra
has been extremely sensitive. I have, moreover, noti<
especially in the latter cases, that more than a single
stricture has existed: that there has been one near the
meatus, or one or two inches from it; and as a rule, with
but rare exceptions, the anterior stricture or strictures have
been found to be most irritable and unyielding.

In such instances as these it is extremely difficult to over-
come the irritable condition of the urethra, and to dilate
the canal ; and then, after this has been accomplished to
such an extent that a Xo. 8 or 9 catheter is introduced,
there is the mortifying result of little or no increase in the
stream of urine, or even of a diminution in size. Now. 1
believe that in such instances, especially where the patients
are young, or the stricture has not lasted long, the fault is

36 Smith. Treatment of [January,

not in the bladder, but that that organ expels the urine with
its wonted power, and that the fluid coming in contact with
the irritable portion of the canal although it has been
dilated to the extent mentioned causes it to contract forci-
bly, and thus produce the fine stream observed. Careful
examination of the urine in these cases shows absence of
any disease of the bladder ; and, moreover, it will be seen
that, small as the stream is, it is expelled with considerable
force, and continuously; which circumstance will not be
produced, I apprehend, by the mere action of the urethral
muscular fibres, whether voluntary or involuntary. In a
very well marked case of simple loss of power in the bladder
lately under my care, in the person of a very fine young
officer, all the symptoms of stricture were present; but there
was hardly any impulse at all given to the urine as it was
being evacuated, and the patient was compelled to strain
violently. There was not the least obstruction in the urethra
itself, and by well emptying the bladder artificially, and by
attention to the general health, this viscus gradually re-
gained its tone, as evidenced by the increasing size and
force of the stream.

In the treatment of the cases I have been considering,
much patience is required, both on the part of the Surgeon
and the sufferer ; for, as I have before stated, the latter is
too apt to be greatly disappointed at the little improvement
which is perceptible, and in his distress, is too liable to be
misled into undergoing some heroic treatment which may
either destroy his life, or give relief merely for a brief
period. It is only by the continuous dilatation of the dis-
eased canal to as great an extent as it will admit of, that the
result so much desired will be obtained. If the patient is
not advanced in years, or has not had stricture for a long-
time, he may be assured that a persistence in the treatment
will be attended with satisfactory results ; sometimes the
desired relief will happen suddenly, at other times, and most
frequently, the increase in the power of urinating will be
only gradual, but will not be marked until an instrument
of considerable size has been introduced. When, however,
the features of the case indicate that the want of stream is
due to a loss of power in the bladder, a long time elapses
before the organ recovers itself, although the urethra has
been well dilated by the Surgeon, and is kept patent by the
sufferer himself. It is especially important in these cases
to attend to the general health; for it will not unfrequently
be found that this has suffered much, and that the loss of

1800.] Stricture of the Urethra. 37

power in the bladder is but a symptom, as it were, of consti-
tutional debility, rather than the mere result of an obstructed
urethra.

The case I flow briefly detail will illustrate some of the
foregoing observations :

A gentleman, aged 23, consulted me February 14, 1858,
for stricture. On examination, I found that the urethra
was remarkably irritable, and that there was a stricture at
the bulb, through which I could only pass a Xo. 1 wax
bougie. The strictured portion of the canal was most
remarkably sensitive, and readily bled. I ascertained also
that there was a stricture two inches from the meatus. The
health of this patient was good; but the bladder Was very
irritable, and he was only able to pass his water with severe
smarting, and in a fine stream. IJrine acid but clear.

On inquiring into the patient's history, I found that he
had had stricture for five years, and that soon after its
appearance he had submitted to a great deal of catheterism
with benefit; about one year and a half since, finding his
symptoms returning, he unfortunately consulted a notorious
person, who passed instruments from time to time during
the whole of the period; he made use also of caustic, and
upon the patient complaining that he had great irritability
of the urethra, and nocturnal emissions, this worthy prac-
titioner told him to have sexual intercourse regularly three
times a week- This injunction was readily obeyed for three
months, at the end of which time the patient's eyes began
to be opened, and he resolved to take other advice. In
order to show how this poor young fellow had been trifled
with, I may mention that he brought to me a Britannia
metal sound, equal to a No. 6, which he had been told to
for himself.

It was evident that in this case the symptoms were due
as much to the extreme irritability of the urethra, which
had been induced by the wretched treatment he had under-
gone, as to the mere mechanical obstruction ; and therefore
it was necessary to relieve this, and at the same time
endeavor to dilate the stricture in the most gentle manner.
I therefore commenced the treatment by giving large doses
of acetate of potash and tincture of hyoscyamus, and
employed the wax bougie as a dilator.

Without entering into minute detail, I may mention that
at the end of four weeks I was enabled to pass a 2so. 4 silver
catheter, but the irritability of the bladder and urethra was
excessive. In another fortnight I was able to pass only a

38 Smith. Treatment of [January,

catheter one size larger, but the irritability was distressing,
and there was no improvement in the stream. I was careful
to be very gentle in my manipulations, nevertheless this
want of improvement was disheartening to the patient,
although the dilatation was progressing, and he placed
himself under the care of another Surgeon, and I saw
nothing more of him until the beginning of June, when he
again consulted me. He informed me that several cathe-
terisms had been performed upon him, at first with success,
but on the last occasions the Surgeon had not been able to
introduce the instrument.

I was able to pass a No. 3 silver catheter, and by the end
of the month had got so far as No. 8, but the distressing
irritability continued, and there was not any improvement
in the stream of urine it was passed forcibly, but in a
small thin volume by August 1st we were still only at No.
8, for inflammation of both testicles had followed the use of
instruments, and I was obliged to desist for a time the
stream of urine was only equal to a No. 2 catheter.

On the 18th I managed, with difficulty, to introduce a
No. 9, but the sensibility at the seat of stricture was
extreme, and the contraction near the orifice impeded the
instrument.

21st. Stream better since the introduction of No. 9, and
it continued improving. I subsequently divided the anterior
stricture, and was enabled to pass as large an instrument as
a No. 12. Found after I had passed this once or twice the
stream became larger than it had ever been in his life, the
irritability of the urethra disappeared, and he left me in the
middle of October quite well and able to pass a No. 10
catheter for himself.

This gentleman called upon me March 21 ; he informed
me that he had no trouble with his stricture at all, and I
saw him introduce a No. 10 catheter into his bladder with
ease ; he adopts this necessary precaution once a week.

This case, although sadly mismanaged at first, illustrates
the position I wish to maintain in this paper, that there may
be no improvement in the power of passing the urine,
although the stricture may have been well dilated, and yet
that the desired relief, though tardy, will be brought about
by continuous dilatation and employed to its fullest extent.
It appears to me also that this case opposes the view of
those who maintain that in all such instances the diminished
stream, with a patent urethra, depends upon a loss of power
in the bladder. Had this been so, the relief which at once

I860.] Stricture of the Urethra, 39*

appeared after a No. 9 catheter liad been passed, and
especially after I had divided the slight stricture af the
orifice, would not have occurred so suddenly. I attribute
the absence of improvement in the power of micturition for
so many months, to the extreme irritability and eontraeti-
bUity of the canal which was only overcome by the most
persevering use of dilating instruments. It might be
objected by some that the continual employment of instru-
ments in the irritable canal will only lead to keep up the
very excitement we intend to allay. If instruments are
passed roughly, or if the attempts to increase their size are
made too rapidly, I believe that the painful condition of the
parts and the constitutional sympathy will be increased :
but it is far different when gentle and very gradual dilata-
tion is adopted the morbid sensibility of the urethra is
allayed, and in course of time entirely destroyed. A
practical accpiaintance with this fact is of value, not only in
the treatment of stricture, but is to be made the most of in
the treatment of stone by lithotrity ; for an irritable urethra
here is. more a bar to success than where a stricture is con-
cerned; but it is well known that the canal may be rendered
comparatively insensitive by the cautious introduction of a
sound several times prior to an operation being performed.

This is just one of those cases where the patient might
have been easily led into the belief that perineal section
wras the only remedy, In fact, he had been informed on
one occasion since his first consulting me, and when the
difficulties alluded to were at their height, that cutting
would have to be resorted to. I doubt not that many of
the e unfortunate persons who have submitted to this
operation, have been in much the same state as this patient
was in for the first few months of treatment, being induced
to do so by the belief that the increase in the stream of
urine would only be arrived at by laying open the canal.

Sometimes it happens that in a severe case of stricture
the earlier attempts to dilate are attended with an improve-
ment in the stream which is satisfactory to the patient.
Then this improvement ceases, and does not show itself
again for a long period, although the dilatation may be
steady and progressive. When such a circumstance occurs
tqere can be no doubt that the bladder is not in fault; but
that it depends upon the irritability of the urethra, or an
insufficient dilatation of the stricture. Without going into
details, I may mention a case of a patient, aged 45, who
was under my care from December to April ; the stricture

40 Smith. Treatment of [January,

"was of fifteen years' standing and situated in front of the
"bulb. Treatment at the hands of various Surgeons of
experience had been pursued, one of whom had performed
internal incision on two occasions. The urethra, moreover,
had unfortunately been wounded on one occasion through
the stilet of a gum-elastic catheter escaping from the instru-
ment. I commenced the treatment of this difficult case by
dilating with silver catheters. The size and power of the
stream of urine increased in proportion with the instruments,
until I had got up to ISTo. 4 and 5; but subsequently to this
there was a good deal of irritation, and when* a Xo. 8 or 9
had been introduced, the stream of urine was not larger
than when a small instrument had been passed. Dilatation
was, however, patiently persisted in, and after Xo. 10 had
been introduced the size of the stream again increased and
continued doing so until I had arrived at Xo. 13, when I
dismissed him, able to pass his water in a good stream.

This case is interesting, as illustrating not only the par-
ticular point I have been dwelling upon, but it shows also
how utterly useless is the practice of internal incision, in
remedying a stricture for any length of time.

The practice of external division of stricture, which a
misapprehension of some of the symptoms and an insuffi-
cient reliance upon the power of dilatation and other agents,
was the means of bringing into use a few years since, has
now been proved beyond all doubt to be so dangerous to
life, and so inefficient to produce the complete remedy once
so vaunted, that it may hardly seem necessary to consider
this subject here ; however, notwithstanding that the opera-
tion has received the coup de grace, still it may be well, for
the sake of those who seek information, to mention any
facts appertaining to it.

It will be seen by referring to this Journal of Xovember
20, 1858, that I detailed the particulars of a case of stricture
which had recently been under my care, and where the
operation of external division had been performed by Mr.
Syme himself only some seven or eight months before. This
gentleman, under 30 years of age, was in a wretched con-
dition, with a most irritable stricture, a fistulous opening in
the perinseum, and broken down health. Xow I will con-
trast this case, win el i had been operated upon, with the
present condition of the case to which I referred to in the
opening words of this paper, and where the patient of about
the same age, and suffering so severely as to have retention
every day of his life, and to be compelled to carry a bougie

18(30.] Stricture of the Urethra, 41

with him wherever lie wont, was to have been cut. Im-
mense difficulties were overcome, and this gentleman left
me last August with his urethra well dilated, and able to
pass a targe cateeter himself. Wishing to know hispresent
condition, I got a letter from him, dated May 7th. lie says:
kt My general health is perfect. I regularly pass, once a week,
a No. i> instrument, which I am able to do without causing
any bleeding. I can retain my urine as long as any one,
and am never troubled by getting up at night. I never
sutler from retention of urine."

I may mention that this gentleman is not in a particularly
favorable condition for the subjugation of a stricture, he
being in the llorse Artillery, and thus compelled to take
much equestrian exercise.

About a fortnight since I had in my house, on the same
morning, two unfortunate gentlemen, in the prime of life,
who had undergone the pereneal section; one, five years
since, at the hands of a London Surgeon of large experiene ;
the other, three years previously, had been cut by Mr. Syme
himself in Edinburgh. They were both in a wretched
condition, the one has his perinaeum riddled with three
tistulous openings ; but as Mr. Syme himself was not the
operator here, the proceeding was of course unskilfully and
improperly done, and I will say no more about it. The
other case, however, was treated by Mr. Syme himself, and
the operation was of necessity done according to the rules
laid down by that Surgeon. Yet, where is the complete
remedy I The unfortunate gentleman assured me before he
left Mr. Syme's care after the operation, he felt the stricture
returning, and that notwithstanding he persisted in passing
the instrument every fortnight, as he was told to do, the canal
contracted, so that he was unable at the expiration of ten
months to pass anything at all. Since then he has been roam-
ing about from one Surgeon to another, in the hope of getting
his stricture dilated. When he first consulted me some blx
weeks since, I could only with the greatest perseverance suc-
ceed in introducing a small No. tt catheter, although a distin-
guished Surgeon in Dublin had introduced a No. 8 only a fort-
night previous. There was no fistulous opening left here, as
in the other; but there is the irritability and contractility of
the urethra as before, although Mr. Syme performed " the
operation himself, and according to the information given to
me by the patient, assured him it would be a certain cure. I
have before enunciated the opinion that not only does this
oporation not prevent the return of the stricture, but that the

42 Ollier. Osseous and [January,

re-contraction becomes more severe than before. As I had
not the opportunity of seeing this gentleman before he was
cut, I cannot positively state whether this holds good here or
not ; but that the induration still remained, or had reformed
at the site of the old disease, was quite evident by running the
finger along the peiinamm. Cutting cannot possibly get rid
of this ; and so long as this remains, the stricture will persist.
Caroline-street, Bedford-square.

Osseous and Cartilaginous System. Histological Character of
Bone produced by the Transplantation of Periosteum. By
Dr. Ollier. *

This observer has given the result of his experiments upon
the artificial production of bones by the transplantation of pe-
riosteum, and on the regeneration of bone after resections and
complete removal. These experiments, of such vast interest
to physiology and surgery, were performed upon rabbits of va-
rious sizes and under various hygienic conditions, in whom he
grafted portions of the periosteum into parts outside the limits
of normal ossification, and under the influence of vessels
strange to such ossification ; and he found that whenever por-
tions of this membrane have been transplanted, exudations
capable of ossification have been produced. At the end of a
certain period the formation of true bone was the result, de-
monstrating that the periosteum is not only a mere limiting"
membranous envelope, and that a tissue may preserve its pro-
perty and functions, although removed from the influence of
all naturally surrounding parts. The author exemplifies espec-
ially the origin and mode of development of new bone, show-
ing that if it proceeds from the periosteum it is not the result
of transformation of its fibrous layers, first into cartilage and
then into bone. Tiie important element of this membrane en-
gaged in the process is a layer of blastema on the inner sur-
face, so delicate that in scraping the periosteum with a scalpel
it is difficult to obtain any portions of it visible without the
microscope ; and this blastema appears as a rule to become
penetrated by calcareous salts between the fourth and twelfth
days, (a period corresponding to the formation of the first os-
seous cavities,) but if this process fails to occur in that period,
the new bone remains in part fibrous, and the development is
slow and incomplete. Insufficient nourishment, suppuration
of the periosteum, and other conditions, injuriously affect the
process. Without digressing further, we will here state the

* Brown-Sequard's Journal de Physiologie, p. 11, Jan., 1859.

I860.] Cartilaginous System.

three kindsof experiments which the author followed in the
prosecution of the question. They were as follows :

1st. Those in Which the portion of periosteum used was still
left in more or less connection with the hone, and was grafted
into the midst of muscles or under the skin, but continuing to
receive vessels from the bone.

2d. Those in which the pedicle of the portion of periosteum
was divided three, four, or five days after trail-plantation, so
as to interrupt all continuity with the bone.

3d. Those in which the piece of periosteum completely de-
tached from the bone and rest of periosteum was at once trans-
planted into neighboring or distant parts.

The new bone formed in any of the above ways, varying In
size according to that of the transplanted periosteum, (in one
case a bone almost as large as the tibia being produced,) is
fonud at its perifery to possess a regular layer of compact os-
seous tissue, and to be covered by its own periosteum. It is
hollowed in the interior by medullary spaces, which terminate
by uniting into a relatively large cavity, and which are formed
by the rarification of the bone-tissue and production of small
cavities, whose walls finally give way. The osseous corpus-
cles, as observed in delicate sections under the microscope, are.
seen at first to be irregularly disposed, but in the compact tis-
sue they are arranged in layers sufficiently distinct around the
vascular canals ; but the regularity which in natural bone is
observed around the Haversian canals is here wanting, as far
as hitherto has been observed. The Haversian canals are gen-
erally parallel to the axis of the bone, but their arrangement
is not perfectly intelligible in some respects. The medullary
spaces are full of a soft, reddish, vascular substance, like foetal
medulla, and is found to contain: (a) Free nuclei (the medul-
ocelles of Robin) and small medullary cellules with a round
necleus ; {b) Plates with many nuclei, generally infiltrated with
fat and granulations, and containing from three to eight nu-
clei analogeous to free nuclei (the myeloplaques of Robin;)
(c) Fatty matter ; (d) Some fibro-plastic elements and some
fibrils of connective tissue ; (e) Blood-vessels. There very
often is to be observed a peculiar longitudinal groove running
all along one of the surfaces of the new bone, owing to the
deficient union of the parallel borders of the portion of perios-
teum; a similar line is also to be observed on the surtace of
bone reproduced after sub-periosteal resections.

The author then describes at length the method of develop-
ment of bones obtained by the transplantation of periosteum,
of which the following is a condensed statement : At the very
commencement an effusion of lymph takes place, at first se-

44 Osseous and Cartilaginous System. [January,

rous and then more consistent, which infiltrates the portion of
periosteum and neighboring tissues. The periosteum soon be-
comes swelled, and its capillaries filled with blood, and on its
inner surface an exudation is formed, which is distinguished
from the above effusion by its greater consistence, and by its
constant increase whilst the other one decreases.

At the end of four or five days an accumulation of firm,
transparent, or slightly grayish material occurs within the peri-
osteum, (for its edges are then united so as to form an envelop
for the blastema.) This material is chondroid rather than
cartilaginous. About the seventh or eighth day the calcareous
matter begins to be deposited, a process not necessarily preceded
by the formation of veritable cartilage, although some-
times we find a substance hard, elastic, and with the external
characters of the latter. When once commenced the ossifica-
tion advances quickly, beginning at the centre and passing to
the periphery. The above-mentioned blastema is found by
the microscope to be composed of a large number of free
nuclei and cellules analogous to those found in embryonic tissues,
imbedded in an amorphous, more or less granular substance.
A few fusiform cellules or very fine fibrils are also met villi ;
and, moreover, cellules with a single nucleus like the small
cellules of the medulla, and large regular cellules with nume-
rous nuclei like the multi-nucleated plates of the same tissue.
The blastema is more abundant in proportion to the growth of
the animal. Under the transplanted periosteum this layer of
blastema continues to be the germ and point of departure of
new bone, the various elements being formed in succession,
and the intermediate substance becoming fibroid, calcareous
granulations being deposited, and ossification accomplished.

In those cases in which cartilage has been found, the cel-
lules and cavities differed from those of normal cartilage in
form and grouping. The author does not appear able to
account for the existence of cartilage in some cases, and its
absence in others. He proceeds to detail experiments showing
that neither the blood-vessels nor external layers of periosteum
suffice to produce bone ; a layer of blastema of embryonic
cellules being necessary. These embryonic elements are seen
intimately mixed at certain points with the cellular tissue and
elastic fibres composing the deep layer of periosteum.

He concludes by speaking at length of the reproduction of
various kinds of bone and joints after resection, and shows
that after the removal of articular extremities of two contig-
uous bones, the articulation is capable of regeneration if the
capsule and ligaments be left continuous with the periosteum
of the resected bone. -As a means of diminishing the risk of

I860.] Jourdan. Fever and Ague. 45

suppurative inflammation of bone after amputation, and of
forming the union of the stump, he suggests that the end of
the bone should be covered, and the medullary cavity closed
up, by a piece of periosteum. British and Foreign Medico-
Ch irurg leal Review.

Fever and Ague. By Dr. Jourdan, of Buffalo, 1ST. Y. In
the western parts of the United States, there exist three
popular prejudices very serious in their result. I allude to
the error, 1st. That the cure of the ague must not be too
sudden. 2d. That it is better to let it wear out itself. 3d.
That the ague is incurable in many localities.

To these errors we would reply that a long standing ague
always determines the irritation or the inflammation of the
brain, or the stomach, the liver, kidneys, and the spleen,
and that a speedy cure of the disease is the only alternative,
if we would prevent those complications ; and, finally, that
fever and ague is a disease curable everywhere, and in a
very short time, without compromising the constitution of
the patient, in the hands of an experienced physician.
Fever and ague, dumb ague, chill and fever, so called, are
nothing else than the intermittent fever in its various forms,
and according to its various paroxysms ; it is not a disease
by itself, but the result of disorder of the nervous system in
general, and particularly of the cerebrospinal axis, consisting
in hyperemia of the large nervous centres, viz: of the spinal
marrow, ganglia, or of the brain. During the attack, the
patient complains of headache, nausea, pain in the back;
there is congestion of the blood in the brain, lungs, liver,
kidneys and spleen. In a long standing ague all these
organs become more or less irritated or inflamed, and always
in proportion to the duration of the fever and the strength
of the patient, his age, and his constitution.

The appearance of an individual who has been suffering
for months with this disease, will convince any one of my
assertion. Some have the appearance of one in the last
stage of consumption ; others appear sinking with a chronic
inflammation of the stomach ; others with affections of the
liver.

But if we refer to the pathology of those who have died of
the effect of along standing ague, we shall always find con-
gestion, or other injury of the brain, sometimes of the
stomach, or of some of the organs above mentioned. In
1852, writing upon this subject, I stated that 2,354 inter-

4(> Clark. Apparent Equivocal Generation. [January,

niittent fever patients in the wards of a French military
hospital on the north coast of Africa, 759 of them suffering
with the quotidian type, had disease of the mucous mem-
brane of the digestive tube, and 321 of them had suffered
from congestion of the brain ; that in those suffering with
tertian fever, the intestines were found diseased in 428
patients, and the brain in 175 others ; 51 were affected with
disease of the lungs, and 25 were affected with disease of the
lungs and brain ; 256 had suffered from chronic obstruction
of abdominal viscera ; 91 from disease of the spleen, and 20
of the spinal marrow.

It is evident, therefore, that if intermittent fever is not
soon checked, it will lead to the inflammation of some of
those organs above noticed, and it will, sooner or later,
compromise the life of the patient ; and if death is not the
immediate result, there always will exist irregularities of the
functions of the stomach, or a chronic inflammation or
obstruction of the liver, frequent headaches, and, perhaps,
chronic pulmonary affections.

It is only necessary to enumerate these results of fever and
ague, when not properly cured, as a sufficient argument in
favor of a speedy check of this disease, in the very beginning.
The most obstinate ague will- yield, in a few days, to the
methodical treatment of a well-informed physician. My
experience several years on the coast of Africa, where inter-
mittent fever is very frequent among the soldiers, and ten
years in the AVestern States, has convinced me that the
physician cannot rely on any specific, but only on a method-
ical treatment, the constitution of the patient, his strength
and age being previously consulted. I have found that
generally a bleeding, followed by the use of quinia, with ^uch
other remedies as the symptoms indicated, have always
accomplished Bpeedy and permanent euros.

On Apparent Equivocal Generation: by E.James Clark, of
Cambridge, Mass. (From the proceedings of the Ameri-
can Academy. Boston, May 10, 1859.)

At the close of our last social meeting I was asked if I
had seen any trace of organization in the globules of the
vibrio-like fibrillar of the muscle of sagitta. My answer
was in the negative. No longer ago than yesterday I was
fortunate in discovering the origin of another, or rather of
several forms of these pseudo-animate bodies called infu-

I860.] Clark. Apparent Equivocal Generation. 47

soria. Whilst watching the decomposition oftheinner wall
of the proboscis of a young aurelia flavidula, our common
jelly-fish, I observed that the whole component mass of
cells was in violent agitation, each cell dancing zigzag about
within the plane of the wall. If any one will shake about
a single layer of shot in a flat pan he can obtain an approx-
imate idea of the appearance of this moving mass. In a
perfectly healthy condition these cells lie closely side by
side, and do not move individually from place to place, but
yet are active on one side, which constitutes the surface of
the stomach, where they are covered by vibratile cilia. As
the young aurelia grows, this wall becomes separated from
the onler one, but not completely, for the cells of the two
adhere to each other by elongated processes varying in
number from one to six or seven- Each cell of the inner
wall contains numerous red or brown grannies, a few trans-
parent globules, and a single large clear mesoblast. When
decomposition ensued, these cells became still farther sepa-
rated from each other and danced about in the manner
which I have thus described. The vibratile cilia were not
observed to share in this movement; in fact, I could not
detect their presence, because, no doubt, they had become
decomposed and fallen away; but the elongated processes,
which heretofore had remained immovable and stiff, lashed
about with very marked effect upon the cells to winch they
belonged, and caused them to change place constantly. At
last the inner Avail fell to pieces, and wwy cell moved
independently and in any direction. If at this time they
were placed before the eyes of EhrenburgOr any one of his
adherents, he would at once pronounce every cell with a
single process a monas ; the red or brown granules would
be recognized as the stomachs tilled with food, the trans-
parent globules as the empty stomachs, and the large
mesoblast as the genital organ or propagative apparatus.
Those with two processes would be to him a ehilomonas or
some other genus closely related to it; those with three or
four on one side would be the oxyrrhis of I) u jar din : and
those with six or seven processes the hexamita of the same
author. To complete the apparently truthful determinations
of these microscopists, I would only have to place before
them some of these cells which I have found in a state of
self-division, each half possessing its genital-like mesoblast.
In all their various shapes and actions, and in the mode of
self-division, there is a remarkable and undistinguishable
resemblance to numerous moving bodies which go under

48 Jones. Iodide of Potassium. [January,.

the name of infusoria, and which may be found, uncon-
nected with any living organism in various kinds of infusions.

Therapeutical Action of Solanine and Dulcamara. Prof.
Caylus, of Leipzig, has undertaken a series of experiments
to ascertain the exact effect of dulcamara, and its active prin-
ciple, solanine. These substances belong to the class of nar
cotico-acids,as they produce a paralyzing action on the medulla
oblongata, and an exciting action on the nerves. They
cause death by producing paralysis of the respiratory muscu-
lar apparatus, by an action analogous to that of coneine and
nicotine. They possess a therapeutical action in spasms and
irritable conditions of the respiratory organs, in simple spas-
modic cough, hooping cough, and spasmodic asthma. Their
therapeutical action in certain morbid conditions of the bloody
as gout, rheumatism, constitutional syphilis, and perhaps in
certain chronic diseases of the skin may be due to their aug-
menting the excretion by the kidneys, of the constituent parts
of the blood which Lave undergone combustion, and not to
the excitement of cutaneous activity. Solanine and dulcamara
may be given without danger in inflammatory conditions of
the stomach and the intestinal tube, as they exercise no action
on those organs. Inflammation of the respiratory organs pre-
sents no contra-indication to the employment of solanine and
dulcamara, but they are contra-indicated in inflammation of
the kidneys. The medium dose of solanine for an adult is from
one to five centigrammes of acetate of solanine, a substance
which M. Caylus prefers to the pure alkaloid, in consequence
of its solubility. The most suitable form of administration is
in pills, the solutions of the salts of solanine having a very disa-
greeable taste. The extract obtained from alcohol, and then
washed witii water to remove the alcohol, is preferable to the
waterv extract generally employed. Presse Medicate Beige,
N(^./l858.

Diuretic Action of Iodide of Potassium. By C. Hand-
field Jones, m. D., F. R. S.
It appears reasonable to expect that the healing influence
of a drug in certain morbid states may be shown to be expli-
cable by its general mode of action, yet there are certain
remedies which exert a very positive curative power, and yet
afford no clue, in their general mode of action, to explain their
special effects. Such a remedy, according to Dr. H. Jones, is
iodide of potassium, which has certainly a strong controlling
power over periosteal inflammations, whether syphilitic or

I860.] Kortum. Typhus Fever. 4<>

rheumatic, as well as over rupial ulcers, which generally heal
under its use. It is also more or less useful in inflammations
affecting fibrous tissues in various parts. Dr. Jones has made
a Beries of experiments upon the effects of iodide of potassium

administered to patients, and has examined the urine in each
case ; ane the general results are thus summed up : 1. That
the quantity of water was greatly increased in three out of six
case- ; a little (one-sixth) increased in one; diminished in two.
2. Out of five cases, the acidity was increased in three, dimin-
ished in two. 3. Urea was increased in three, diminished in
three. -4-. Phosporic acid was increased in four, diminished
in two. 5. Sulphuric acid was increased in four, diminished
in two. 6. Chlorine was increased in three, diminished in
two out of five cases ; in two the increase was very considera-
ble. 1. Uric acid was diminished in four out of six cases,
greatly increased in the remaining two. The most marked
effects seem to be the increase of the water, of the phosphoric
and sulphuric acids, and of the chlorine. But Dr. Jones
adds, that as tar as these confessedly empirical results go,
there seems to be no help or clue afforded to trace out any
connection between the empirical facts just noticed. A va-
rying diuretic effect does not give any explanation of the
modus opt randi of the drug in curing a node or an ulcer. For
the present Dr. Jones concludes that we cannot attain to
more than an empirical acquaintance with the operation of
iodide of potassium. Beetle's Archives of Medicine, No. 3.

Proposition of an Abortive Treatment of Typhus Fever.
By Dr. A. Koettjm.

The means proposed by the author consist in the applica-
tion .of a lotion composed of a solution of chloride of calcium,
four grammes 5i to five hundred grammes Sxvi of water,
The body is sponged with this lotion threetimes daily, and
besides, there is kept applied to the abdomen a folded cloth
saturated with the liquid.

The observations upon which the author bases his proposi-
tion show that he has treated perfectly characterized typhus
fever, the progress of which has been arrested, and the cure
effected much sooner than if allowed its habitual course. The
author regards the skin as the principal seat of the poisonous
matter that characterises typhus, and he believes that it is in
the capillaries of the skin that the blood becomes charged with
this virus, from which it is disseminated into the system. Ac-
cording to this view, the chloride of calcium neutralizes the
poison. The author concludes by entreating his medical con-

50 Fountain. EpistaxU [January,

freres to employ this mode of treatment, and to make known
the result. Gas< tt> Med., Aug. 20, 1859 ; from Journal Fuer
Kinderlcrankheiten. E. B. H.

On the Employment of Veratria in AcuU Diseases of th Chest.
(Bulletin General de Therapeutique, Jan. 30th, 1859.)
M. Aran has called the attention of practitioners to the
remarkable effects produced by the internal use of veratria
in febrile diseases, and especially pneumonia. In the 'Sar-
dinian Medical Gazette' an article has appeared, in which
Dr. Ghiglia, without any knowledge of Mr. Aran's re-
searches, recommends the use of veratria in the same cir-
cumstances, except that lie never employs this alkaloid alone,
but associates it almost always with opium, sometimes in
the form of pill, sometimes as syrup. The dose of veratria
is five millegrammes (.077 of a Troy grain) in a pill with
the same quantity of opium, and the number of pills to be
taken in the twenty-four hours varies from six to seven, and
even twelve, according to the circumstances. In this dose,
according to M. Ghiglia. vomiting rarely occurs, but nausea
and the other depressing effects of veratria arc present.
The results obtained by M. Ghiglia in certain cases of
pneumonia, bronchitis, and broncho-pneumonia, have been
sometimes most remarkable, but have been occasionally
unfavorable, and the following are the results arrived at by
this author: " 1. The inflammation of the respiratory
organs, when they have arrived at such a period as to pro-
duce disorganization of the parts, are net improved by the
use of veratria. 2. The action of this substance is the more
favorable in proportion as the disease is more recent. 3.
The tolerance is very various, aecordingto individual habits,
and perhaps also according to certain peculiarities which are
not yet well understood. 4. The more easily the tolerance
ceases the more marked is the depression. 5. Veratria is
in many respects a preferable medicine to others which are
more constant in their action but less easy to take. And 6.
It is perhaps prudent, in severe inflammations of the respi-
ratory organs, to order a few bleedings before prescribing
the veratria."

Epistaxis of Alarming Character Arrested by Injections of the
Perehloride of Iron, By E. J. Fountain, M. IX, Daven-
port, Iowa.
I am induced t<> publish the following case from reading

the report of " Death from EJpistaxis," occurring in the

practice of Dr. Triplett, of Virginia.

I860.] Of Alarming Character. .~>l

About two years ago L was summoned in haste to see a
young man who was reported to be in a dying condition

from the loss of blood. The bleeding had continued
uninterruptedly \'ov about thirty hours, escaping constantly
from the nostrils, and frequently thrown out in clots from
the posterior nares.

He bad been attended by a Grerman physician, who had
not succeeded in arresting the haemorrhage, and before my
arrival be bad abandoned the case, from motives which J
need not here mention.

I found him in a frightful condition, bis face, bands,
linen, and much of the bed-clothing, and the floor, being
covered with blood, In one corner of the miserable apart-
ment, where many people were crowded, was a pile of rags
and towels, saturated with blood.

] le was so impoverished that he could not support himself
in an upright position, and the extreme palor of his skin
and colorless lips indicated plainly that he had lost a large
quantity of blood.

I immediately plugged the nostrils, anteriorly and poste-
riorly, in the usual way. I supposed this would arrest the
haemorrhage, but I was mistaken. Very soon the blood
escaped through the plugs in each direction, and the flow
returned as profuse as before. I then removed the pings,
and rolling up two quite large pieces of fine, dry sponge,
I introduced them as before, and so firmly, that I thought
it would be impossible for a drop of blood to escape. 1
then left him, and returning an hour after, I was astonished
to find the blood escaping asfreely as ever. 1 again removed
the pings, and washing out the nostrils by injections of cold
water, I pressed into each a roll of tannin, made into a soft
mass with a little water and glycerine ; I packed the nostrils
full with this, but it did no good. I then introduced the
plugs a third time, using compressed sponge, and forcing
them in so firmly, that I feared I might have great difficulty
in removing them. I then had ice applied constantly to
either side of the nares, and kept the patient perfectly quiet.
This answered the purpose for about half an hour, and then
the bleeding returned as bad as ever. By this time the
patient experienced the alarming symptoms of exee<sive
loss of blood ringing in the ears, occasional blindness, &c.
The case looked desperate to me, while the patient, and
even some of his friends, protested against further effort, as
useless and cruel. I saw that it must be checked very soon,
or it would surely he fatal. I removed the plugs with some

52 On the Spinal Cord, [January,

difficulty, and washing out the nares, I passed into each a
piece of nitrate of silver, about a quarter of an inch in
length, carrying them back with the forceps about four
inches. I also introduced a curved injecting instrument,
perforated towards its extremity with a number of small
openings, and forcibly injected a strong solution of the same
caustic. This did no good.

It now occurred to me that the perchloride of iron might
answer the purpose. I soon procured it, and after washing
out the nostrils as before, I injected a quantity of the undi-
luted perchloride into each nostril. This immediately
checked the bleeding, and proved an effectual remedy.

Twenty-four hours after this the bleeding again returned,
when I repeated the injections, and with the same happy
effect.

There was no recurrence of haemorrhage after this, and
the patient soon recovered, so as to go about, but for quite
a long time felt the effects from the loss of so much blood,
which had been so excesive as to leave him but a very
slender hold upon life. I know not in what other way it
could have been saved ; and the publication of this maybe
the means of rescuing others in similar circumstances.

" On the Spinal Cord. The Compte Rendue, Eo. 24, 1859,
contains an analysis by Mr. Flourens, of a memoir to the
4-cademie des Sciences, by MM. Paolixi, on this subject.
The resume of his experiments are set forth in the follow-
ing :

" 1. The posterior and lateral cords of the spine are
endowed with exquisite sensibility.

"2. The division of these cords impedes sensitive
impressions to the encephalon.

" 3. The impressions are transmitted by the posterior
spinal roots, after a short passage by the side of the medul-
lary fibres of these cords, thence pass into the gray substance
of the column.

"4. The gray substance although insensible to the same,
and incapable of receiving impressions excited in the
sentient Bystem, yet appears to be the channel or means
indispensable for the transmission of these impressions to
tlir sensorium commune.

" 5. The posterior cords alone, being cut transversely, it
is found that the sensibility of the parts of the animal
below the section are temporarily augmented.

I860.] Sedillot. Epithelial Cancers. 53

u6. The posterior cords preserve their proper sensibility
well, when cut at two or three points, at certain distanc< -
from each other.

" 7. The anterior cords are insensible to the immediate
application of stimulus.

" 8. Finally, the anterior cords are essentially motors,
and strangely enough they*have no semblance to the pro-
duction of sensation.

"M. Flourens at the same time submitted an analysis of
a paper by M. VanKempen, of the University of Louvaine,
concerning some physiological experiments on the trans-
mission of sensibility and motion in the spinal cord. The
author has repeated his experiments for several consecutive
years, and those also of other physiologists, and arrives at
the following conclusions :

"1. In frogs, the transmission of conscious sensibility, is
crossed (croise,) and continues the entire length of the spine ;
that of movement, on the contrary,- is direct in the lumbo-
dorsal portion, and crossed in the cervical portion.

" 2. In pigeons the inter-crossing of the conductors of
conscious sensibility are placed throughout the entire length
of the cord. The transmission of voluntary movement is
direct in the lumbo-dorsal region ; and is, on the contrary.
but part'" din crossed in the cervical region.

u 3. In the mammifers, the propagation of conscious s< nsi-
bility is crossed for the length of the column. The trans-
mission of voluntary movement is direct only in the lumbo-
dorsal region ; in the cervical region it is in part crossed.
and a very large part is again direct ; in all our experiments
upon the posterior side of the organ, we have found strong
paralysis of the opposite side." Pacific Medical and Surgical
Journal.

On the Treatment of Epithelial Cancers by the Application of the
Aetual Cautery. By M. Sedillot. (Revue de Therapeu-
tique Medico-Chirurgieale and Journal de Medecine de
Bordeaux, October, 1859, p. 693.)

In the treatment of epithelioma, the rule, which is always
observed, is to remove the whole of the morbid mass, to-
gether with a portion of the surrounding healthy tissues, in
order to prevent a return, and this object may be effected
by the use of the knife, the potential cautery, or by means
of the Vienna, arsenical or Canquoin's paste.

There are some cases which are very embarrassing to the

54 Sedillot. Epithelial Cancer$. [January,

surgeon, as it is difficult to stop the progress of the disease,
and two dangers are thus encountered, either to abandon
the patient to his fate or to expose him to great deformity,
which is scarcely counterbalanced by the certainty of a
cure. Cases of this description are those in which the can-
croid affection threatens to involve the free border of the
lids or attack the whole thickness*)f the walls of the nose,
or when it approaches the commissure of the lips or the
auditory canal.

It has long been known that fibrous tissue is not prone
to be invaded by epithelial cancer, and M. Sedillot consid-
ers it philosophical to profit by this fact, and, by the appli-
cation of the hot iron, produce a dense, fibrous tissue, with
slight organization and no tendency to morbid changes.
By this means to destroy the disease, and create a barrier
to its extension with little danger of relapse.

Another motive for adopting this practice is, that pro-
longed suppuration is favorable to the elimination of can-
cerous elements, an opinion which the author has verified
by the microscope, finding that portions of tissues, infiltrated
with cancer at the time of the operation, did not present
any trace of the disease after several weeks of suppuration.
This was a favorite treatment of M. Boyer, who persisted
in causing the wounds made in the extirpation of cancroid
growths to suppurate for some time, with the effect of
having but few returns.

M. Sedillot reports five cures by this procedure, of which
the following case is a good example. A woman, seventy
years of age, presented herself at the clinic with an epi-
thelioma of the lower lip, of seven months duration, one
and a third inches in breadth by one inch in length. The
mucous membrane was scarcely ulcerated, but if the ordi-
nary operation by a Y-shaped incision had been performed,
it would have been necessary to remove two-thirds of the
lip. The most projecting portion of the tumor having been
snipped off with the scissors, the hot iron was applied to it,
and in four days more was again repeated. The cure was
complete in fifteen days, and in two months after the
operation a photograph of the patient was shown to the
Academy of Sciences, from which it was evident that the
middle portion of the lip was restored in a regular manner,
its breadth and length being preserved, and the cicatrice
being soft and unbroken.

The author believes the procedure to be very simple, not
attended with much loss of substance, and more sure than

I860.] Jeannel. On the Action of Fatty Bodies 55

the knife. As chloroform is always to be administered,
the patient's w-av* arc quieted, and he experiences no pain.
Should an indurated spol appear in the cicatrice, denoting
a tendency to a return of the disease, it musl be treated in
the same manner.

On tin Action of Fatty Bodies in the Absorption and Assimila-
tion of the Metallic Oxides. By Dr. Jeannel, of Bordeaux.
(L'Union Medicale, Feb. 15th, 1859.)
Dr. Jeannel has niade a number of experiments, from- the

results of which he is led to 1 slieve that lie will be enabled
to explain the very obscure question as to the part taken by
the acid or neutral fatty bodies of the blood in the absorp-
tion and assimilation of the metallic oxides. These experi-
ments will also, he thinks, contribute to support, in a novel
point of view, the opinions offered by MM. Arthaud and
Dupasquier as to the hygienic operation of the bicarbonate
of lime, which is in fact a mineral aliment. They will at
least prove this singular fact, that in the experiments of the
laboratory, the bicarbonate of lime of the potable waters
may become the medium of dissolving the metallic oxides
in the fat oils, in tact, he hopes to prove that several im-
portant smalts, as sulphate of iron, potassio-sulphate of iron,
sulphate of copper, bichloride, biniodide, and protochloride
of mercury, being decomposed by the bicarbonate of lime
of the potable waters, by the alkaline carbonates or bicar-
bonates in a weak solution, or by the carbonates of the
alkaline animal liquids in presence of the fatty oils, are
dissolved in considerable proportion by the latter, especially
at the temperature of the body. Dr. Jeannel observes that
the metallic salts introduced into the stomach, if they resist
the solvent action of the acid liquids in the first digestion,
and if they are not absorbed with the water taken as drink,
must necessarily pass into the intestine, and there undergo
the decomposing action of the alkaline liquids in presence
of the fatty matters with which the oxides form combina-
tions susceptible of being absorbed under the form of
emulsion. lie also finds in liquid blood, which is at once
alkaline and fatty, the elements which his experiments
proved, when artificially united, to be capable of transform-
ing the mineral salts dissolved in water into insoluble but
deleterious oleo-stearates or oleo-margarates ; and he is led
to believe that the fatty salts are the definitive form assumed
by the metallic salts, whether they pass directly into the

56 Jeanxel. On the Action of Fatty Bodies. [January

blood in the form of a weak aqueous solution, or undergo
decomposition by the alkaline intestinal liquids. It would
therefore be under the form of fatty salts that we ought
rationally to administer metallic agents, when we propose
to moderate irritability of surface and to obtain constitu-
tional effects.

From the results of numerous experiments, Dr. Jeannel
draws the following conclusions :

1st. A solution of a metallic salt being decomposed by
an alkaline carbonate in presence of a fatty oil in excess at
the ordinary temperature, a part of the metallic oxide passes
in solution into the fatty body. This reaction is favored
by a temperature of 40 Cent,

* 2. The bicarbonate of lime of the potable waters decom-
posing very weak metallic solutions, the oil which is shaken
in the mixture seizes the metallic oxide, at least in part.

3. The alkaline animal liquids, as serum of the blood,
milk, and white of egg, being placed in contact with a me-
tallic salt in weak solution, and oil, the alkaline carbonate
contained in the animal liquids is most frequently sufficient
for decomposing the salt, the oxide of which is dissolved in
notable proportion in the fatty body.

4. If it is supposed that an aqueous solution of a metallic
salt having escaped digestion in the stomach, arrived as tar
as the intestine, it must be admitted that it is there decom-
posed by the alkaline animal liquids mixed with fatty
matters,, and that the metallic oxide enters in solution into
the latter.

5. The same facts and reasonings lead us to admit that
an aqueous solution of a metallic salt arriving at the blood
undergoes at first a double decomposition, the final conse-
quence of which is the formation of a fatty salt.

6. Calomel is decomposed by a weak solution of bicar-
bonate of soda; chloride of sodium, and probably bichloride
of mercury, are formed and dissolved together. The presence
of chloride of sodium retards this decomposition and solution.

7. Calomel being mixed with water containing bicar-
bonate of lime or bicarbonate of soda in solution, if oil is
shaken with the mixture, it becomes charged with a notable
quantity of mercury. All these reactions are favored by a
temperature of 40 Cent.

8. If in the administration of medicines from which a
c( institutional or dynamic effect is desired, we would en-
deavor to imitate the compounds formed naturally in the
organism, we ought to prefer the form of fatty salts in the-
administration of metallic agents.

I860.] Mitchell. Cataract in Frogs,

On the Production of Cataract in Frogs by the Administration
of Sugar. By S. Weir Mitchell, M. D. (Read b<
the Biological Department of the Academy of Natural
Sciences, October 3, 1859.)

A few months ago I had occasion to perform a large
number of experiments upon the osmosis of woorara
through animal membranes. During one of these experi-
ments, a solution of the poison was placed within the
stomach of a rabbit, and, the two extremities of the organ
being secured by ligature, it was suspended in syrup. v At
the close of two hours a portion of the syrup, about two
drachms, was 'injected into the subcutaneous tissues of a
pigeon, who did not suffer from it in any way. A frog of
small size received at the same time, in the dorsal subcu-
ticular sac, about one and a half drachms of the suspected
syrup. Much to my surprise he became feeble, and died
in about four or five hours. As it was not impossible that
the syrup used might contain woorara, owing to this sub-
stance having exosmosed from the stomach, the death of
the, frog was attributed to the poison. To correct this result,
the remainder of the syrup, about three ounces, was evapo-
rated to dryness and treated with alcohol. The alcohol
was then carefully evaporated to a small bulk, and injected
under the skin of a pigeon. Upon close examination it did
not appear to be poisoned, or to be in any way injured by
the injected material. It now occurred to me that, as the
amount of sugar employed in the case of the frog was very
great compared to his bulk, it might, possibly, be destruc-
tive to life when used in very large doses.

Experimmt To test this view, three frogs of middle size
were treated with sugar in the form of syrup, two drachms
being injected into the dorsal subcuticular sac of each ani-
mal. Within two hours the first frog became sluggish ; the
dorsal sac, which had gradually enlarged, swelling from an
accumulation of fluid in its interior. This fluctuating mass
was the syrup, augmented by the exosmosis of fluids from
the vessels or extra-vascular tissues, or both. As the frog
became more and more feeble, the larger part of this collec-
tion of fluid disappeared. The frog died at the close often
hours. During the latter portion of this time my attention
was arrested by the white appearance of the frog's eyes,
which, on close examination, proved to be eataractous; the
cornea remaining perfectly clear and transparent.

Experiment. The second frog was treated with repeated
doses of syrup given internally. The phenomena of exos-

58 Mitchell. Cataract in Frogs [January,

mosis were for less marked in this case, but large quantities
of mucus collected in both stomach and oesophagus, and
were finally disposed of, in part, by vomiting. The mode
of death did not differ from that last described. The cata-
ractous appearance was not seen until just after the frog's
death.

Experiment. The third frog was placed in syrup, so that
when seated in the usual posture the syrup covered its hind
legs. Death took place in seventeen hours, but the cataract
was not formed as usual, or, at least, was not externally
visible. I did not examine its eyes post-mortem.

From the time I observed the development of this curious
form of cataract it became a chief point of interest in the
sugar poisoning, and was studied with attention. A few
preliminary experiments convinced me that the best and
most certain mode of causing the cataract was to inject the
sugar in syrupy solution into the subcuticular sacs. The
results thus obtained were extremely curious. Of eight
frogs, nearly alike as to size, and all of one species, (R.
pipiens), thus treated with injections of two and a half
drachms, six had cataract. In four of the six this was
apparent during life, in one it was doubtful until after
death, and in one no cataract could be seen until after
death. Of the cataractous cases one was thus affected short
of six hours, the remainder became so affected between six
and thirty-eight hours. Two of the frogs suffered con-
siderably from the poisoning, if such it may be termed; but
both survived, and had no externally visible cataractous
opacity. . In all of these experiments the frogs were placed
under bell glasses, tilted to insure ventilation, and were
kept moist in each case by a piece of wetted sponge. In a
second series of experiments, conducted in precisely a simi-
lar manner, it was found that when the frog died very early,
as sometimes occurred, no cataract became visit)] e. When
they survived rather longer, the cataract was a more fre-
quent incident; but in a few cases no such formation took
place, in despite of frequent doses of sugar to a very large
amount.

It now became clear to me that I had discovered a method
of producing in frogs an opacity of the crystalline lens,
which might be of some value as illustrating the pathology
of a subject which has always been one of extreme difficulty.
So far as I am aware, no one has ever succeeded in causing
cataract in the eyes of dead animals without wounding the
organ, and all heme of being able to govern its synthesis in

I860.] By Administration of Sugar. 59

living animals lias long since been given up. Many of the
frogs upon whom I operated survived the constitutional ef-
ects, and remained more or less active with highly catarac-
tons lenses. The change produced was not, therefore, of ne-
cessity associated with mortal symptoms, nor could it be
regarded as a mere post-mortem phenomenon, since, even in
the animals which did not finally survive, the lens became
opaque some time before death.

With the view of ascertaining the cause of the opacity of

the lens produced' hy the sugar poisoning, eel-tain experi-
ments were directed towards the determination of the effect
of altering the external conditions while the frog was still
suffering from the sugar. The first experiment was as fol-
lows :

Experiment. A large frog received under his skin about
two drachms of syrup. Two drachms were also forced into
the stomach through a tube, and the same amount was
given in a similar manner at the close of an hour. As soon
as the frog became sluggish he was placed in water and left
there, lie soon began to recover, and the water about him
being changed thrice in the ensuing eight hours, he recov-
ered perfectly. The dose of sugar would certainly have
Bufficed to destroy life had the supply of water been limited.
A repetition of the hist experiment satisfied me that, even
with a very large dose of sugar, the animal was safe if
allowed to remain in water kept fresh by frequent changes.
Thus tar everything pointed to osmotic changes as tbe
probable agents in the production of the curious variety of
cataract under consideration. The result of the next
experiment, which in the sequence of thought naturally
suggested itself as a test of this hypothesis, was such as to
strengthen it considerably.

Experiment. About two drachms of syrup were injected
under the skin of a large frog. In twenty-four hours the
lens was opaque, and, as the animal appeared lively, it was
placed in water in order to test the permanence of the
opacity. Ten hours in the water sufficed to remove most
of the opacity from the lens, which began to clear in the
centre first. Twenty-four hours after the frog had been
placed in water the eyes were perfectly transparent, and the
animal itself entirely well.

Experiment. A distinct case of double cataract was pro-
duced in a large frog by the usual means. When the
cataract first began to be visible it was placed in water.
During live hours the opacity increased. In the ensuing

60

Mitchell. Cataract in Frogi

[January,

eight hours it diminished perceptibly, but, although the
water was changed twice a day, some traces of the cataract
were visible during several days. The frog recovered en-
tirely from all the effects produced by the sugar.

Experiment. A large frog was seated in syrup. In a few
hours he was nearly dead. The mucous membrane of the
mouth and tongue was intensely congested, and the parts
under the eye particularly so. On placing the animal in
water he slowly recovered. The eyes remained clear
throughout, and were not visibly affected. The congestion
above referred to is a constant accompaniment of the death
by sugar, but varies in degree to a remarkable extent, and
does not seem to be in any way connected with the altera-
tion of the lens.

It was found in the course of the several experiments
related, when syrup was thrown into the subcuticular dorsal
sac of a frog, it at first acquired increased bulk, owing to
the rapid osmosis of their fluids from the frog's tissues.
During this period no change occurred in the lens. As the
saccharine solution became more aiid more diluted the cur-
rent of interchange developed, and the sugar gradually
soaked into the tissues of the frog, so as to be found in
most of the subcuticular sacs as well as in the peritoneal
cavity. As it was still possible that the original loss of
water by the tissues during the first stage of sugar poison-
ing, might be the cause of the cataract which afterwards
formed, and, as in this case, the effects produced would be
in some respects similar to rapid desiccation, the following
simple test was employed :

Experiment. Two frogs were placed in open jars and
allowed to remain without water, the temperature being
from 75 to 88 F. During the experiment one frog died
on the fifth cla}^, the other on the sixth day. In neither of
them was there any cataract. Both frogs were much
shrunken from the loss of fluid. Mere desiccation was,,
therefore, insufficient to cause the opacity.

From time to time, during the conduct of these experi-
ments, the lenses of the poisoned frogs were carefully
examined by Dr. Ilewson, Dr. Hunt, and myself. Dr. Hunt
very kindly furnished me with notes of his observations,
and, as they accord perfectly with my own results, I shall
content myself with quoting his description of the general
appearances presented by the cataractous lenses: " The
capsule of the lens is clear, and the cells upon its lenticular
surface are unaltered. The opacity begins upon the poste-

I860.] By Application of Sugar. 61

rior face of the lens directly in the axis of vision. If is nexl
seen on the anterior surface around a clear < pot,

which corresponds to the line of cleavage between the dif-
ferent systems of lens fibres or tubes, the centre of the
of the lens. The opacity gradually extends all around the
lens, but as yet I have never met with a case where it
involved the central portions; which, on the contrary,
always remain clear notwithstanding this limitation. The
outside color of the lens is often of a pearly whiteness, and
the simulation of a true cataract is absolutely perfect,"

When such a lens is viewed under a low power, in place
of the faint indication of the track of the lens fibres which
is usually seen, the line of cleavage is unduly distinct, and
the lib res setting out from it are edged with dark, irregular
lines, marking the interlocking with the neighboring fibres.
A good deal of granular matter is also dispersed through
the preparations. In more advanced cases the fibres or
tubes are enlarged irregularly, and, their interior contents
escaping, arc seen abundantly in the form of yellowish pel-
lucid globules about the tubes and throughout the field of
view. My friend, Dr. Hunt, and I have also observed that
the same changes may be produced by soaking the eyes of
frogs in syrup. By properly regulating the strength of the
syrup, cataract may be thus induced without any rupture of
the eyeball. I have made no experiments with larger eyes,
>ut it is probable that, in these also, cataract could be thus
induced, and the eyes then made use of to teach the opera-
tive manual. Some' such resource has long been considered
lesirable by teachers of ophthalmic surgery.

It may be further remarked that opacity by sugar may
>e produced by simply soaking the exposed lens in sugar
and water. However caused, the cataraetous whiteness
disappears when the lenses are placed in water, but they
do not become entirely transparent where the opacity has
existed for some time, or where it is very highly marked.
Tins may be owing to the fact that in extreme cases the
lens tubes are not merely altered in form, and in their
relations to one another, but are also ruptured and partially
emptied of their softer albuminous contents ; lesions which
no restoration of their aqueous supply could entirely relieve.

It appears, from the various experiments here related,
that mere abstraction of water from the lens is insufficient
to cause opacity ; a conclusion which is strengthened by the
knowledge that the exposed lens, when dried, does not be-

62 Mitchell. Cataract in Frogs. [January,,

come opaque. As it is found that the formation of the
cataract attends the second stage of sugar poisoning, or that
in which the sugar soaks into the tissues, it is probable that
the direct contact of sugar with the lens is essential to the
production of the phenomenon in question. That the
changes which then result are osmotic seems sufficiently
clear ; but whether due chiefly to absorption of sugar in
solution by the crystalline humour, or to exosmosis of the
thinner portions of the lens fluids to the sugar, we have no
means of determining. We may conclude, however: First.
That sugar in large amounts destroys the life of the frog
when given internally, injected under the skin, or thrown
into the stomach. Second. That an abundant supply of
water frequently enables the frog to eliminate the sugar
and escape death. Third. That the formation of a peculiar,
variety of cataract is one of the most curious and striking
symptoms attendant upon the sugar poisoning. Fourth.
That the cataract is due to mechanical disturbances of the
form and relative position and contents of the component
tubes of the lens.

It is, perhaps, unnecessary to remark here that we have
no knowledge of any such form of cataract in man. Not-
withstanding this, it would be improper to omit to state
that cataract has occasionally been found to co-exist with
advanced diabetes mellitus. Very recently, indeed, Mr.
France* has reported five cases of double cataract occurring
in dialtetic cases. In all of these, the cataract, which was
always soft, formed with great rapidity when the constitu-
tional malady was far advanced ; and in all of them the
lens increased in size antero-posteriorly, and the opacity
attacked portions of several strata of the crystalline humour
at once, leaving clear and transparent interspaces. Xow
that the diabetes has any other causative relation to the
cataracts in question than through the general impairment
of the nutritive functions common in this disease, I do not
pretend to say: but as it is possible that the long-continued
presence of even a small amount of sugar in the blood may
cause in the crystalline lens osmotic changes productive of
opacity, I have felt it proper to call attention anew to the
relation between the two maladies in question.

* American Journal of the Medical Sciences. July. 1S59. p. 266 : from Ophthal-
mological Hospital Reports, January, 1859.

I860.] Maissonneuve Operation. 63

Maisonneuve's Operation for the Removal of Nasopharyngeal
Fibrous Polyps. (Gazette Hebdom., Nos. 39, 40, pp. 609
and 625, September and October, 1859.)

The French medical world has lately been occupied in
discussing an operation, proposed by M. Maisonneuve, for
the extirpation of fibrous polyps involving the posterior
nares and pharynx. The difficulties with which the sur-
geon has to contend, in reaching and completely removing
the pedicle of these tumors, are well known to all operators;
and with a view to their obviation, the author advises the
division of the soft palate in the median line, leaving intact
its free border. Through this opening, which he denomi-
nates the palatine button-hole, he brings the tumor, and then,
placing as far back on its pedicle as possible a loop of wire,
he removes it by ecrasement, afterwards closing the opening
by points of suture or leaving it patent for further opera-
tions,' if deemed necessary.

The principle on which this operation is founded is not a
new one. In 1717, Manne, of Avignon, advocated the re-
moval of fibrous tumors of the pharynx by dividing the soft
palate in the median line, but he also included its free bor-
der in the incision. Nelaton also divided the soft palate,
and with it a portion of the hard palate. Richard confined
the incision to the hard palate, while Botrel proposed a
modification of Kelaton's procedure by not including the
free border of the soft palate. Dieffenbach seems to have
been the first to propose leaving the free border intact; but
he doubted its success, and reports only one favorable issue
from this operation.

M. Maisonneuve has, therefore, merely revived an old
operation, which had fallen into disuse, but which may
prove of signal service, since the difficulty in this class of
cases is not only in reaching the tumor, but in preventing
its return, which may be effected by the judicious use of
caustic applications. We thus infer that if the procedure
be practiced, the wound should not be closed immediately,
but that surgical interferance be maintained until we are
certain that the pedicle of the tumor be destroyed, a result
absolutely necessary to a radical cure. In case of hemor-
rhage, the incision may be performed on one day and the
tumor be removed the next; and it is stated that such
wounds unite very readily.

64 Delattre. Oleum Morrhce. [January,

Comparative Researches on Oleum Morrhuce, Rajce, and
Squali. B}- M. Delattre.
In order to test the statement of M. Ilomolle, that the oils
of the codfish, ray, and shark are of nearly the same com-
position, M. Delattre has subjected these oils to a careful
examination. He prepared them from the fresh livers of
these fishes, excluding atmospheric air as completely as
possible during the process, and used for this purpose an
apparatus of his own invention, consisting of a very large
sand bath, in which large balloons of glass are buried to
their middle. The livers, cleaned from all impurities, are
put into these balloons, and the latter are brought in con
nection with a reservoir, out of which a stream of carbonic
acid is generated, which expels the atmospheric air. This
being done, the sand bath is heated to 50 or 60, the oleum
virgineum beino; gained at 50, the amber-colored oil at 60.
Especial care is taken to prevent the formation of oleic,
sulphuric, or phosphoric acid during the process. The
author obtained the following average for the composition
of cod-liver oil, (I,) the oil of the ray, (II,) and the oil of
the shark, (HI,) :

I

Oleine .... 9$8.70

Margarine ... 8.06

Chlorine . . . 1.12

Iodine . . . 0.32

Bromine ... 0.04

Sulphur . . . 0.20

Phosphorous . . 0.20

Loss .... 1.34
During his investigations, M. Delattre observed the
following important facts: 1. While cod-liver oil contains
at common temperature 180 grmm. of margarine in 1000
grmm. of oil, it loses at zero nearly all its margarine, so that
it contains not more than 4 grmm. in 1000 grmm. ; along
with the margarine a corresponding quantity of anorganic
substances is separated. 2. Iodine, bromine, chlorine,
phosphorus and sulphur do not exist in the oils of these
fishes, combined with potassium or sodium, as is generally
believed, but in the free state. The three oils, as obtained
by M. Delattre, do not, in fact, contain any alkalies at all.
3. During spring the cod-liver oil does not contain any
iodine. Further investigations might, therefore, prove the
necessity of keeping the oil obtained at that season out of
trade.

H.

III.

986.94

987.17

11.01

10.12

1.12

1.01

0.18

0.34

0.03

0.03

0.16

0.16

0.28

0.20

0.24

0.94

1800.] Schroff. ? of Hetteborus. 65

From experiments made on the sick, M. Delattre amyed

at the following conclusions in regard to the therapeutical
action of the three oils: 1. The physiological action of all
of them is the same; they may, therefore, be \\^>(\ as sul
tutes foreach other. 2. Thereexists, however, the following

difference in regard to their therapeutical applicability :

;! is more efficacious in phthisical patients

than the oil of the shark and of the ray. b. The oil of the
ray is employed with greater advantage in the diarrhoea
attending dentition, and in swellings of the mesenteric
glands, also in chronic diseases of the skin, and in rheuma-
tism. 3. The oil of the shark is most useful in affections of
the bones.

Devergie, who compared cod-liver oil and the oil of the
shark with each other, found the latter not only more
pleasant, but also quite as efficacious as the former. It is
thus an important circumstance, as the supply of sharks
(particularly of Squalus catulus) is never deficient, while
Gadus Morrhuse can often not be obtained, and as the shark
possesses much less value than the codtish. (Buttetm de
...\\ xxiv. p. 820, 1859.)

On different Species of Hetteborus. By Prof. Schroff.

After treating in a very thorough manner of the phyto-
graphy of the different species of helleborus which he has
investigated, (Helleborus niger, viridis, orientalis Lam., and
fcetidus.) the author proceeds to the second part of his
treatise, in which he communicates the results of his experi-
ments with different preparations of these plants. The
following is a summary of the most important tacts observed
by him :

I. Results of the experiments made with hetteborus nig
rabbits, and on man in health and disease. 1. The root of
helleborus niger. which is inodorous and nearly tasteless.
does not possess any volatile active principle, as the fresh
root in its totality is just as inefficient as a corresponding
quantity of the dried and pulverized root. From on<
four and a half drachms of the fresh root acted upon rabbits
just as little as one or two drachms of the dried root. 2.
The root of helleborus niger possesses but little efficacy : its
aqueous and ethereal extracts do not produce any perceptible,
or, at the most, but a transient effect. Only the alcoholic
extract of the root, obtained in May, is somewhat more
active ; its administration had a fatal result in two animals,
and in a third one it produced very serious symptoms. At
all other stages of its development, the root yielded an

66 Schroff. On Species [January,

alcoholic extract which was almost inert. Also the leaves
of the plantpossess but little activity. 3. The root obtained
in May is more active than that gathered at any other period ;
next to it in efficacy is that obtained in June. 4. Two of
the experiments instituted on animals, but particularly the
observations made in sick men, prove, in a striking manner,
the cumulative action of the root of helleborus. Given to
rabbits in gradually increased doses, it produced in a few
days considerable emaciation, in spite of the existing desire
for food, and finally death. In patients to whom the extracts
were administered in gradually augmented doses for several
days, the first few doses did not seem to have any effect ;
but, after several doses had been taken, the action of the
medicine became perceptible, and increased with each
subsequent dose to such a degree of intensity that the
medicine had ito be discontinued ; large quantities were,
however, necessary to obtain such a result. Helleborus is
thus a medicine to which the organism does not accustom
itself, but which, like digitalis, colchicum, aconite, strychnia,
and veratria, adds to the action of each subsequent dose
that of all the former doses. 5. As in aconite, digitalis,
and pulsatilla, the active' principles in helleborus are a
narcotic and an acrid one. The presence of the narcotic
principle is testified by the following symptoms : Heavinesss,
dullness, stupefaction of the head, vertigo, tinnitus aurium,
dilatation of the pupil, sopor, or a restless sleep, interrupted
by dreams, reduction of the frequency of the pulse, unusual
lassitude, ill humor, anxiety, and apprehension. The
presence of the acrid principle, and particularly its action
on the digestive apparatus, is proved by the increased
secretion of saliva occasionally observed, the vomiting, the
pain in the stomach and intestines, the diarrhoea which
occurs in exceptional sases, and the increase of the urinary
secretion noticed in some instances. Applied to the skin,
neither the fresh root of helleborus niger, nor the powder
of helleborus orientalis and viridis, made into a poultice
with water, produce any irritation, inflammation, or vesica-
tion, as is commonly assumed. 6. The immediate cause of
death is paralysis of the heart, which is probably owing to
the action exerted by the blood upon the ganglionic nervous
system. It is remarkable that the irritability of the stomach,
small intestines, and heart disappears in an unusually short
time, (a few minutes after the last respiration.) 7. The
drastic properties ascribed to helleborus have not been
confirmed, and the gastro-enteritis, said to follow the

1660.] Of Helleborus. 67

exhibition of large doses, has neither been found in acute
nor in chronic cases of poisoning. 8. The aqueous extract
is inferior in efficacy to the alcoholic extract ; the former
contains chiefly the narcotic principle, while in the latter
also the acrid principle is found.

II. Mcperiments with helleborus viridis on rabbits and men.
1. The root of helleborus viridis, like that of helleborus
niger^ does not contain any volatile principle. 2. The root
us well as the herb possess, compared with that of
helleborus niger, a high degree of efficacy. Two drachms
of the fresh, or one drachm of the dried and pulverized root,
produced death in seven and seven and a half hours, while
four and a half drachms of the fresh root, and one to two
drachms of the dried root of helleborus niger gave rise
to no perceptible symptoms in animals. Doses of fifteen
grains of the pulverized root make a decided impression,
but do not produce death of the animal. One drachm of a
stronger alcoholic extract killed the animal in one hour ;
the same dose of a weaker extract in three hours. Ten
grains of the alcoholic, ethereal, and aqueous extract caused
death always in from four to twelve hours, while one or two
drachms of the aqueous and ethereal extract of helleborus
niger produced but little effect. The extracts of the leaves
acted in a corresponding manner, 3. Also helleborus viridis
contains a narcotic and an acrid principle, but in much
larger quantity than helleborus niger. The symptoms are
the same as produced by helleborus niger, but are much
more intense ; the irritation of the intestinal canal espe-
cially is much more violent, and attended with fluid
discharges, (even after a dose of two to four grains ;) the
diuresis is much increased. 4. Helleborus viridis, like
helleborus niger, pioduces death in consequence of the
paralysis of the heart. The depression which induces the
paralysis i->. however, often preceded by a stage of exaltation,
during which the action of the heart and the lungs becomes
more rapid and tumultuous, and congestion of the blood
takes place to the brain and its membranes, and to the
spinal marrow, which may give rise to hemorrhages, o.
Also from the use of helleborus viridis a distinct gastro-
enteritis has never been observed. 6. The aqueous extract
is not inferior in efficacy to the alcoholic extract; the alco-
holic extract of the leaves is at least quite as active as the
alcoholic extract of the root.

III. Experirm nts with helleborus om ncalis. (The roots with
which the experiments were made were obtained from M.

68 Schroff. On Species of Heleborus. [January,

Landerer, of Athens.) 1. The root of helleborus orientalis
considerably surpasses the root of helleborus niger, and
even that of helleborus viridis, in efficacy; it is the true
representative of the action of helebori. One drachm of
the pulverized root was fatal in four hours; one drachm of
the alcoholic extract in twenty-five minutes ; one drachm
of the aqueous extract in two hours. Five grains of the
alcoholic extract produced in rabbits chronic poisoning,
which led gradually to a high degree of emaciation, and to
pecutiar rigid contractions of the posterior extremities. 2.
Helleborus orientalis contains an acrid and a narcotic
principle, but in greater quantity than helleborus viridis.
3. Like helleborus niger and viridis, helleborus orientalis
causes death by paralysis of the heart ; the preceding stage
of excitement is still greater than that observed after the
use of helleborus viridis. 4. Gastro-enteritis could not be
discovered. 5. The alcoholic extract proved to be more
active than the aqueous. One drachm of the former pro-
duced death in twenty-five minutes ; one drachm of the
latter in two hours ; ten grains of the alcoholic extract were
fatal in less than two hours ; the same quantity of the
aqueous extract in seven hours. The ethereal extract,
which seems to contain particularly the acrid principle, is
still to be examined.

Experiments with helleborus fcetidus in animals. xYs the
author could not obtain the fresh plant for his experiments,
he does not consider them completed ; he is, however, able
to state the following facts : 1. Helleborus fcetidus surpasses
the helleborus niger in the poisonous properties of its root
and leaves, but is, however, inferior to helleborus orientalis,
and even to helleborus viridis. One drachm of the alcoholic
extract of the leaves of helleborus foefidus caused death in
two hours; one drachm of the alcoholic extract of the fibres
of the root in half an hour; one drachm of the whole root
in one hour; one drachm of the aqueous extract in six
hours ; while equal doses of the corresponding extracts of
helleborus niger did not produce any, or but a slight effect.
2. The experiments with helleborus fcetidus also prove the
presence of a narcotic and of an acrid principle. In what
proportion they are present, and whether a third principle
is united with them, as the peculiar odor of the plant seems
to indicate, are questions to be derided by further investi-
gations. The acrid principle seems to be most readily
extracted by ether, and should, therefore, preponderate in
the ethereal extract ; but the symptoms during life seem to

L860.] Demarquay, On Glycerin. 69

indicate that the narcotic principle predominates; the
animals suffered of prostration, of diminished frequency of
the pulse, and of respiration, of spasms in various parts of
the body, and died either after an attack of convulsions, or
gradually under the symptoms of paralysis. 3. Death is
caused likewise by paralysis of the heart. 4. The plant
and the extracts gradually lose their efficacy even with the
most cautious preservation. Ppdger, Vierteljahrschrift, xvi.
2 1859; and Schmidt's Jahrbucher, 1859, No. 10.)

On Glycerin, and it's Application in Surgery and Medicine. By
M. Demarquay. (Pamphlet, octavo, 42 pp. Labe: Paris,
1859.)

It is about five years since attention was directed to the
advantages which the employment of glycerin presented,
especially in surgery. M. Demarquay was one of the first
to make use of this substance, and it is the result of a long
experience which he makes known in his recent treatise.

The first part of it is devoted to the history and pharma-
cology of tliis liquid; it is produced, as is well known, in
the fabrication of soaps and candles, but often remains im-
pure, and does not present the necessary qualities ; it is then
more injurious than useful. We must therefore assure
ourselves at first of the purity of the liquid which we are
going to employ ; the best glycerin is known at present by
the name of English glycerin ; it must not form a precipitate
with the salts of baryta, sulphuric acid, hydrosulphuret of
ammonia, and oxalate of ammonia ; the adulteration with
glucose is recognized by boiling the liquid with a small
piece of caustic potassa, when the adulterated product
assumes a dark color. Pure glycerin is neutral, as is proved
by litmus-paper.

After having pointed out the conservative properties of
glycerin, in regard to organic, and particularly animal sub-
stances, M. Demarquay speaks of its application in the
dressing of wounds in general ; the dressing is much more
simple and more proper than that with cerate ; the deposit
of crusts around the wound is avoided ; but particularly in
cases of wounds of bad nature the use of glycerin is indi-
cated; this liquid prevents the development of hospital
gangrene, and causes the disappearance of this complication
when it is developed, on the use of ordinary dressings. It
is used with advantage in the dressing of gangrenous
wounds, and particularly of those which succeed the in-
cision made in anthrax. In military surgery it is particu-
larly useful, in cases of contused wounds abundantly

70 Demarquay. On Glycerin. January,

suppurating, when the dressing cannot be renewed often
enough, and when the wounds, in consequence of the
accumulation of the wounded, and from bad hygienic con-
ditions, have a tendency to assume an unfavorable character.

In cases of deep abcesses, with burrowing of matter and
fistulous passages, glycerin is advantageously employed, in
order to check the abundance of suppuration, to clean the
secreting surfaces, and to modify the bad quality of the pus ;
the liquid can be injected into these anfractuous sores ; in
the same way it may be used in the sinuous passages which
are so often formed in stumps after amputation.

M. Demarquay then points out the utility of glycerin in
dressing burns, all kinds of ulcers, chancres, chaps, and
chilblains. In diseases of the external ear and affections of
the eyes glycerin is equally serviceable.

We have not yet finished with the applications which can
be made of this substance ; it may perhaps be believed that
the properties of so inert a liquid as glycerin are exag-
gerated; M. Demarquay protests against the prejudice
which considers all those substances inert and without real
action which are inoffensive and require no great precaution
or prudence in their management ; yet glycerin, already
very useful in itself, can be rendered still more active by
the addition of some other medicines, such as laudanum,
tannin, iodine, aloes, etc.

A combination of glycerin with tannic acid, {glycerole ch
tannin,) for instance, is used with advantage in the treatment
of vaginitis ; the preparation is composed as follows :

Glycerin 100 parts

Tanic acid ^ . . 10 to 20 ^ "

"The speculum having been introduced, an injection of
water is applied, in order to remove all the purulent mucus
adhering to the walls of the vagina ; these, afterwards, are
wiped with a dossil of dry charpie placed at the end of a
long forceps. I introduce then one or more tampons of
cotton, soaked in the tannic glycerin; and, in addition to it,
a dry tampon, destined to retain the drops which tend to
escape."

It may be useful to add a little tannin to the glycerin
employed for dressing wounds. The reporter of the Journal
du Progres, who has treated some cases with this application,
states that it seems to accelerate cicatrization.

Finally, M. Demarquay terminates bis interesting memoir
with the use made of glycerin in the treatment of diseases
of the skin, and reports some experiments which he has
made with glycerin taken internally. Journal du Progres.

I860.] Editorial. 71

EDITORIAL AND MISCELLANEOUS.

The Sixteenth Volume of the Yew Series of the Southern Medical and
Surgical Journal.

The opening of a new volume brings forcibly to our minds the im-
portance of the work in which we are again about to engage. Though
the science of medicine is confessedly imperfect, Medical Literature, it
might be suspected, has reached its culminating point. Books, pamphlets
and periodicals crowd upon us in such profusion, that even the most in-
defatigable reader is overwhelmed, and abandons the laudable determi-
nation with which he set out, of "keeping up with the Profession." The
day of book-reading, for men actively engaged in the practice of medi-
cine, is rapidly passing away, and it will soon be superceded by the more
useful, practical and practicable reading to be found in journals. The
student, the teacher, the reviewer, the book-maker, may still find time to
delve in heavy volumes, bringing forth the few grains of gold to be
found in the mass of worthless ore ; but the practitioner of medicine, the
man who needs precepts, the dealer in facts, and the applyer of princi-
ples, cannot read books. He is the man for whose use all facts, all
principles, indeed, all medical knowledge is cultivated. He it is that
converts them to the good of man, and his hand is the dispenser of all
the blessings they can be made to yield. He has but little time to de-
vote to extended treatises, to winnow out the wheat from the chaff. The
brief and the practical are alone open to him. He cannot be the reader
of books, his daily necessities compel him to be the reader oft. journals.
There he finds, in compendious but comprehensive form, the whole em-
bodiment of his science principles which he sees every day illustrated
in his own practice, precepts to guide him through the most embar-
rassing difficulties, and a filum labarynthi leading him through the
mazes of the most obscure and even unexplored regions of his science.

The man who attempts to inform himself entirely from books, ever
finds his knowledge more or less defective it is nearly always second-
handed, for in the journals, every fact and principle of value makes its
first appearance. Buy books, we would urge, for reference ; they generally
contain, in a well arranged and organized form, the science of the sub-
ject on which they treat ; but for daily reading, for real advancement in

E< litoriql. [January,

science, and in order to keep pace with the Profession, subscribe to jour-
nals. Reading them imposes no labor, and the variety of their contents
beguiles us through their pages, while we gain instruction almost una-
wares.

Through the liberality of our publisher, Dr. William S. Jones, the
Southern Medical and Surgical Journal has been enlarged by the
important addition of eight pages to each number, presenting in this and
our succeeding issues for the coming year, a capacious monthly periodical
of eighty pages. In justice to the publisher, we must state that, con-
sidering the quality, of the paper, and the solid, well executed typography,
few monthly periodicals. North or South, present a larger amount of
reading matter than the one over which it is our good fortune to preside
as Editors. On our own part, we promise to do all in our power, during
the coming year, to fill well this ample space, and to secure to our read-
ers as much valuable information and scientific recreation as can be com-
pressed, during one year, into nine hundred and sixty octavo pages. To
this end, we earnestly call upon contributors, readers and subscribers in
their several or combined relations, to second our labors and to hold up
our hands.

Transactions of the American Medical Association, Vol. xii.
We received the above valuable work just as our editorial matter is
going to press too late for any extended notice at present. On looking
over its table of contents we find, besides the minutes of last meeting,
Business Reports, and the- President's excellent address, 1st. Report
of the Special Committee on Government Meteorological Reports, by
Richard H. Coolidge, M. D. 2nd. Report of the Committee on Crim-
inal Abortion. 3rd. Report on the Medical Topography and Epidemics
of California* by Thomas M. Logan, M. D., of Sacramento. 4th. Re-
ports on a Uniform Plan of Registration of Births, Marriages and
Deaths, by W. L. Sutton, M. D., of Kentucky. 5th. Report on the
Topography and Epidemic Diseases of Michigan, by J. H. Beech, M.
D., of Michigan : and lastly, we are gratified to find that a large portion
of the volume is made up by a Report from our colleague, Professor
Joseph Jones, of this city, viz : Observations on some of the Physical,
Chemical, Physiological and Pathological phenomena of Malarial Fever.

In the present bare acknowledgment of the volume, we cannot do
justice to any of the above papers. None can more fully appreciate the
value of Professor Jones's " Observations on Malarial Fever,"' than the
readers of the Southern Medical and Surgical Journal. A more
extended notice may be expected in a future number.

I860.] Editorial,

Return of Southern Mepical Students from Northern
Colleges For the first time, to our knowledge, in the history of this
country, have political acerbity and intolerance risen to such a height as
to cumber the walks of science and to invade the personal comfort of
those who would follow her peaceful pursuits. Paz ct Scientia have
been so long and so naturally coupled in harmonious association, that
their severance will appear, to most minds, like the abstraction of the
combining principle from chemistry or the cohesive- force from the
constitution of matter. Ever considered in the light of a universal,
benevolent mission to all mankind, the votaries and practitioners of
Medicine have gained access, indeed welcome, into the interior of all
countries, even in times of the highest religious or political excite-
ment even in actual war, our Profession has been allowed to pursue its
researches and to carry its ministrations wherever the interest of science,
on the one hand, or the highest benevolence on the other, has demanded.
The Turk, the Chinese and the Savage alike, have ever respected the
divine mission of the Physician and have admitted him cordially into
circles where even the devoted and self-sacrificing Christian Missionary
has been excluded and whence he has sometimes been driven with scoffs
and stripes. Religion indeed, has often found it her interest to combine the
medical savant with the Gospel-bearing man of God.

So Catholic heretofore has been the spirit towards men of our science
and so universal the good will which they have enjoyed in all commu-
nities, so little have they been made to feel the disturbing influences of
the ordinary walks of life, and so uninterruptedly have they been allowed
to pursue their unobtrusive and peaceful employment, that the world of
science has been in truth, a world apart a world within itself a
cosmopolitan Republic escaping and ignoring all tyranny and tumult
whencesoever they may come " A river in the ocean'' flowing on, grandly,
majestically but calmly, despite the surging waves which may sometimes
form its stormy banks.

Such has ever been our ideal of the science of medicine and of it S
independence of all extraneous perturbations such we would ever have
it, and such, it ever and everywhere is, unless too strongly conflicting
influences so far pervert the general spirit of communities as that they
ignore her lofty aims and interrupt her benign labors, by violating even
higher and more sacred feelings than those which wed us to our science
we mean those which wed us to our homes.

The determination of a large number (nearly three hundred) of young
gentlemen. Southern students in Medical institutions at the North, to

74 Editorial. [January,.

secede from those schools and their arrival at the South seeking admis-
sion into Southern Colleges to complete their studies, will naturally give
rise to much inquiry among the Profession. As the proceedings of the
several Students Meetings already published present a very full account
of the character and causes of the dissatisfaction, we forbear at present to
make any remark on the subject.

The following preamble and resolutions adopted at a meeting held at
the Assembly Buildings in Philadelphia we find in the N. A. Medico-
Chirurgical Review :

Whereas, We have left our homes and congregated in this city, with
a view to prosecute our medical studies ; and having become fully con-
vinced that we have erred in taking this step ; that our means should
have been expended, and our protection afforded to the maintenance and
advancement of institutions existing in our own sect:ons, -mid fostered by
our own people :

Resolved, That in a body, or as many as approve of the act, we secede-
from the institutions in which we have severally matriculated, return to-
the South, and herein pledge ourselves to devote our future lives and
best efforts to the protection of our common rights and the promotion of
our common interests.

Resolved, That in taking this step, we disclaim any personal animo-
sities, and depreca-e any political agitation.

Resolved, That we tender our grateful acknowledgments and heartfelt
thanks to the Hon. Henry A. Wise, Governor of Virginia; Dr. L. S.
Joynes, Dean of the Virginia Medical College, at Richmond ; Henry R.
Frost, Dean of the Medical Department of the University of South
Carolina ; to President Robinson, of the Philadelphia, Wilmington, and
Baltimore Railroad, and all others who have extended to us the substantial
encouragement and aid so essential to the furtherance and successful
accomplishment of our enterprise.

Resolved, That we extend a cordial invitation, and will cheerfully
welconre in the South, any Northern student who will subscribe to the
previous resolutions.

Resolved, That a copy of these proceedings be sent to all Northern
Medical Colleges, for the benefit of Southern students who may have
matriculated in them.

Resolved, That the Southern papers generally, be requested to publish
the proceedings of this convention.

On the 20th of December a telegraphic despatch was received at this
place from Southern studeuts in Philadelphia, reporting their determin-
ation to return to the South and making inquiry if they would be received
at the Medical College of Georgia for the remainder of the term ? The
answer returned was in the affirmative and the terms stated on which
they would be received, viz., that those who felt it their duty leave should
be received on equal terms with the regular matriculants of ihe Medical
College of Georgia the candidates for graduation paying the diploma

I860.] Editorial. 75

fee. On the arrival of a large number of these gentlemen a few days
afterwards, they were cordially welcomed by both the Faculty and the
(Mass.

In the full exposition of the causes of dissatisfaction presented by these
gentlemen will be found ample reason to exonerate them from all rash-
ness or impropriety indeed as set forth in their presentation by Dr.
Matthews we are obliged to yield them our unreserved commendation
for their calm determination under trying circumstances, their modera-
tion and their gentlemanly propriety.

If the illy concealed prejudice of Northern communities against their
brethren in distant parts of our common country has degenerated into
actual hostility, and if their fanatical misconception of a perfectly humane
and benevolent institution, has caused them so far to forget the iaws of
self-interest and even the higher laws of hospitality so as no longer to
tolerate even a temporary sojourn of these brethren among them, these
communities have now received a lesson at the hands of the Medical
Profession which they surely cannot soon forget and they have done
their commerce and their institutions of learning, innocent as the latter
certainly are, an injury which years of conservatism and most strenuous
effort only can repair. Southern patronage has been their chief, their
most reliable support and yet these very patrens, it appears, have found
the brief period of their sojourn among them, no longer bearable. In the pre-
sent state of political feeling in Northern cities, it became impossible to con-
tinue the pursuit of studies requiring the entire occupation of the mind.
Their attention was naturally turned to the institutions at home, which
for no good reason, they had left, and they determined henceforth to
advocate the attendance of Southern students in Southern Institutions.

Fully impressed with these sentiments, a decorous and orderly meeting
of Southern students wras held Their grievances, their motives and
their final determination were temperately set forth in a series of resolu-
tions which, while they exhibit in sufficiently strong but moderate terms,
their dissatisfaction with Northern institutions, as places of instruction
for Southern students, we are gratified to say, carefully exonerate the
distinguished Professors of those institutions from any possible charge as
to the cause of their determination.

They have everywhere been kindly and cordially received by the
Colleges throughout the South. They have been at once admitted into
the several classes where they have applied, so far as we know, upon
terms which are in the strictest accordance, both with professional ethics
and that good fellowship which should ever characterize the dealings of

70 Editorial. [January

Medical Colleges, however distantly located from each other, or what-
ever may he the public sentiment or political state of the country.

On the arrival of a number of these gentlemen at this place, they
reported that many of their friends Southern students yet remained
in Northern cities, very unpleasantly situated ; " they had determined
and were anxious to return, but were prevented from doing so by a
temporary want of funds." The City Council of Augusta, in a special
meeting, promptly, and with uncommon unanimity, voted the appro-
priation of the liberal sum of One Thousand Dollars, to be applied to
the purpose of assisting those who might, in the above circumstances'
desire to complete their course of study in the Medical College of
Georgia.

We are unwilling to discuss any more fully, in these pages, the
painful political and social causes which have given rise to these
proceedings deplorable as these causes may be, we here earnestly
express the hope that, the decided measures so conscientiously and so
firmly adopted, may contribute to their entire removal, and be productive
of a state of good feeling throughout our great Republic, which seems
now so unfortunately interrupted.

Great and permanent benefit will doubtless naturally grow out of these
demonstrations, to Southern Medical Colleges, by awakening the entire
South to their real merit and to the importance of fostering, in her own
bosom, superior institutions of learning ; but a higher benefit, a greater
good, a far more widely extended blessing will be dispensed by them,
in that they strikingly warn the fanatical of Northern communities that
it is to their own advantage to respect the constitutional rights of others
their warm-hearted and impulsive, but honorable and independent breth-
ren of the South. Even by these means, would we hope that our glorious
Union may be consolidated and cemented, not only in the bonds of a
common interest, but, as in times past, in the stronger and more reliable

bonds of a common Love.

Cataract in Frogs Produced by Sugar. We are pleased to ob-
serve that Experimental Physiology is becoming so important a means
of investigation in this country, and that it has found such an able and
successful cultivation in the person of Dr. Mitchell. We have had occa-
sion, once or t^wice before, to refer to his investigations with commenda-
tion. Those made by him, in connection with Dr. W. A. Hammond, on
the Woorara poison, certainly throw more light upon certain parts of
this obscure and difficult subject, than any researches since the early
investigations of Sir Benjamin Brodie and Orfila ?

I860.] Miscellaneous. 77

"\Vc rotor here again to his recent experiments with Cinchona
inhalation, and, in the present number will be found a valuable contribu-
tion on " The Production of Cataract in Frogs by the Administration of
Sugar. Anything which has oven the slightest tendency to throw light
on that most mysterious subject the origin and mode of formation of
Cataract is certainly most worthy our attention, and should be foil
up with zeal and industry by those capable of pursuing successfully the
investigation. We know of none more capable of effecting this impor-
tant contribution to Surgical Pathology than Dr S. "Weir Mitchell.

Hospital Statistics.

Guy! 8 Hospital^ founded by Thomas Guy, in 1721, for the
reception of 400 patients, and recently enlarged through the
aid of a large bequest from the late William Hunt, contains
at the present time nearly 550 beds ; and, with its extensive
buildings and airing grounds, occupies an area of about seven
acres. The hospital is divided into medical, surgical, clinical,
ophthalmic, uterine, and venereal wards, independently of a
ward, -in a detached building, fur lunatic patients, the vacan-
cies in which the governors of the hospital have of late years
forborne to fill up, In the year 1857, 44,2S1 persons were re-
lieved by its means ; 5,2i;d as in-patients, 9,889 as out-patients
and 25,886 as casualties, besides 1,781 women who were
attended in their confinements, and 1,510 who received advice
from the Lying-in Charity. Four hundred patients are now
received into the original building of Guy, and one' hundred
and fifty into the part of the new wing already completed ;
the latter building, when finished, will admit three hundred
persons.

St. Bartholomew^ Hospital contains 650 beds, of which
420 are allotted to surgical cases and diseases of the eye, and
230 to medical cases and the diseases of women. The num-
ber of patients is more than 95,000 annually; the in-patients
amounting to upward of 6,0 JO, the out-patients and casualties
to more than 89,000.

The London Hospital contains 445 beds, of which 135 are
allotted to medical, and 310 to surgical cases ; of these 310
beds, about 190 are exclusively appropriated to cases of acci-
dent. In the year 1858, the hospital received 27,790 patients,
including 3,976 in-patients and 23,814 out-patients. The acci-
dents brought into the hospital, during 1858, were 11,529, in-
cluding 2,090 in-patients and 9,439 out-patients.

The Middlesex Hospital, from recent enlargements, con-
tains upward of 300 beds, of which 185 are for surgical, and

78 Miscellaneous. [January,

120 for medical cases. The cancer establishment receives 33
patients. Wards are specially appropriated to cases of uterine
disease and of syphilis ; 2,109 in-patients were admitted dur-
ing the past year. The number of out-patients during the
same period amounted to 16,469.

Royal Westminster Ophthalmic Hospital. This hospital
set the example in London, in 1816, of receiving the poor on
their own application, without letters of recommendation.
During 1857, 6,315 persons were treated, of whom 160 were
admitted into the hospital, and 6,155 were treated as out-pa-
tients ; of these, nearly 2,000 were children of tender age.
The principal operations were 57 for hard cataract ; 40 for
soft cataract ; 14 for the formation of artificial pupil ; 220 for
strabismus; 227 for the removal of tarsal tumors; 5 for the
removal of deformity of staplryloma; 3 for the removal of
tumor in the orbit ; 2 for osteal abcess ; 1 for extirpation of the
eyeball, on account of malignant disease. In addition, seve-
ral hundred minor operations were performed.

Royal Orthopaedic Hospital. The daily attendance of out*
patients exceeds 100, the average number annually being
1,600 ; and the number admitted from the commencement ex-
ceeds 21,000. Out of this large number, it is stated, not one
death lias occurred under treatment, neither has there been
any instance of permanent suffering or injury.

Loch Hospital, London. Patients treated, from January,
1747, to 31st December, 185 T, 74,389. In-patients cured from
31st December, 1857, to 31st December, 1858, 333 ; out-pa-
tients ditto, 2,187 ; in-patients, 31st December, 1858, 52 ; out-
patients ditto, 269 ; died, 22,843. Making a total of 77,232.
Asylum. Admitted from July, 1787, to 31st December, 1S5S,
1,555 ; restored to their friends since the opening of the insti-
tution, 309 ; placed in respectable service, ditto, 391 ; died,
ditto, 22.

Glasgow Royal Lnfirmary. When the buildings at
present in progress are completed, the accommodation will be
much increased. Number of beds, 600. During the year
J858 the number of in-patients treated was 3,500. Out-pa-
tients. 10,422 were treated at the dispensary. Operations
during the year, 185 ; amputations, 60; excision of tumors, 32 ;
excision of bones and joints, S ; reduction of dislocations, 23 ;
lithotomy, 13 ; various, 49.

The Lying-in Hospital. Rutland Square, Dublin. This
Hospital, establi ilied in 1745, and chartered by George II., in
X756, is the largest establishment of the kind in the British

I860.] MiscdUtneous. 79

dominions, and contains 130 beds, L5 of which are appropri-
ated to the diseases of females. Aboul 2^000 women
annually received into the institution. London Lm

The General Council of Medical Education and Regis-
tration of Great Britain. This body, of which Sir B. C.
Brodie is President, began its second session August 3d, at the
Royal College of Surgeons ofErigland. This council, of which
we have given sonic account, is the Medical Parliament of
England; having the power not only to place the profession
upon a proper basis, but to establish a uniform standard of
medical education, and compel its adoption by the various
universities and schools. The first session was devoted to the
subject of registration ; at the present session medical edu-
cation is to be the principal subject for consideration. We
shall look with interest for the conclusions to which this
distinguished body of representatives of the medical profession
arrive.

The rate of payment for attendance upon the meetings of
the council, which the members have voted to themselves, is
five guineas per day to each member attending; five guineas
a day, coming and returning, when the member resides over
200 miles from London ; travelling expenses being paid at the
rate of 9 9s. for Scotland, and 8 8s. for Ireland.

Ancesthetic Effects of Bisulphide of Carbon. "Dr. Wm.
H. Uhleu, of the Falls of Scuylkill, at a recent meeting of the
Academy of [Natural Sciences, mentioned that he had a short
time before accidently inhaled the vapor of the bisulphide of
carbon, which had produced complete anesthesia. He was
removed from the laboratory by the workmen in a completely
insensible condition. He revived in a short time suddenly
and completely, and he did not subsequently experience any
nausea or the least unpleasant symptoms. Whilst in a state
of anaesthesia, his visions were of the most pleasant and
agreeable character.'' Med. JVeivs.

On Neuralgic Dysmenorrlicea By Dr. J. Y. Smrsox.
** All pathologists admit a neuralgic division. That is, all
admit that dysmenorrhea may occur in patients who are
subject to neuralgic affections, and in whom pains disappear
from the other organs and parts of the body at the time of
menstruation, only to become concentrated, as it were, in the
region of the womb. Such patients complain habitually of
aches and pains in the lace, the head, the mammae, the inter-
costal spaces, or elsewhere, and these pains all become

cllaneous.

.' the
tnenia. jtant pah evel-

ual flow sets in, the pains

the body bi lieved. In such

erine neuralgia pe *f hole menstrual

period -remitting, perha] ether

mitting." wU }8 R< firoq

Raw Meat in tfu Oolliquativ< Diarrhoea of
Children at tin Breast. By Dr. ' i - >r of

the Children's Hospital Petersburg. (L'Union

\pril 7th, 185! .
iventeen years have passed since Dr. "W ew the

.attention of the profession to the beneficial i attending

the i!-'.' of raw meat in the treatment of the colliquative
diarrhoea of children at the breast, and since that time nume-
iniirmed the views origii Ivanced.

Dr. Weisse now declares, after an experi twentyyears,

raw meat, reduced into a pulp by Bcraping, to the exclu-
sion of all other treatment, is the true sp< rtruc-
tive i >i va of diarrhoea, lie can larks
Hr. Charles Hogg, who recomi e< f-tea in preference,
for he finds in raw meat not only an aliment for the children,
but also a remedy for the kind of diarrhoea in question;
besides, he I . oken of the juice of the meat, but has
Ldedl Liscularsn >lf, minced or scraped,
swallowed and digested without difficulty. The
roposed is to introduce into the digestive tube the
muscular substance of the meat, and the beef-tea has no
controlling power over the diarrhoea, for by its mere fluidity
it trj oo rapidly the intestinal canal. By giving the
meat in a pulp, the solid parts remain longer in the intestine ;
act by contact, and may, dual
mucous membrane, stimulate absorption ; and it is probable
also that this plan may contribute to neutralize the acidity of
the gastric juice. The treatment of children's diarrhoea by
raw meat lias become general at St. Petersburg, and has been
adopted rather by the establishment of the good - inch
have resulted from it than by the publication of special
memoirs. l vr. Weisse has employed the treatment in nearly
two hundred cas< b, and the result lias been always satisfac
when the case has been taken in time. When the diseas

..-Ivanced, and has assumed the characi
malacia, a cure is seldom obtained; but even in such circum-
stances, it is possible to mitigate some v\' the symptoms felt
he patient, such as the inextinguishable thirst and the

SOUTHERN

MEDICAL AM) SURGICAL JOURNAL

U\U IL'fiL'STA. GE0KGIA. FEBBUABV. ISfift. 11!

ORIGINAL AND ECLECTIC.

\i: i rci I

/ on the Ado j''<ir < 'limate to the Co?isump

/.' nation of tfu I
rt : and a&o, an I -

\ ' i'lf ( Hi,,.

\ '' - inted to the Medical Society of
tli- i;i, at its annua] meeting, held at At-

lanta, April 13th, 1859. By Wii.uam Eenri Douqhi
M. I)., of Augusta, Ga.. (Ordered to be printed.)

itiuuotl from De . Vol. 1 .". p

I DIRE PACIFIC CO 1ST, WITH Tli
. LORID \. \!> >PTING THE MOST ELIGIBLE LOCALITIEi
ff, WITH THE V1KW OF SHOWING ITS GREATER
ADAPTED \ RESORT FOB THE CONSUMPTIVE.

The pan.- of this continent the subject of the present
comparison are bo extremely unlike in their relation to
the continent at large, and are possessed of such antipodal
topographical featui i render il somewhat difficult so

to arrange them, as to ensure to rath a proper exposition
of its meteorology. They differ not only in the relation
which each sustains to the entire mass the one running
parallel with it- s I arrangement, and extending over

uteen degrees of latitude; the other, being the |
jecting, fragmentary terminus of its largest slope but also
in their own general structure, their geological formation,
and in their physical connection with the adjoining seas.
Florida has a flat, level surface; is doubtless of recent geo-

ical formation; has a porous, sandy Boil, intermixed with
a rotten limestone, in its northern and interior parts ; and

i it little above the level of the sea. The Pacific coast is
the rapid decline of a lofty mountain range to the Pacific
I I an, whose rough and serrated edge hear- testimony to
the constant lashing of the waves forages, and comprises
a narrow strip of nearly uniform dimensions throughout

82 Doughty. An Essay on the Adaptation [Feb.,

Florida, by means of its narrow pointed extremity, juts
out into the ocean depths, occupying a part of the angular
space made by the Gulf Stream in its escape into the At-
lantic from its mother waters, and thereby exposes its
eastern, southern, and the greater part of its western
boundaries to the corroding influence of the Atlantic Ocean
and its great inlet, the Gulf of Mexico. The Pacific coast
has only a western boundary of water surface. Florida,
again, is exposed on its southern and western sides to the
uniformly high temperatures of the Gulf, whilst on its
eastern it has the low temperatures of the Atlantic, inter-
posed between it and the Gulf Stream, so that the local
climates of the two coasts are made to differ in their sensi-
ble characters. The Pacific coast, however, is subjected to
such changing sea-temperatures as tend to the production
of a general uniformity of its temperature condition.

Finally, Florida is eminently exposed to the full action
of both marine and continental influences, whilst the Pa-
cific coast is accessible to the former only, and is almost
effectually protected from the harsher impressions of the
latter. Every impulse that affects the eastern portion of the
United States may be transmitted to the former, and mark
its climate with its own harsh 'features; but at the latter,
the treasured influences of the mild Pacific, aided by the
great interior mountain barriers, sensibly mitigate, if they
do not entirely counteract, all injurious impressions origi-
nating towards the mass of the continent.

In the coming comparison, we shall disregard our usual
method, (that of comparing the individual seasons with
each other) and make an arbitrary division of the climatic
year into two periods, which we propose to designate as the
period of heat, and the period of cold. The period of cold
is intended to embrace such months as are characterized
by low temperatures, including also, those which manifest
the earliest and latest depressions. The period of heat is
necessarily embraced in those months which have an unin-
terrupted course of high temperatures. The first, then, will
extend from October to March inclusive, and the second

I860.] Of Climate to the Coyisumptive, c. 83

from April to September inclusive. As applied to Florida,
this division may seem somewhat Btrange, but we trust that
its advantages will sufficiently appear in the progress of the
comparison. To say nothing of the exhibition of the high
and low temperatures, coincidently and concurrently, it is
still farther advantageous, in that, it causes the length of
time embraced at Florida, to conform to the leading natu-
ral divisions of the climate of the Pacific coast the wet
and dry seasons.

The special investigations which have been made of the
State of Florida, in most cases, undertaken with the view
of testing its agricultural capacity more particularly in
reference to the proposed introduction of tropical fruits
demonstrated, at the same time, the most important prac-
tical features of its climate. Thus the parallel of 28 was
fixed as the most northern point at which tropical fruits
could possibly flourish, and hence arose a division of the
peninsula into tropical or southern, and northern Florida.
Its climate is usually referred to by means of its geograph-
ical divisions, namely, East, West and Middle Florida ;
this, however, is obviously wrong, since at least one-half of
its area (from lat. 29 30' southward) could not be included
under either head. Again, we find it referred to as that of
the interior, and of the coast; but this, to us, seems a need-
less degree of minuteness, since, if the entire extent of its
sea-shore parts, together with the peculiar investment of
the whole by the sea be considered, no interior, strictly
speaking, can be said to exist. Although, so far as the
mere distinction of some unimportant local differences is
concerned, it may be admitted. We shall adopt, as best
suited to our present purpose, the first of the divisions men-
tioned a northern and southern part still retaining, how-
ever, for convenient reference, the subdivisions of the
northern. Of these, we shall use only the northern division
in the comparison the southern, because of its tropical
features high heat, great relative humidity, and profuse
precipitation being conceded to be positively hurtful to
those whose benefit is sought by it. Nevertheless, inciden-

84

Doughty. An Eswy <m the Adaptation [Feb.,

tal deferences may be made to certain of its posts, situated
in its most northern part.

We have selected, as proper points for comparison for
this State, Fort Marion, at St. Augustine, on its eastern
coast, lat. 29 48' ; Fort King,f in lat. 29 10', nearly mid-
way between its eastern and western coasts ; and Fort
Barrancas,* near Pensacola, on its extreme western, lat.
30 18'. On the Pacific coast, we have chosen those of
San Diego, San Francisco, and Fort Vancouver, whose
topographical relations have already been given.

Special Comparison. The difference of the successive
months :

Mean

of

Advance from

April.

Ap. to My

My. to Ju|Ju. to Jly|Jivto An.

Au. to Sp.

S-p. to Oc.

San Diego, Cal., (5 years)

61 23

144

4=72

5=33

0 96

-2=81

-o=37

San Francisco, " 4 "

55^37

-C 08

tl57

fl 04

-068

tl04

-0C 55

Ft Vancouver, " 5 "

6=40

372

6=04

-3 15

-4=75

-7 51

" Marion, Fla., 20 "

68 78

4Z 72

5=86

154

-034

-196

-6-72

" King, " 6 "

71=41

4=98

30 39

102

-0 71

-191

-7=62

" Barrancas." 17 "

63=51

6= r>4

5= 35 1 46 -n 62

-3= 17

-8 39

In consequence of the more southern latitude of the State
of Florida, the mean temperature of the month of April
must be higher than at any part of the Pacific coast. Never-
theless as great a number of those irregularities, which are
common to the eastern United States, and which mark the
distribution of heat for the spring season, "by great varia-
bility in successive years."' and "great constant differences
of the successive months," are recorded here as at the latter.
The two stations upon its opposite shores afford, during
this month, the same mean temperature ; and in their gen-
eral advance from month to month, to July, which lias the
highest mean for the year, display also corresponding rates
of progression. The rate of progression is over five de-
grees from May to June, but from June to July is dimin-
ished to one and a half degrees. Fort King, except that
the successive differences are not quite so extensive, and
an increase in the mean of April of about three degrees,
presents a great resemblance to them. The same parallel-
ism is continued in their decline from July, being uniformly

tTbis poi1 :^ ibout fortj d ilea from th< coast of the Golf of Mexico, and sixty miles from the
Atlantic coast. The surround: 11 countr adulating, alternately sandy piue barrens and

marshy hummocks w Army Met. Register, page 588.

"This post is "exposed to the Golf," and 's "al out eight miles southwest of Tt nsacola." See
same reference.

I860.] Of Qxmah to the Consumptive, ,vc 85

small to August, and from this month to September, and
very rapid to October. It may therefore be Btated, that in

Florida a rapid, though not uniform advance takes place
from the early Bpring temperatures to the highest summer

means, and that the decline from this to the later fall tem-
peratures, is equally irregular and material.

On the Pacific coast, the nearest approach to this record
is found at San Diego and at Fort Vancouver ; although
the latter differ in certain particulars, materially from each
other. San Diego has an irregularly increasing monthly
advance to the highest monthly mean, which is here post-
poned until the month of August. It differs from the
Florida posts as to the periods at which the greatest advances
take place. Here in the commencement of the series, the
smallest rates are given, and they increase so rapidly that
the advance from May to June is three times the first, and
from June to July, it is nearly four times as great; whilst
at the others, these features are almost completely reversed.
In other words, the principal increase of temperature occurs
at San Diego, in the passage from May to July, and in
Florida from April to June, thus anticipating the former
one month. Furthermore, although the decline at this
western post, from August to October, appears to begin
with larger measures than at either of the others, yet the
actual amount of decrease does not equal them there
being at the former a total decrease of 8 18, and at the
latter an average decrease of 10 48. But of the Pacific
stations, that of San Francisco affords the most remarka-
ble and signal differences, as well as superiority over those
of Florida. Here the mean of April is thirteen degrees
(13) below the lowest of the others, and sixteen degrees
(16) less than the highest; and from this to the culmina-
ting point of the dry season, the greatest difference between
any two succeeding months, is only 1 57. Here, also, the
monthly mean temperatures continue to increase at this
gradual rate, to September, thus extending the period of
heat two months farther than in Florida ; and the whole
amount of augmentation of temperature, during the entire

$6 Doughty. An Essay on the Adaptation [Feb.,

period from April to September, as evidenced by the differ-
ence of their means, is only 2 89. May, instead of giving
a mean from 4 72 to 6 94 above that of April, declines
slightly from it; and June only increases over May, so far
as to exceed the mean of April by 1 49; from June to
July, the increase is only 1 04, whilst August retreats so
far from July as to make its mean only 0 36 higher than
that of June; and finally, September gives a mean of 1 04
above that of August, but only 0 36 over that of July.
The entire period of a declination of temperature occupies
here a single month, and amounts to only one-third of a
degree. By this nominal decline, the month of October
presents the same mean that July has. Hence an unparal-
leled uniformity of temperature condition exists here from
April to October. At other places on the coast of Califor-
nia, similar, though not identical results are manifested ;
and for some degrees of latitude, both northward and
southward of San Francisco, a corresponding uniformity
is observed, so that the advance of temperature during the
summer, amounts to only " one degree for one hundred and
twenty miles northing."

In conclusion, Fort Vancouver, the most irregular and
extreme of the Pacific posts, corresponds more nearly to
those of Florida. They resemble each other, both in the
amount, the irregularity, and the rapidity of the ad-
vance of the heat, and in the length and extent of its decli-
nation: although higher means are necessarily recorded at
the latter than at the former.

I860.]

Of Climate to the Gonsumpt

c.

87

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88 Doughty. An Essay on the Adaptation [Feb.,

with those possessing in an extended series of years, an
extreme continental nature. On the other Land, the Pacific
spring climate, as far as we are permitted to apply it in a
much more limited series, shows a permanency or rather
a uniformity of temperature, unsurpassed probably by any
equal extent of sea-coast in the temperate zone.

The same general variability is manifested also in the
individual months of the spring, and in some parts of the
peninsula, it is true also of those more advanced in the
summer and towards the fall. Upon inspecting the foregoing
table, these remarks are observed to be true, for Fort Ma-
rion presents a range of 11 68 for April, and 13 75 for
May, and March transcends both of them, having an ex-
treme of 15 51 ; and the monthly possible range is
continued throughout the summer season at an average of
over 7 ; and with the addition of the range of September, it
gives, as the mean possible range for the entire period in
the table, 8 96. At this post, the greatest variability of
the period is manifested in the month of May, and from
this to September it gradually diminishes. At the mo: 2
central post, however, the greatest measures of variability
are not noted in the spring months, but in those of the
summer, that of June being the highest for the period. .v
that the eastern coast and the southern interior, whilst they
differ as to the months having the greatest variability, yc i
resemble each other in the whole measure the average
monthly range for the period being over 8 00. But farther
differences exist between the western coast and both of
these, the variation of no single month being equal to the
highest of either of the others; on the contrary, the major-
ity of them have, in comparison with the others, a reduced
range, thus establishing the fact of a measurably more
uniform temperature condition along the Gulf coast. The
measures of heat actually experienced at the various
places differ also the eastern eoast being somewhat below
the Gulf and the interior: this last being also slightly above
the former. The causes of these differences are evident in
the differing temperatures of the surrounding sea-waters.

1800.] Of Climate to the Oonsum'ptiv . . 89

The Gulf of Mexico is of high temperature, hence the sta-
tiona of its coast are elevated to it, more or less; whilsl
the temperature of the Atlantic waters, which are in con-
tact with the eastern coast, and separate it from the Gull
Stream, are lower in their thermometrical condition, and
consequently refrigerate all places having that exposure.
uTlu> Gulf Stream," says Mr. Blodget, "is somewhat above
the mean temperature of the east coast of the continent in
the same latitudes, even in summer, and the isothermala
would curve northward rather than southward, in their ex-
tension at sea. if no influences other than that stream or the
undisturbed sea were encountered. " There is, however, no
point of the coast at which the temperatures of summer are
greater for th we of the Gulf Stream, as the continental

influi na s evi rywfo r< pn dominate under the prevalence and con-
trolling charact r of the w\ sti rhj winds" " The sea-winds and
mist are here noticeably colder than the average tempera-
ture of the sea itself, at any considerable distance, and
exposures open to these have a temperature perceptibly
reduced as far southward as Florida" "The cause of this
refrigeration is found in the cold masses of water present
on the northern part of the coast, or returning in currents
next the Gulf Stream, and beneath it." "For most parts
of the Atlantic coast, these causes are sufficient only to
affect the winds from the northeast, which is the direction
covering the largest water surface of this character, and the
summer temperatures are reduced by the effect of these
alternations, without the production of a decided single
extreme, and without the uniformity which characterizes
the refrigerating winds of the Pacific." "It is difficult to
illustrate this feature by citation of measures of tempera-
tures, as the depressions appear in fit form of tiro or three days
of generully I ire,* without reaching a single mini-

mum as low as might be attained at an interior station,
from the effect of radiation alone." Finally, notwithstand-
ing the differences of the two coasts, the range of the
variability is about the same for the period represented, for

* All of these italics are our own.

90 Doughty. An Essay on the Adaptation [Feb.,

the extreme range from the lowest to the highest mean
here given, is at Fort Marion 21 27, and at Fort Barrancas
21 69. Just here we may add, that the difference between
the means of April and the hottest summer month, which
indicates the usual range for the period, is at Fort Marion
12 12, at Fort Barrancas 13 75, and at Fort King 9 39.

Again, the high means of heat the extratropical mean
temperatures, as they are called recorded in this State,
some of which have been given in the table, might be made
a subject of extended remark with us, especially when we
bear in mind the humidity of the summer season, its large
and heavy precipitations, but we forbear to do so, reserving
all observations on this point until we come to contrast
their relative states of humidity.

How, now, do the Pacific stations compare with these ?
The first contrast presented at a general view of them, is
the vast difference in the relative position of the various
mean temperatures. At San Francisco, the highest mean
temperature ever recorded, is below the lowest of either of
the stations of Florida, and yet its lowest is only about
nine degrees (9) below that of the others. At San Diego
and Fort Vancouver, the very highest recorded means are
yet lower, by some degrees, than the ordinary means of the
summer months in Florida. At these stations, whose
records are far more irregular and variable than that of San
Francisco, the possible ranges of those variable months,
April and May, at Florida, are much less, and their average
possible ranges for the entire period are little more than
half as extensive. Nevertheless, the difference between
their ordinary mean of April, and that of their highest
summer mean, is fully equal to those of Florida.

At San Francisco,* however, the difference amounts to

*The data given tor this post in the table differ from those acted upon in the
respective tables of the spring and summer season, under the head of the '" gen-
eral range of the mean temperatures-" We have used, in the collection of these
means, another year's record, 1857, found in the Patent Office Reports for that
year. And although it causes some variation from the data of these tables, yet
it does not invalidate the materiality of the conclusions drawn ; and aiming, as
we do, at an equitable and just comparison, and having no preconceived notions
to carry out. we have cheerfully made the alterations, as tending to exemplify
more fully and correctly the thermometrical history of this part of the Pacific
coast.

I860.]

Of 0 the Consumptive .

91

only 2 89, and constitutes about one-sixth the natural
range of the temperature at the Florida posts. At this post,
the maximum range of any individual month ia 5 82, in
June; and next to this are the months of April and Sep-
tember, which have a range of 5 and a fraction. The
greatest possible range here barely transcends the lowest
of the eastern posts, and the average possible monthly
range for the period may be taken at about one-half oi
theirs. At this post, then, by means of the unusual circu-
lation of the Pacific, a permanent refrigeration is kept up,
so that a general uniformity of temperature condition is
maintained from the later spring months to the second
autumnal one. At other parts of the coast, irregular, anti-
periodic manifestations may be occasionally seen, but here,
and in its vicinity, the constantly existing physical agents
prevent their material appearance.

The third point of comparison is the extreme single ob-
servations for the individual months.

April.

Obs.
lit. !.

r'.I

Obs.

Obs. P.
lit. Lt. R.

July.

August.

Obs. PTH)1^. V.
lit. Lt. K.Ht. Lt. R,

Septemb'r.
lit. Lt. R.

San Die<ro, CaY

Sau Francisco, "

Fori Vancouver, Oregon.

Fort M.

Fort King,

Fort Uarr.incus, "

921 30
94 44

I so

J3

)."

93 t8

84 47

94 1 43

1031 581 45

10fi 00 46

L04 62 12

50 43

40 1 41

60 40

70i 20

64 39

671 31

'49 ',-2
43 51
40 ! 50

171 4S|42

The record here given represents, most probably, the
absolute position of the single extremes at the posts of
Florida, for the period embraced in its formation extends
from twelve to twenty years, many of which were charac-
terized in the United States for the extremity of their
measures. That of the Pacific stations, on the contrary, is
not so reliable, because the period over which it extends is
probably insufficient to exemplify the highest and lowest
attainable points of the thermometer: The two months of
most value in the comparison are those of April and May,
and upon inspection, they are at once observed to be more
variable in Florida than upon the Pacific. And although
"the line of ice and frosts, in April," of the Eastern States,
does not generally include within its area the north of

92 Doughty. An Essay on the Adapiati [Feb.,

Florida, yet, as irregular, non-periodic temperatures do
occur here Low enough to form them, and are possessed of
great value in a discussion of climate like the present one.
And when these occasional low temperatures are recorded
in this latitude, they produce, in connection with their
usual degrees of heat, a very extensive range of the ther-
mometer. Thus, at St. Augustine the lowest, being two
degrees (2) below the freezing point, and the highest
ninety-two degrees (92), a possible range of sixty-two de-
grees (62) is produced. The variability thus signified, not
only surpasses that of the Pacific posts, but fully equals the
fluctuation of the thermometer at many interior sites
farther north. The advance of temperature to May, how-
ever, at this place, is so great that the very lowest recorded
point exceeds that of April by eighteen (18) degrees, and
reduces its possible range to forty-nine (49) degrees. During
the summer months, at all of these southern stations, the
opposite extreme may be as significant. At Fort Marion,
in June, the highest is one hundred and three (103) de-
grees one hundred and six (106). at Fort King, and at Fort
Barrancas one hundred and four (104) so that this extreme
measure of heat is at intervals incident to the entire penin-
sula. Nevertheless, the thermometer may recede to such a
degree as to produce a rangjfe for the month of nearly forty-
five (45) degrees.

These high measures may be maintained at Fort King
throughout the remaining months, even to September, but
at the others, August alone (at Fort Barrancas) gives a
record of a hundred degrees. July, at these places, seems
to be the most uniform in its temperature condition, its
possible range being much less than that of any other
month.

Upon the western coast, and in the centre, the oppo-
site extremes are not so great as upon the eastern ; for
the lowest at Fort King exceeds that at Fort Marion by
fourteen degrees (14), and at Fort Barrancas it is eight
degrees (8) above it. But at the last it is six degrees (6)
less than at Fort King. The highest recorded temperature

L860.] Of ( Umati to the Consumptive^

for the month, (April) however, is made a1 Fort King, and in
May it also gives the lowest figures of the three stations. Ta-
ken altogether for these two months, less variability is found
on the Gulf coast than at the other points the possible range
of the thermometer for cadi month, being Less than that of
the others. Finally, the average monthly fluctuation of
temperature from April to September, inclusive, at the
three stations, is forty-three degrees (43), and it* March
was added, it would be still farther increased.
- On the Pacific side, the lowest points at San Diego and
Ban Francisco are ten or twelve degrees respectively, above
that of Fort Marion, and two and four degrees respectively,
above that of Fort Barrancas. At the first, however, the
highest is one degree above that at Fort Marion, and ten
above Fort Barrancas, and the consequent degree of fluc-
tuation is fifty-three degrees. But at the second, the highest
point is only eighty-four degrees, which, together with the
lowest, secures a possible range less than all the others, 42.
In May, at these two Pacific coast stations, the temperature
data are more conservative; so much so that the possible
ranges are reduced much below those of Florida. July
and September, at San Diego, afford an instance of one of
those elevated extremes which are noticed in Florida 99
being the highest inJuly, and 101 in September. But at
San Francisco no such record is found, the very highest
being 94 in September, although it is possible that this
may be transcended in a longer series of years. At this
last a remarkable state of uniformity appears to be main-
tained throughout the period, the lowest points varying
from 42 in April to 51 in September, and the highest
from 81 in May to 94 in September.

At the remaining post of the Pacific, the mean possible
range for the period (51) is very extensive, although those
of the two spring months are scarcely more so than in
Florida. The*lowest recorded point here in April is one
degree above that of Fort Marion ; but of the other months
the lowest extremes are much below those of the Florida
station. An extensive range for the period, and lor the

i

94 Doughty. An Essay on the Adaptation [Feb.,

individual months, characterize this post, although its mean
possible range is only four degrees greater than that of
Fort King.

In conclusion, we remark that the prime deduction from
this comparison of their greatest extremes is, that the
Florida stations equal in their monthly fluctuation at least,
the more variable of the Pacific ; whilst they fall far sliort
of the least variable, as San Francisco, in point of unifor-
mity of temperature condition, for the months and the whole
period.

As incidental to the foregoing, we present the following
data, illustrating the daily ranges and extremes of tempera-
ture for the month of April, at San Francisco and War-
rington, Florida. The record from which they were drawn
may be found in the Patent Office Eeports for 1857 and
1858. Warrington is a Post Office in West Florida, of
twelve feet elevation above the sea, and situated in lat. 30
21', and long. 87 16. In April, 1857, at this last, the
average daily range of the thermometer was 16 9; the
greatest daily range was 28 ; the lowest recorded point
was 38, and the highest 75 ; and the extreme range
for the month was 37. During the month there were
Lve days which gave a range of over twenty degrees
(20). ' The same month of the same year gave, at San
Francisco, the following record: The average daily range
of the thermometer was twelve degrees (12) ; the greatest
daily range was 22 ; the lowest recorded point was 51 00,
and the highest 83 00; and the extreme range for the
month was 32. During the time, only two days gave a
range of over twenty degrees (20Q). In April, 1858, at San
Francisco, of which there is no record at Warrington, the
average daily range was 12 5 ; the greatest daily range
30 ; the lowest recorded point was 48 ; the highest 81 ; and
the extreme range for the month was 33. Throughout'
the remainder of the period, the average flaily range at
the latter was preserved during the two years at about the
position already assigned, namely, 10 5 "for the live
warmer months, from May to September." But at the

I860.] Of (Mmate to the Consumptii . 95

former, the daily range from this month to the end of the
period, was greatly reduced, being made equal, perhaps I
than at San Francisco. We submit them without further
comment.

4th. Winds and Weather. The State of Florida, occupying
on this continent, a position intermediate to the tropics, and the
belt of westerly winds that are known to prevail throughout the
temperate zone, lias its mode of circulation of the air classified
under the head of an abnormal circulation " that is, as be-
al and peculiar influences, and not to systems."
se local influences, being variable and varying in their
character, necessarily determine results equally so; and hence
originates that irregularity in the course, and strength, and
frequency of the winds throughout the peninsula of which we
are abon ak. At certain of its seasons, as the spring

and winter, it is emphatically a theatre of conflict between the
continental or polar, and the equatorial winds. But during
the greater part of the year, occupied by an increasing high
iture, the natural diversion is from the sea to the land
yet the resulting winds transcend in force the ordinary sea-
breeze-, especially on the Gulf side. The preponderance of
winds toward the land is produced by the elevated tempera-
ture of the more central and middle parts, but their irregu-
larity, both in regard to strength and frequency, and their
want of uniform prevalence in successive years, is a matter of
it importar.ee. On the eastern coast, as at Fort Marion,
this is especially well marked, so much so that the relative
force or frequency of any prevailing wind for one year, affords
, no true basis upon which to predicate the character of any
future circulation. During five years' observations of the
winds here for April, nothing could be more irregular winds
from north to south-east being irregularly recorded ; and these
may be considered to embrace the principal points of the coin-
's over which the record of the period of high and con
tinned heat extends. Those from the north-east and east had
the greatest force. May, for a similar period, gave a corres-
. ponding record, with a slightly increased prevalence of the
south-west winds ; those, however, from the east and south-
east had the greatest force and frequency of the single ones.

96 Doughty. An Essay on the Adaptation [Feb.,

The regaining months gave a similar record hence, taking
this post as the representative of the Atlantic portion of the
State, we may state that a prevalence of easterly winds upon
the whole, is the rule.

At Fort King, the Atlantic and the Gulf influences appear
to be in constant strife for the ascendancy, and each irregu-
larly gains a temporary predominance over the other. For
the most part, however, we believe that those from the Gulf
are oftenest felt here. Thus, in April, May and June, of the
years 1841 and 1812, the south-west winds were the prevailing
winds at this station ; but in July, 1811, the north-east pre-
vailed, and in the same month of the following year, the
south-east was the predominant wind. So also in August,
1811, the south-west were recorded, but in August, 1812, the
north-east and similarly reversed conditions obtained in
September of the same years. So that places in the interior
may be said to have an alternating though irregular circula-
tion of the atmosphere. The winds from both quarters,
however, whilst in the endeavor to relieve the disproportion
of temperature distribution over the land and sea, correspond
in their relative states of humidity. And although the ele-
vated temperature of these months prevents the more sensible
appearance and influence of the state of moisture induced by
them, yet they maintain a permanently high dew-point.

The same record will -apply to the extreme western station,
Fort Barrancas. The south-east, south-west and north-east
winds being the prevailing single winds. A large proportion
of northern or continental ones were observed in April and
May, but the south-east and south-west were generally of great
relative force.

The general features of the atmospherical circulation of the
Pacific coast have already been dwelt upon, therefore we
need only remind the reader that throughout the present
period, a uniform prevalence of westerly winds is observed
winds from some quarter into which west enters, generally
the north-west and south-west, and possessed of great relative
strength, and of low temperature, uniformly blow to the end
of the dry season. Compared with each other, we find one
characterized by a constantly recurring, permanent and uni-

Of Climate 10 the Consumptive

97

form method of circulation, whilst the distinguishing features
of the other are irregularity, both as to (force and frequency,
and a marked instability. The relative merits of each, how-
r, in the discussion of their appropriateness to consumptive
residence, may be about the same, for we have already inti-
mated that the chilly nature and the i those of the
Pacific, may possibly be an objection to the climate.

The subjoined table is a synopsis of the weather, in its
varying characters:

San Diego, Cal

San Francisco,

Ft. Vancouver,

ion, Fla,

May. June.

July.

Days. Da. s. Days.

CI. R. Fr. CI. R. iFr. CI. R. 'Fr. Cf. R.

13 81 5.d
12.5 9.0
19.2 L0.7

King, F.

.. 10.4 G.O
91 2.1 4,

13.2117.

23.6

S.4

17.8! 12.2
21.0 9.0

17.8 10.2 11. (
5.8 3.8,18.6 ! 3.8 7.6
I 1.4 l">-6 9.0

23.0 I 8.2 I
12 66 18.33

2.3.2
20.6

11.6

August. I September.

Fr.

Days.
CI.

Days.
Ft. CI. R.

22.8 I 8.2

10.66 20.33
23.3 I 7.66

7.7 11.7 20.0 ! 7.0 '10.6
5.2 I 5.2.19.8 5.1 6.1
19.4 Il3.4h4.8 ' 16.2 1 9.8

The means are as follows : San Diego,

fail

days

19.33 cloudy, 11.2

rainy

. ... >

1.9

Pan Francisco,

'

14.98

" 15.21

"

2.84

Fort Vancover.

"

18.55

' 11.88

11

4.78

Fort Marion.

"

20.5

8-6

"

9.1

Fort Ki^g,

"

21.2

4.8

"

4.95

Fort Barrancas

"

15.9

M 15.2

M

9.1

The characters of the period here embraced, at the respec-
tive places, differ so materially as to render a comparison
between them quite difficult. On the Pacific coast the regu-
larly alternating dry season is at this time fully established,
varying, however, at the different posts in the ascent of the
coast, as to the exact time of its commencement and contin-
uance. These variations alluded to, inasmuch as they imply
necessarily the longer or shorter continuance of the wet season
at the several points, occasion essential differences between
them, in respect to the relative number of fair, cloudy, and
rainy days. At San Francisco, however, other causes, entirely
independent of the measurements of rain, are in operation,
which produce in the middle and close, an increased number
of cloudy, over the others. So that, that immediate connec-
tion which elsewhere exists between the amount of precipita-
tion and the proportion of cloudy days, or between the ratio
of cloudy and rainy days, is here absolved. On the other
hand, m Florida, this period embraces those months during
which the greatest monthly records of the fall of rain are
made, and which, both from its degree and the period of its
occurrence, has, to some extent, identified it with tropical
7

8 Doughty. An Essay on the Adaptation [Feb.,

regions. At Fort Marion, the months so embraced extend
from June to September, and at Fort Barrancas, from May to
September, and at Fort Brooke, a little to the south of Fort
King, from June to September. In the months excluded
from this rainy period April at Fort Barrancas, and April
and May at the others the ordinary precipitation of the
eastern United States is recorded. At San Diego, by the
measurement of rain, the dry season is seen to extend from
April to October ; at San Francisco, from May to October ;
and at Fort Vancouver, or its parallel point upon the coast,
from June to September.

In consequence of the profuse precipitation during the
summer in Florida, it is generally alluded to as the wet sum-
mer, but this does not warrant the inference of an opposite
dry season to it. Hence, in this S: ate, we have a period
of increasing precipitation from April forward to the fall
months, which maintains a direct relationship to, and a depen-
dence upon, the relative number o\ cloudy and rainy days.
Yet even this is not strictly absolute, because of the very great
measurements that are sometimes made in short periods of
time ; and this fact affords a clue to the record of a greater
number of rainy than cloudy days, during certain months, at
some of the Florida stations ; for in those days upon which a
fall of rain is observed, which occupies only a limited part of
the day, (falling in the character of showers, sometimes exces-
sive,) it would be an error to report them as cloudy days, since
the cloudiness may have existed only a few hours. Hence the
real signification of the term rainy-days, is those upon which
there was a fall of rain, without reference to the period occu-
pied by its fall, or to the extent of cloudiness which preceded
or accompanied it.

The two sections, then, present opposite conditions at this
period ; the Pacific coast having a dry and rainless period,
almost uninterrupted, whilst in Florida there is a continuously
large and increasing precipitation throughout it both of
which are equally unnatural to the person who apprehends
the proper climate of the eastern United States, by the amount
and character of the precipitation, north of the Gulf coast, or
in its middle latitudes. But so far as the discussion of the

I860.]

.

data in the above table, is of value to us in our investigation,
both sections might be classed under that condition, in which
a general preponderance of fair weather over foul weather is
maintained. For although this is apparently contradicted by
the calculated means of the cloudy days, at San Francisco,
equalling those of the fair, yet the essentiality of the classifi-
cation remains undestroyed, because of the relation of the
cloudy and rainy days. The proportion of cloudy days is
produced by certain local causes, which oj^erate during the
day, most intensely ; but the clouds thus produced disappear
without a fall of rain. Dr. Gibbons says that " in almost
every month of the year, even during the dry season, the
clouds put on the appearance of rain, and then vanish. It is
evident that the phenomena which produce rains in other cli-
mates, are present in this; but not in sufficient degree to
accomplish the result, except during the rainy season, and
then only by paroxysms with intervening periods of drought."
At San Francisco, after the passage of the two spring months,
we observe the proportion of cloudy days rapidly augmenting,
so that the proportion of June to that of September, stands as
9 to 16.6, some of the intervening months having a still higher
increase. But as has already been remarked, how do the rainy
days behave during this increase of the cloudy ? They remain
at the same figures, less than one-fifteen part of them. As it is
expressed in the computed means for the period, the rainy
clays would embrace 2.84 days of every month. Now, there-
fore, under the head of fair weather, as here advanced and
understood in its relation to physical, out-door exercise, twenty-
seven days or more would be embraced. If the same be ap-
plied to San Diego, the proportion becomes increased still
further to nearly twenty-nine days. In this light, they trans-
cend the posts of Florida, the ratio being, at Fort Marion,
twenty days ; at Fort King, twenty-one days ; and at Fort
Barrancas, twenty-two days. In this peninsula, the average
number of rainy clays at Fort Marion exceeds slightly the
cloudy, the relation being as 9.1 to 8.6 ; at Fort King it is as
4.95 to 4.8 ; but at the other posts, the rainy days constitute
only about three-fifths of the cloudy days.

5th. Bain in inches. Of the precipitation at this time, we

100 Trent. Hydrocyanate [February,

shall have little or nothing to say, reserving our remarks until
the discussion of their humidity is commenced. A simple
statement of the measures at Florida will suffice the others
having already been referred to in other parts of this essay.
At Fort Marion, in a period extending from three to four
years, the mean of April is 1.56 inches ; of May, 2.00 ; of
June, 4.27 ; of July, 3.24 ; of August, 3.03 ; and of Septem-
ber, 5.85. At Fort Brooke, in a period of sixteen years, the
mean of April is 1.95; of May, 3.21; of June, 7.04; of July,
11.10 ; of August, 10.10 ; and of September, 6.23 inches. At
Fort Barrancas, with nine years' observation, the mean of
April is 2.94; of May, 4.05 ; of June, 4.66; of July, 6.80;
of August, 7.23 ; and of September, 5.25 inches. From this,
it appears that more rain falls in the southern and western
parts, than in the eastern.

Hydrocyanate of Iron In Epilepsy By Peterfield Trent,
M. D., of Richmond, Ya.

ARTICLE VI.

In August 1858, I was called to see Miss V. A. I found
her senseless, and convulsed, her face was tinged and livid,
she was struggling violently, and foaming at her mouth,
her pulse was hard, and every indication of plethora existed.
I directed cups to her spine and active purgation.

On paying my second visit I found her still comatose
no return of Epileptic fit, her pulse was softer, the pur-
gative had operated well.

Third visit Found my patient perfectly conscious, was
not aware of having had such an attack.

Upon enquiry, I found Miss V. A. had been liable to
similar attaks from her 12th year she being now 18 years
old. The attacks occurred at intervals of some week or
two, she had been for a long time under the best Physicians
of our city : all the usual remedies had been resorted to in
these attacks, and afterwards everything that skill could
suggest was tried, her mind I found was evidently impaired,
upon enquiry, I found her catamenia very regular as to
return and no material variation as to quantity. Iler bowels

I860.] Of Iron. 101

were regular, and there was no tenderness upon pressing
the spinal column. I directed cold water to be poured upon
the head from a pitcher by a person standing in a chair,

and Misters to be applied to the spinal column al short
intervals. The bowels to he kept always open with a Little

Bicarb Sodse pure and Rhubarb. Her diet to be light, but

nutritious. I further directed pills of 1 gr. oxide of silver
and extract Hyosciami 3 times per day. I saw my patient
at intervals of three or four days for upwards of a month,
she improved very slowly. Being called from town I saw her
no more until about the month of Dec. 1858, when I was
called to see her in another attack, I found the attack not
as severe as the first one, learned from lier Aunt that she had
had several attacks since the one I was first called in to see
her. In this attack I used purgatives, and applied a blister
four fingers wide, the whole length of the spinal column
no other treatment used. Having seen Dr. McGuffin's
communication to Messrs. Tilden & Co., of New York,
relative to the use of the Ilydrocynate of Iron" with Valerian
in Epilepsy, I immediately directed one hundred and twenty
pills made according to his formula, and ordered her to take
one pill three times per day with the dose to be increased
at the end of a week to four pills per day I directed also,
if there was still some warmth about the head to continue
the pouring of cold water upon the head once a day, also
occasionally to apply small blisters three and four along the
spinal column, as soon as one healed in three or four days
more to put another lower down I further directed a spare
and nutritious diet, and the eating of no supper nor
anything that would cause flatulency or derange the digestive
organs. I did not see my patient again until Aug. 1859,
when I was called to see her labouring under bilious
attack. I found her married, and looking very well, upon
enquiry I found her attacks had become less and less frequent,
and at the time I saw her she had no symptom of her old
enemy for a month or two; she continued taking the pills,
when I last saw her husband she had had no attack of her
complaint.

102 Trent. Hydrocyanate [February,

Case 2d. January 29, called at 2 A. M., to see W. B. a
stout athletic drayman, 35 years old. Upon my arrival I
found "Washington labouring under the usual symptoms of
an Epileptic Fit. I immediately bled him, and directed a
brisk cathartic after the operation of which, if he was not
entirely restored to consciousness a blister four fingers wide
to be applied the whole length of the spinal column upon
my second visit I found the purgative had acted well, and
my patient was conscious, but was entirely unconscious of
having been sick. Having procured from Messrs. Tilden
& Co., an ounce of the Hydrocyanate of Iron, I immediately
prepared some pills according to Dr. McGugin's formula.
I gave the same directions relative to diet, &c. as I did in
case Xo. 1.

During the month of May I was called again to sec
Washington, found the attack not so severe as the first one.
Directed an emetic believing a hearty supper had brought
the attack on, the emetic revealed my opinion to be right,
he however soon had another fit. I had him cupped along
the spinal column, and gave a brisk purgative ; 2d visit my
patient had gone to work. Dec. 1859, called to see Wash-
ington, but found the fit had passed off, he was, however,
very drowsy, and as is usual in severe cases he did not
recollect being sick, expressed much surprise at seeing me
that time of night

His wife informed me that her husband had improved
very much, and that the pills, alluding to the Hydrocyanate
Ferri, etc. had done him a great deal of good, and that his
spasms as she called them were not near so severe, and did
not come on so often as they did at first and that she
believed if "Washington had continued to take the pills
regularly as I directed, he would have been cured long
since. He is still taking them, and I have every reason to
believe his case will be a complete cure. The following
is the formula I have had my pills made from:

g Hydrocyanate Ferri 5j, Ptflv Valerianae 5ij, by pill
No. 120. Dose one pill three times per day gradually
increased to four pills a day.

I860.] Of Iron. 103

In a case now under treatment, I have by the advice of
Dr. W. L. McQugin, of Keokuk, Iowa, added to the above
formula $j of extract Cannabis Indira, the general treat-
ment the same as prescribed for cases No. 1 and 2 reported
in full. This disease is seldom fatal, yet often ends in
fatuity or insanity ; well may a family which it has onoe
entered look with dismay and anxiety whenever it threatens
to revisit a beloved one in that family one striking pecu-
liarity in this disease, is that a case seems always to improve
underany new plan of treatment. I believe with Dr. Watson
that everything should be done during the interval of I
attacks to prevent their recurrence. Try and get rid of the
predisposition of the disease, by protecting the patient
against its exciting cause pay proper attention to the
health first bf all. If there is a disposition to plethora
reduce it by proper attention to the diet, avoiding crudities.
orge gentle exercise and if need he, deplete by cups to the
spine. If on the other hand a different state of things
exists, they can he removed or lessened by tonics, properly
and judiciously used. In our treatment we should aim to
give stability and firmness to the nervous system. In
almost every epileptic subject there is a readiness to be
impressed, and great mobility of the nervous system. Iron
cannot he called a specific in this disease, yet it invariably
does good by giving tone to the nervous system, and
rendering it less prone to be effected by the slighter exciting
causes. The preparation of Iron, the Hydrocyanate I have
alluded to as having used in the treatment of the cases just
detailed, certainly possesses advantages that entitles it to
consideration among the profession, the smallness of dose,
and the ready manner it can be administered, and in
sufficient doses small as they may appear to do good, it
does not constipate, nor produce any unpleasant symptom
either in the head or stomach.

104 Fever The Duality of its Source. [February,

Fever The Duality of its Source. By Dr. Wm. Addison,

F. E. S., &c.

[Dr. Addison starts with the assumption that "fever is
the expression of disorder in the corpuscles of the blood;"
then, as these corpuscles derive the materials of their growth
and nourishment from two sources, viz., the atmosphere
and the plasma, the argument is continued that they may
be disordered by injurious matter derived from these two
sources. Thus we have two forms of fever, designated
respectively contagious and hectic. Yet in common with
other cellular bodies, the corpuscles of the blood possess
considerable power of resistance to disease. It is not every
passing impurity of the atmosphere, nor every injurious
change of quality of the plasma, that establishes symptoms
of fever. Hectic fever is produced by the effects of a local,
disease (as pulmonary suppuration, or suppuration owing to
necrosis of bone,) on the plasma of the bloodn To show
that a local disease may and does produce changes in the
blood plasma, an experiment is detailed in which aggluti-
nation of red corpuscles and formation of colourless matter,
could be seen in the capillaries of a frog's foot, as the result
of irritation these altered blood elements passing into the
circulation along the dilated veins. The author then
continues :]

No one can doubt that the fluid of the blood is altered,
and may be distempered, by unwholesomeness of diet, and
by neglect of the daily excretions by the skin, bowels, and
kidneys. It is also evident that these common sources of
distempering of the fluid of the blood must operate not
only in persons of health, but also in persons who may be
afflicted with chronic forms of inflammation, such as are
present in necrosis of bone, in diseased joints, pulmonary
consumption, &c. And if, in these last mentioned exam] >les,
distemperature of the fluid of the blood from errors in diet,
or other such causes, concur with distemperature from
absorption of spoiled matter from places of chronic suppu-
ration, then there will be ({enteropathy of the plasma, or
disturbance of the qualities of the fluid of the blood from
two points at the same time ; namely, unwholesomeness of
food and absorption of morbid matter. And it follows from
the physiological relation subsisting between the corpuscles
and the fluid of the blood, that an increasing debasement
of the qualities of the fluid must at length disorder the
corpuscles.

But one of the chief points we have been arguing for, is

1800.] Fi -u- The Duality of its Source. L05

the therapeutical relations of inflammation to the fluid of
the Mood. Suppuration is a means whereby injurious
matter is eliminated from the plasma ; and granulations and
pus may perform the office of a depurating organ vica-
riously. Now we are saying thai chronic suppuration and
ulceration will occasion deuteropathy of the plasma, and
thereby fever. This seems an incongruity. A little
consideration, however, will show thai it i> only a seeming
incongruity. Diet sustains life and health only by measure:
it is pathological in excess and by deficiency. Heat or
temperature contributes to life and health only by measure.
Oxygen, an essential constituent of the atmosphere, is an
element of health and life only by measure ; any great
variation from a mean amount is pathogenetic. Too much
or too little wouUl equally occasion disturbance of health.

So likewise o\' the matters we arc discussing : the process
of repair in the commonest injuries has its pathological as
well as its therapeutical aspects. The reaction upon which
cure depends may be too much, or too little, or too long
about. Granulations may be languid, or indolent, or
deficient; or they may luxuriate, and usurp the place of
fibrous tissue when fibrous tissue is needed for reparation.
And fibrous tissue may hold its ground when osseous tissue
is demanded for cure. This is sometimes the case in
fractured bones. In ordinary contusions, great swellings
appear and disappear. In their appearance, matter from
the plasma of the blood must have become stationary in the
part. In their disappearance, this matter must have been
absorbed again into the blood. There must be, therefore,
in these cases, in some way or other, a ready passage for
elements from the injured tissue into the fluid of the blood.

Analogously, inflammation as a depurative reaction in
distemperatures of the fluid of the blood, maybe hindered
and interfered with in various ways. There may be too
much or too little of it; and certainly it is very often
protracted by the persistence of the blood-disturbing causes.
If, then, there be a ready passage to and fro, as it were
between the fluid of the blood and the common tissue, it is
not difficult to perceive that interference and hindrances
may interrupt, or even reverse, the action in this particular.

The ordinary process of repair, then, has a double aspect ;
and so, also, has inflammation. And our argument is, that
protraction or* chronicity in either of them introduces the
liability to absorption of spoiled material, and that thus
therapeutical reactions may operate retroversely and patho-

106 Fever The Duality of its Source. [February,

logically upon both parts of the blood ; the fluid first, and
then the corpuscles.

But, that we may give an outline of the argument as it
relates to hectic fever, we take as examples necrosis of bone,
gout, and scurvy; and, in contrast with these, scarlet fever.

Necrosis of bone produces inflammation. There are
hinderances to the removal of the dead bone ; therefore
inflammation passses into protracted suppuration and ulce-
ration. These gradually weaken the patient ; they disable
him from taking exercise; digestion is impaired; and the
functions of the depurating organs are disturbed.

This is one source of distemperature of the plasma.
Distemperature of the plasma aggravates the existing
inflammation ; but the antecedent the dead bone cannot,
in the case we are contemplating, be removed. Therefore
disorder must proceed, until at length, from the places of
suppuration, morbid matter ebbs back into the circulation ;
and the plasma, thereby thoroughly disordered, reacts upon
and disorders the corpuscles, and hectic fever, more or less,
appears. Upon this interpretation of the sequence of events
between dead bone and fever, to cure the fever the blood
corpuscles must be relieved from their disorder; to relieve
them the qualities of the plasma must be improved ; to
amend the qualities of the plasma, the chronic suppuration
must cease ; and that chronic suppuration may cease, the
dead bone must be taken away. We all know that the
effectual removal of the dead bone will cure the fever.

Errors in diet by excess produce distemperature of the
plasma. And if the depurating organs, or some of them,
fail in removing the distemperature, inflammation arises.
In gout, the patient is sui rounded with every comfort.
The error in diet is most probably one of excess; it can,
therefore, be easily interdicted ; the antecedent can be
readily removed : and, by medicine, the depurating organs
can be stimulated to a more active working. For these
reasons, distemperatnres of the plasma are concluded to be
simple ; its qualities are disordered from manageable
sources, which may be attacked and abolished before
disorder is communicated to the corpuscles. Inflammation
in gout is, therefore, acute, and without fever.

On the other hand, in scurvy, the errors in diet are those
of deficiency or unwholesomeness, and are much more
difficult to deal with, especially where persons are crowded
together in unhealthy localities, or limited to camps or ships.
The individuals are poor, or from other circumstances,

I860.] Fl n / The Duality of its Source. 107

cannot command the necessaries of life. Therefore, forma
of inflammation, which in (he rich are simple and acute,
are here (or in the poor) chronic, and pass on to suppuration
and ulceration, as in the sailors before mentioned, whose
bare legs and feel were bitten by mosquitoes; upon which
example we oh^i've thai because the unwholesome diet
and confinement could not be changed, therefore the bitten
parts passed into chronic ulcers. And if, in persons thus
situated, with forms of chronic ulceration from continued
imwholesomeness of diet, or other privations, morbid
matter should be continually ebbing hack into the circu-
lation from places of chronic ulceration, the elements of
fever, from a double debasement of the plasma, would
exist; and fever thus arising would obviously be different
from fever arising through miasma, in the air.

In scarlet fever, it is concluded, that disorder of the blood
begins, not with the plasma, but in the corpuscles. The
illness commences, not with forms of inflammation, but
with symptoms of fever. There has been no error in diet :
a miasmatous air has acted on the blood ; a specific poison
is generated ; and the plasma is distempered posteriorly to
disorder of the corpuscles. But (here as in small-pox) no
natural depurating organ seems adapted for the removal of
the poison of scarlet fever from the plasma ; therefore
inflammation arises that is to say, reactions between the
plasma and the common tissue. The forms, amount, and
duration of inflammation in scarlet fever, indicate the
amount and severity of the disorder of the blood. Without
these reactions, the patient would die from a poison shut
up in the blood ; with them, in their severest forms, there
is a battling for life. When a joint has been crushed, death
would take place from mortification, were there no reaction;
but, this established, the patient is saved from the first and
most pressing danger, though afterward he has to pass the
ordeal of inflammation, abscess, suppuration, ulceration,
and very probably hectic fever too, as best he can, or suffer
amputation for a chance of life. In scarlet fever, to cure
the inflammation, the plasma must be freed from poisonous
matter; and no more must enter it. That no more may
enter it, the corpuscles must cease to generate and excrete
a poison. 2s"owt, from the course observed in normal cases
of an exanthematous fever, we may probably conclude that
the corpuscles pass through their disorder in from four to
six or eight days. When their disorder has passed, no more
poisonous matter is discharged from them into the plasma ;

108 Fear The Duality of its Source. [February,

and, no more poisonous matter mingling with the plasma,
the inflammatory reactions and the natural depurating
organs together succeed in restoring the plasma to its
natural state ; whereupon, the blood regaining its normal
constitution, inflammation comes to an end, and the patient
is cured. The pathological and therapeutical sequences
are the same as in small-pox.

In the midst of these therapeutical actions and reactions
for the depuration of the blood in fever, it would seem that
a depurating organ is sometimes coerced, as it were, to an
increased and incongruous working; matter not naturally
found in the secretion of the organ appearing in it at the
crisis of the fever. In the performance of this enforced
duty the elimination of poisonous matter from the plasma
the parenchymatous elements of the organ may be over-
tasked and injured. Thus, in scarlet fever, the poison in
the blood sometimes occasions parenchymatous disease of
the kidneys ; and, in such cases, there is evidence also of
inflammatory reactions in the common tissue of the organ.
This complication may have the same reflex effect upon the
blood as chronic ulcerations. Spoiled material from the
overburdened kidneys may ebb back again into the circu-
lation ; and a new blood-distemper may be inaugurated
from elements of urine retained in the plasma. Such being
the case, there would be present the antecedent of a second
or reactionary fever ; namely, deuteropathy of the plasma.
that is to say, distemperature from disease of the kidneys,
superposed upon the remnant of the poison of scarlet fever.
And it is in perfect accordance with the argument, that a
secondary fever from disease of the kidneys should be more
apt to appear as a consequent of the primary fever, where
the inflammatory reactions in the skin are too slight or
insufficient for the full and effectual discharge of the poison.
Butit is to be observed, that the second fever is not a
relapse or reappearance of the first ; it is another fever, of
different origin. The first fever was occasioned by an
aerial miasm ; the second is occasioned by a debasement of
the plasma acting injuriously on the corpuscles of the blood.

Let us give a brief summary of the facts and of the
arguments.

In necrosis of bone, the pathological series begins with
dead bone. If this cannot be taken away, it ends with
fever, from deuteropathy of the plasma disordering the
corpuscles of the blood.

In pulmonary consumption, the pathological series begins

1S(I0.] Syphilitic Pneumonia,

with tubercles in the lung, There are hindrances and
difficulties in their discharge : suppuration is made chronic ;
and the phenomena end with fever from deuteropathy of

the plasma.

[n scurvy, the series begins with unwholesomeness or
deficiency in diet, or other privations which cannot be
changed. Ulcerations arise ; and the scries may end with
fever, from deuteropathy of the plasma.

Iii these examples namely, hectic fevers disorder of
the blood-corpuscles is posterior to a debasement of the fluid
in which theyswim: and. forms of inflammation, protracted
for longer or shorter periods, precede the fever.

On the other hand, in the contagious primary fevers, the
pathological scries begins with disorder of the corpuscles.
it ends with forms of inflammation ; because distempe-
rature of the fluid of the blood is, in these fevers, posterior
to disorder of the corpuscles. Thus we interpret the
relations of fever to inflammation, and of inflammation to
fever, by the difference between the two parts of the blood.
The facts are, that sometimes fever precedes inflammation,
sometimes forms of inflammation precede fever; because
sometimes (from serial poisons) the corpuscles are disordered
before the plasma ; and sometimes (from unwholesome diet,
privations, and chronic ulcerations) the plasma is disordered
before the corpuscles. If you accept these interpretations,
the whole subject of repair, inflammation, and fever,
presents a coherency which is worthy of your attention.
Thus :

Mechanical objects injure the common tissue ; and the
process of repair arises.

Errors in diet disorder the plasma; and inflammation
appears.

Miasms in the air affect the corpuscles of blood ; and
primary fever is the result.

Both the process of repair and inflammation, from
hindrances and difficulties, may pass into chronic or
protracted forms of suppuration, ulceration, and discharges ;
whereupon, if spoiled material should enter the circulation,
and, by reiteration or quantity, thoroughly debase the
plasma, the corpuscles suffer, and fever appears ; namely,
reactionary, hectic, or a plasma fever. British Medical
Journal, May 28, 1859.

Syphilitic Pneumonia.

We well remember bearing Dr. Stokes describe
a form of pneumonia common amongst drunkards,

HO Syphilitic Pneumonia. [February,

and which he called "drunkards' pneumonia." There
is also an inflammatory consolidation of the lung which
owes its origin to the poison of syphilis, and hence is
well worthy of the appellation of " syphilitic pneumonia."
At the Royal Free Hospital, on the 22dult, we were shown
a well-marked case of the latter, under Dr. O'Connor's
care ; the patient, who was admitted about the middle of
July, being thirty-five years of age. His syphilitic history
was clear, "and was associated with a papular eruption, some
of the copper-coloured spots being visible up to the present
time about the back and shoulders. On his admission, the
physical signs of pneumonia were present, the dulness
over both lungs was very considerable and extensive, and
the vocal resonance was strong and distinct all#over each.
The dyspnoea, therefore, was urgent, but the breathing was
not so embarrassed as in ordinary pneumonia. There was
also frequent cough, without expectoration, associated with
much wasting, and a small and quick pulse (100.) His
treatment consisted of blisterings all over the chest, five-
grain doses of iodide of potassium from the 23d to the 28th
of July, and four grains of mercury, with four grains of
extract of conium, three times a day, were ordered, and
continued till the mouth became sore ; and a quarter of a
grain of muriate of morphia every night. The gums are
tender now ; he is taking iodide of potassium with his
cough mixture, and the disease is yielding. One of his
testicles was much enlarged, of a pyriform shape, and
indurated, principally depending upon enlargement of the
epididymis. His voice is hoarse and husky.
This is one example in some six or seven which have
been admitted into this hospital with the symptoms of
inflammatory chest disease, clearly the result of syphilis.
A case, in many respects similar to it, is under Dr. "Will-
shire's care at the Charing-cross Hospital, differing only to
this extent, that the bronchial tubes, trachea, and faucial
mucous membrane have been affected, instead of the lung
tissue. The patient is a middle-aged woman, whose history
is obscure, but the ulcerations and other peculiarities point
to syphilis as the cause of the disease. The secretion from
the tubes is copious, and occasionally hemorrhagic. She
has much improved under the use of the syrup of the iodide
of iron.

We have seen cases in the Royal Free Hospital, under
Dr. O'Connor's care, wherein the evidences of phthisis were
present, with an absence of the physical signs of the disease,

I860.] Formation of Clots During Life, 111

the symptoms depending upon constitutional syphilis, and
readily fielding to the exhibition of mercury, Lancet
Sept. 3, 1859, [>: 238.

The Formation of Clots During Life: By George Murk ay
Humphrey, M. D., F. R. S., Surgeon to Addenbrooke'a

Hospital; Lecturer on Surgery and Anatomy.
[The following extracts from an unfinished series of papers
(accompanied with cases) are taken from recent numbers of
the British Medical Journal, the cases being generally
omitted.]
i. Format/ion of Clots in the Veins.

The obstruction of the veins, by clots forming in their
interior, has, of late years, been the subject of investigation
by several pathologists, who have pointed out clearly the
conditions under which it most frequently occurs, and the
changes which take place in consequence. Still, doubts
appear to exist, respecting the causes of the phenomenon, and
the starting point of the mischief; and, though the affection
is one of very frequent occurrence, and may usually be diag-
nosed with facility, it certainly has not attracted the attention
of practical men so much as it deserves. Very commonly it
is suffered to pass unnoticed during life ; and, after death, the
vessels concerned are seldom examined to a sufficient extent,
and with sufficient care to enable the observer to form a
correct opinion upon the matter.

In all the cases that I have seen, with the exception of one
or two, the patients have been in a feeble state, most of
them having been previously reduced by some other disease.
The most frequent causes of the accompanying debility, were :
some chronic disease, such as phthisis, or a discharging abscess ;
old age ; low fever ; or an acute inflammatory affection, more
particularly of the serous membranes, or of the lungs. In no
instance has the condition of the veins appeared to be the
cause of death, either directly or indirectly ; though in many
cases the patient died of the diseases which preceded that
condition, and the state of the blood which was induced
appeared in some, to accelerate the fatal result. It is, moreover,
a very important fact that in no case, which has occurred
within my observation or reading, has this afiection been
productive of any of those alarming and much to be dreaded
symptoms, which attend occasionally upon traumatic inflam-
mation of the veins, and occur under other circumstances and

112 Formation of Clots During Life. [February,

which are supposed to depend upon the admixture of purulent,
or other morbid fluids, with the circulating blood. In some
instances, as in that first related, the affection is attended with
uneasiness, or pain, in the early stages. More commonly, it
comes on insidiously, and does not attract attention till the
swelling of the limb is observed, when some tenderness in
the course of the vein may generally be found. Not unfre-
quently, we are called upon to treat an edematous state of one
of the lower extremities, which commenced during an attack
of fever, or some other illness, and which may be traced to
an obstruction of the vein thathacl escaped notice. In several
cases the first suspicion of any obstruction to the circulation
has been excited by the observation, after death, that one of
the limbs was swollen ; this has led to an examination of the
veins, and to the discovery in them of clots, which must have
existed many days.

The circumstances under which the disease occurs, and the
fact that it often affects several parts of the circulatory system
at the same time, or consecutively, in the same person, are
quite in accordance with the supposition that it depends,
primarily, not upon a morbid condition of the vessels ; but
upon a preternatural tendency to coagulation in the fibrine ;
and this view derives confirmation from several of the following
phenomena, which may be observed in the origin and jJrogress
of the malady.

Thus, the obstruction most frequently commences in the
parts of the venous system which are most favorable to the
coagulation of the blood, viz : in the great veins, particularly
those of the lower extremities, where the current is more
feeble than in other regions. The points of selection in the lower
limbs are: first, at or near the junction of two large veins, as
the external and internal iliacs, the superficial and deep
femorals, the anterior and posterior tibials ; the projecting
angles between the confluent trunks, furnishing favorable
spots for the settling of the blood ; secondly, in the neighbor-
hood of the valves. These present loose, free edges, to which
the fibrine may readily adhere ; and they also have the effect
of shutting off from the circulating current the small quantity
of blood which lies above them, included in the retiring angle,
between the upper surfaces of the valves and the adjacent
wall of the vein. The blood so situated must be almost at
rest when the circulation is feeble and the limbs are kept
quiet, because the valves will be then only partially opened,
and, being at rest, it has a favorable opportunity to coagulate
and become the nucleus of a larger clot. That this is no
imaginary cause is proved by a case in which I found small

I860.] Formation of Clots During Zdfe. 113

dry clots lying above that is, under shelter of the valves
of" the femoral vein; the remainder oi the vein being free
from clots, or nearly so. However, the veins just above the
valves often present slight bulgings, or dilatations. Their
walls are here a little thicker than at other parts, and they
exhibit a faintly reticulated appearance upon the internal
surface.*

It is to be remarked, that the valves are more numerous in
the lower limbs than in the upper, and in the deep veins than
in the superficial .f They are also often placed in the main
veins near the points of junction of large branches; so that a
-number of causes combine to facilitate the coagulation of the
blood in these situations.

Thirdly, the formation of the clot often begins in the popli-
teal vein. This has relation, not merely to the fact that the
trunks of the anterior and posterior tibial veins, and the
saphena minor are here united, but also to the fact that the
internal surface of the popliteal vein is often remarkably
uneven, presenting quite a reticulated appearance from the
interlacement of opaque strengthening bands which form
projections in the interior.

In the upper part of the body, the clots form most frequently
at, or near, the junction of the jugular and subclavian veins,
where there are always large valves, and in the cerebral
sinuses.! In- the latter the peculiar construction of their walls
prevents much variation in their calibre (see my Treatise on
Human Skeleton, p. 200,) so that there must be considerable
variations in the rate at which the blood traverses them ; and
they present, at the points of junction of the branches, many
and marked projecting angles favorable to the settling of the
fibrine.

The clots form not unfrequently in the venous plexuses
around the prostate, and in the hemorrhoidal veins.

* In a man. aged 76, who died of senile gangrene, I found a reddish brown
clot, which was evidently of many days standing, closely adherent to the valves
of the femoral vein, near the junction of the profunda. The rest of the veins, in
both lower extremities, were healthy, and contained no peculiar clots.

f I have found the distances at which the valves are placed in the superficial
veins of the lower limbs to be about equal to those at which they are placed in
the deep veins of the upper limbs.
_ % They were found by Virchow Froriep's Notizen, xxxvii, 30, in the cerebral
sinuses, in six cases out of eighteen.

In a man, aged 67. who died with sloughing of the nates, after fracture of
the thigh, I found several short thick firm clots, with stunted branches, in the
veins near the prostate. They were smooth, quite unadherent, and tumbled out
of from the divided vessels. A section of each showed a central cavity contain-
ing red fluid, surrounded by a wall composed of tough, laminated, reddish or
mottled fibrine. The fluid exhibited red corpuscles and a great number of pale
nucleated cells.

8

114 Formation of Clots During Zdfe. [February,

It appears that, in general, the formation of the clot com-
mences on the outside, that is near to the coats of the vein,
where the current must he somewhat slower than in the axis
of the tube ; and the first stage in the process is the settling
of a patch or layer of fibrine upon the inner surface of the
vein. This is increased by the addition of successive layers
upon the interior, whereby the channel tor the blood is dimin-
ished. Soon the tube is completely obstructed ; this result
being commonly accelerated, more or less, by the clotting of
the blood, in addition to the settling of the fibrine. The two
processes fibrinous deposit and blood-clotting which differ,
probably, only in the circumstances that the greater rapidity
of the latter causes the entanglement of the red globules with
the fibrine, go on somewhat irregularly, wdience the mottled
appearance of the coagula ; but, as a general rule, the clots
are firmer and more fibrinous near the exterior, softer and
darker in the middle.. In a young woman, who died of fever,
with peritonitis, excited by approaching perforation of the
ileum, wre were led to examine the veins by observing some
oedema about the left ankle, and found the external and
internal iliacs, at and near their junction, on both sides,
occupied by coagula, which, on the left side, extended down
below the popliteal vein, and, on the right, terminated in an
ordinary clot at Poupart's ligaments. Sections of these clots
showed them to consist of laminated fibrinous tubes, mode-
rately firm, and enclosing central cylinders of dark, soft blood.
The thickness of the fibrinous tubes varied. In some places,
more particularly near the junction of the iliacs, where we
judged the affection had commenced, it was so great as to
leave little space for the dark central portion of the clot. In
other parts, the fibrinous layer was thin ; and in one place it
was separated from the internal surface of the vein by a layer
of soft, dark, clotted blood, resembling an ordinary recently
formed coagulum in consistence and appearance. This was
probably formed from blood, wdiich had insinuated itself
between the clot and the vessel, and had coagulated shortly
before, or possibly after, death. A transverse section of one
of these clots showed very clearly the central dark soft
coagulum surrounded by a circle, or tube, of laminated fibrine,
which again was enclosed by a more recent dark external
layer.

The exterior of the clot is usually smooth, sometimes having
quite a polished appearance, except at the points where it has
become adherent to the sides of the vein. These adhesions
are not usually very extensive ; they are most commonly
found where the clot began to form, and vary in their firmness

800.] Formation of Clots During I L15

witli the period of their duration. The Bmooth character of
the external surface of the clot is important, inasmuch as it
rather militates against the view so much advocated by
Virchow and some other pathologists, that portions of the clot
are very liable i<> be detached, and to be curried along
in the blood-current, till they cause obstruction and give rise
to secondary coagula in distant vessels.*

The < i of the clot in the direction of the heart is

usually limited by the junction of some large vein which is
sufficient to maintain the current of the main trunk. Often
the clot does not reach quite so far as this. Thus, when the
clot commences at the junction of the iliacs, on one side, it
commonly extends about halfway up the common iliac; and,
in a case of cancer of the uterus, in which the iliacs, on both
sides, were obstructed, the clot extended up the vena cava
nearly as high as the renal veins. Sometimes the clot reaches
further, and terminates in a round or conical end on the
cardiac side of the point of junction of some large trunk. In
the peripheral direction, it is prolonged to a variable extent
into the tributary branches, but does not usually reach the
small veins ; indeed, the latter are very rarely obstructed,
either primarily or secondarily, in this affection.

The clot not only fills and chokes up the vessels, so as to
prevent the passage of blood through it, but also distends or
stretches it, and this distension, together with a certain amount
of irritation resulting from the presence of a solid body in its
interior, soon produces an effect upon the walls of the vein,
the results of which are exhibited chiefly, or almost exclu-
sively, on the exterior of the vessel. Thus, we soon find that
there is inflammation of the investing cellular tissue, causing
an effusion of serum, lymph or pus : whereas, in the interior,
there is commonly little change beyond a removal of the
epithelium from the lining membrane, and more or less
intimate adhesion of the clot to it. There may be also an
increase of redness at some parts, which is evidently due to
staining by the contiguous blood, inasmuch as it is commonly
proportionate to the color of the contained clot, being deepest
where the clot is darkest, and less marked, or quite absent,
where the clot is composed chiefly of fi brine. I have never
seen lymph or pus, or any inflammatory product, formed from
the interior of a vein. This proves that the inner coats of
veins are by no means easily excited to inflammation, and is

* Mr. Hevvett. Medico-Chimrgical Transactions, xxviii, 74, found the in clot
one case l" enveloped in a perfectly distinct, transparent, smooth, polished mem-
brane, presenting the appearances of serous tissue, with arborescent vessels in
its structure."

116 Formation of dots During Life. [February,

quite in accordance with the results of experiments made upon
the veins of animals by Lee,* Mackenzie,* and Virchow
(fflmdbuch der Specidle Pathologie urid Therapie, i, 161.)

It accords also with the general results of my experience,
which by no means indicate a liability to inflammation in
the inner coats of veins. I have, in many instances, applied
a ligature to the chief vein of a limb after amputation, without
any ill result in a single case; and I have never seen any
mischief caused by the ligature of a varicose vein or a hemor-
rhoidal tumor, though I have employed that method of treat-
ment very often. It is not improbable that where unfavorable
symptoms have ensued in cases of this kind, they have been
caused, not so much by inflammation of the vein itself, as by
suppuration in the surrounding cellular tissue.

^Vhen examining a vein which is plugged by a tough and
adhering coagulum, one can scarcely be persuaded that the
circulation could ever have been re-established through it, if
the patient had survived ; yet there can be no doubt that this
does take place, and that a vessel may, in process of time,
resume its functions, ami be restored nearly, if not entirely, to
its natural condition, after its channel has been completely, or
to a considerable extent blocked up by a clot. The perfect
restoration of the limbs in several instances, assured me of this ;
and it is in accordance with the great difficulty which I have
experienced in effecting the permanent obliteration of vari-
cose veins by temporary ligatures, or by other means which
had for their object the formation of coagula in the vessels!
It appears that the blood is almost sure to revert to its natural
channel, in 'process of time, unless the vein be completely
destroyed.f The dissection in the following case illustrated
the condition to which the clots became reduced. A man,
aged sixty-three, died, of erysipelas and pleuro-pneumonia,
ten days after resection of one ramus of the lower jaw, per-
formed on account of extensive necrosis and suppuration,
which had continued for several months, and had reduced him

* Med iro-Qhirur iral Transactions, xxxv. and xxxvi Dr. Mackenzie infers,
irom the results of numerous experiments on the venous system, that the origin
of obstructive phlebitis is to be sought for in a vitiated state of the blood, that
this causes an irritation of the lining membrane of the veins at various points,
which, in turn, leads to coasulation of the blood. I do not, however, discover
sufficient evidence of this irritation of the lining membrane of the veins, and
think there are many reasons against admitting that it is a necessary, or even
the ordinary, intermediate link between the vitiated and the coagulated condi-
tion of the blood.

f Hence the treatment of varix, where it seems desirable to resort to opera-
tive procedure, my practice is to pass a needle or silver wire beneath the vein,
and to allow the metal to find its way out by ulceration through the vessel and
the superjacent skin.

I860.] Formation of dots During I 113

to a very low state. Hie health had Long been bad; but he
did not mention that he had Buffered any particular affection
of the lower limbs. I was led to examine the veins i:'. c< i
quenceof the conditiou of the pulmonary arter 3< ntly to

be described, [n dissecting out the femora] and popliteal
vein of the left side, I remarked that the investing layer of
cellular tissue, usually so delicate, was mor< rse, tough,

and closely adherent than natural. With this excepti< n t]
was nothing to attract attention on the exterior of the vesg
or in the structure of their walls. In the interior were nume-
rous delicate, but tough, white hands or strings, extending
across or along the v< ome were adherent in their whole

length, and others only at their ends: also, small, firm lumps
of pale yellow, or gravel, or golden color, smooth on the
surface, i js adherent to the inside of the vein.

In some places there wore merely yellowish stains in the
lining membrane of the vein. The nature of these stains
would have been scarcely recognizable, had they not been in
most instan itinuous with the threads or some other

evident remains of the clots. These veins contained i
coagulav which appeared to have been formed recently, pro-
bably after death. The popliteal and lower part of the femoral
vein, on the right Bide, presented appearances similar to those
on the left. 1 lie upper part oi the femoral vein was occupied
by a firm, dry. mottled clot ; and the profunda was tightly
plugged by a continuation of the same, of white color. Above
the junction of the profunda, the vein was distended by a clot
of comparatively recent formation, which in the centre, was
semifluid and of dirty cream color. This soft part contained
red corpuscles, and larger pale cells having indistinct nuclei.

It is no uncommon thing for the middle part of the clot to
be, as in this instance, softened and converted into a dirty
pultaceous or creamy substance, in which corpuscles are found,
varying in size and shape, less regularly formed than pus-cells,
and having less distiuct nuclei. These are intermixed with
oil-globules and red corpuscles, which may be. natural in
appearance, or more or less misshapen and granulated, and in
various stages of dissolution. The changes which the bl<
thus nndergi as it would appear from the experiments

of Mr. Gulliver (Medico- Chirurgical Transactions, xxiL, 138,)
similar to those which take place when it is subjected to
concoction after its removal from the body. They seem most
frequently to occur when the clot has been quickly formed.

In all the cases that I have seen, except one, the soft central
part of the clot was walled in by the firmer exterior portion,
so that there was no opportunity for any of the debris to enter

118 formation of Clots During Life. [February,

the circulating current. We come next to inquire what are

the conditions of the blood which predisposes it thus to coag-
ulate in the veins during lite. It has been already remarked,
that the clots are most liable to form in persons who are in ai
enfeebled and cachectic state. Now,* in this state, it is wel
known that the fibrine of the blood exceeds its normal pre
portions ; and it appears that its tendency to coagulation is
increased by their being also in the blood an excess of water,
which dilutes the saline or ammoniacal elements, and thereby
renders them less able to hold the fibrine in solution.. Never-
theless, persons often remain in cachectic and anaemic states
for great lengths of time ; and they may, in addition, suffer
several and- prolonged attacks of syncope, without any coagu-
lation of the blood taking place. Indeed, the cases in which
the latter occurs are quite the exception ; and we therefore
search for some other cause to explain the phenomenon in
these exceptional instances. It is most frequent when the
cachexia has been induced by some inflammatory affection ;
and we know that the effect of inflammation, more parti-
cularly when it attacks the serous membranes, is to increase
the amount and the coagulability of the fibrine. The partu-
rient state, which, especially in the early period of lactation,
is productive of a similar -effect upon the blood, is also marked
by a great tendency to clotting of the blood in the venous
system. The researches of Dr. Richardson (The Cause of the
Coagulation of the Blood : 1858,) continued with great
assiduity and care through a long period, give strong reason
for his view that the fibrine is held in solution by the presence
of ammonia; and that its tendency to coagulate in the body
is increased, and its coagulation out of the body is accelerated,
by a diminution of the volatile alkali of the blood ; and it is
quite probable that, in the cases which we are discussing, an
insufficient quantity of this solvent medium is one of the
proximate causes leading to the clotting of the blood in the
vessels.-" There may be, in addition, some alteration in those
relations of the corpuscles to one another and to the vails of
the vessels, which, though not well understood, have an
important influence in facilitating the circulation of the
blood. f Certainly, there seems no good reason to attribute

* The researches of Scherer and Lehmann {Phxjsiologkal Chemistry, i. 97 )
show that the blood sometimes exhibits an acid reaction in the puerperal state:
the acid present is supposed to be the lactic. This may be associated with the
fact that I have often observed the skin to be remarkably dry in cases in which
the blood coagulated in the vessels during lite. An incipient decomposition of
the blood is regarded by Ziinmermann to be one of the chief causes of its coagu-
lation.

t The commencement of the clots must, doubtless, be attributed to influences
affecting the fibrine rather than the corpuscles, because at the parts where they

I860.] 119

the affection to an introduction of pua or other morbid fluid
int.* the circulating current.

(Edema of the Limb
is often the .' nptom. This ma; led with,

preci ded by, un< \ in the course of the affected vessels;

and tin enlargement of the superficial ritb,

perhaps, induration of them. When the femora]

vein is the inner jh is 801

swollen in a marked manner. The integuments usually
remain white ; occasionally they are inflamed in patches, or
in a mo- ,1 manner : and occasionally they are mottled

by purplish spots, like petechial spots, or like tho ting

iron Mortification rarely or never results from

this cause alone. (Yirchow, Handbuch derSpeeieUen Patho-
!., 171.)

I have already said that the affection is rarely attended
with any serious consequences. It does not commonly seem
much to aggravate the patient's condirion, or to diminish his
chance ot rec . I have sometimes observed an

amelioration in the general condition of the patient to be
coincident with the swelling of a limb which indicated an
obstruction in the great vein ; as though the general mass of
the blood had become thereby relieved of a certain quantity
of its redundant fibrine, and was consequently better fitted to
minister to the healthy nutrition of the body. If the obstruc-
tion of a vein occur during the course of an inflammatory
disease, it generally takes place when the disease is subsiding:
it may, therefore, be regarded as an attendant on recovery,
though it is an evidence of a low or cachectic state of system.
I may again remark, that it seems to have no relation to the
malady called ^ pyaemia" : and though necropsies prove that
it is sometimes associated with the formation of clots in the
pulmonary arteries, I have not in any case had clinical
evidence of its being followed by that formidable affection.

Nevertheless, it is a dispiriting, tedious malady; it retards
the restoration of the patient, keeps him confined to his bed,
and causes much annoyance and apprehension. The liability
to its occurrence is to be borne in mind as a reason against
having recourse to depletion or purgation, or other measures

are first formed they are usually composed almost entirely of fibrine- Neverthe-
less, it is most probable that changes in one of the constituents of the blood are
attended with corresponding alterations in the others ; and the analogy drawn
from what is observed in inflammation and in pregnancy, suggests that an in-
crease in the coagulating tendency ot the fibrine is accompanied by an increase
in the adhesive qualities of the corpu-cles. which would materially contribute
to the formation of clots, and which may, indeed, sometimes be the immediately
originating cause of them.

120 Formation of Clots During Life. [February,

which may exhaust the patient, or draw away the saline and
watery ingredients of the blood, in the latter stages of an
inflammatory or febrile affection. I have given ammonia in
some cases in which I thought there might be a predisposition
to the formation of clots ; and, where the general condition
of the patient is likely to he benefited by the use of such a
medicine, we should not ignore the evidences which have been
afforded of its influence in retarding coagulation of the fibrino.
If given in a pure form, it is probable that some of it will
enter the blood; and that it will operate in the living vest
more or less, in the same manner as it is found to do when
mixed with blood which has been removed from the body.
When the blood has begun to clot in the veins of a limb, I
do not think that much good results from any perticular local
treatment. The affection runs a certain course, and, if the
disease upon which it is an attendant do not prove fatal, will
gradually subside spontaneously ;. and the veins usi
become clear again. Considering the nature and cause of the
malady, we should be unwilling to resort to the use of leeches.
Nevertheless, I have known decided relief follow their appli-
cation when the pain and inflammation around the vein was
considerable. Fomentations are sometimes attended with
comfort.

Of the instances which I have seen, the greater numb<
have been in males/- Nevertheless, it appears to be the
same condition of the veins which in women, after delivery,
usually constitutes the disease known by the name of "phleg-
masia dolens." The cause of the disease, and the results
disclosed. by dissection, appear to correspond very cloe
whether it be developed after parturition, or in the course of
an illness ; and the name "phlegmasia dolens in the male"
has. accordingly, been applied to it by Sir IT. Halford
cal Gazette, x., 172) and others. Phlegmasia dolens e
frequently occurs after parturition at that time when the
fibrine of the blood is found to be most abundant, viz: during
the early period of lactation ; and it is most common in
women who are weak at the time of delivery, or whost
strength has been reduced by flooding, and especially in those
in whom there has been, in addition, peritonitis or some
inflammatory affection of the chest. Moreover, when a fatal
result has followed, it has commonly resulted, not from the
condition of the veins, hut from some other cause. + It must.

* Of forty non-puerperal cases tabulated by Dr. Mackenzie (Medico- Chirur-
gical Transactions, xxxvi.. 235) about two-thirds were females, and one-thin
males-

t See paper by Dr- Davis, who first pointed out the true nature of this disease.
Medico- Chirurgical Transactions. .vol. xii. ; also papers by other writers in the

i860.] Formation of Clots Thtring Life. 121

however, be observed that, in phlegmasia dolens, the pain is
usually more severe, and the disease, on the whole, Is of
a more acute nature than in the ordinary obstruction of the
veins: it Beems sometimes to originate in a morbid condition
of the uterine veins, and is sometimes attended with, or pro-
ductive of, those inflammatory and suppurative affections in
distant parts which are attributed to a morbid condition of
the blood.

Indeed, phle{ lolens would seem to occupy an inter-

mediate position between the simple and comparatively
innocent obstruction of the veins, which we have been
considering, and the more severe and dangerous affection of
the veins, which has been described by Arnott,;}; and others,
as an occasional attendant upon wounds and injuries. The
changes which occur in the veins, and in the blood contained
in them, seem to be much the same in the three classes of
cases, except that in the traumatic variety the inflammatory
symptoms are commonly more severe. And there is the
further important difference, that in it we are liable to
encounter that alarming, and commonly fatal train of symp-
toms which is supposed to depend upon a purulent infection
of the blood ; whereas, in the ordinary obstruction of the
veins, as I have already said, such concomitants are little to
be apprehended.

The purport of the foregoing remarks may he condensed
into the following summary :

1. The great veins are very liable to become obstructed by
clots forming in them when the patient is greatly debilitated,
and when the circulation is enfeebled by inflammatory
affections, by discharging abscesses, difficult labors and other
causes.

2. The clots result from an altered state of the blood,
disposing the fibrine to solidify in those parts of the veins
which offer the greatest facilities for its so doing.

3. The inflammation of the veins is a consequence of the
presence of the clot, and is chiefly confined to their outer
coats, and to the surrounding cellular tissue.

4. The clots may soften and become intimately connected
with the walls of the ves>els. and may lead to the complete
same Transactions, and in various medical journals. Dr. Simpson, in his lec-
tures recently published in the Medical Times and Gazette, calls attention to the
met that in some well marked cases of phlegmasia dolens the veins have been
found *mite healthy

% Medico- Chirurgical Transactions, xv., 46. Mr. Arnott remarks, and I think
he was the first to call attention to the fact, that the inflammatory changes are
usually limited by the passage of a current of blood ; where a trunk is con-
cerned, the boundary line being the entrance of a branch, and where a branch
is concerned, the boundary being the junction of this with the trunk.

Formation of Clots During Life. [Februai

and permanent obliteration of their canals : more commonly,
however, they are removed, or shrink into delicate bands or
fibres, which offer little or no obstruction to the circulation.

5. The affection raiely leads to any serious result. It may
be associated with so-called pyaemia; but has no necessary or
frequent connection with it.

ii. On the Formation of Clots in the Pulmonary Arteries.

There can, I think, be little doubt that the fonnation of the
clots in the pulmonary arteries, in these, and other like cases,*
is due to the same causes as the formation of the clots in the
great veins; that is to say, it is due, primarily, to an increase
in the coagulative tendency of the fibrine of the blood, and,
secondarily, to some facilities which the vessel offers for that
coagulation to take place. With regard to the primary cause:
the pulmonary clots have been found chiefiy, if not exclu-
sively, in cases where the vital powers have been lowered by
some other disease ; in short, in cachectic states, especially
where an inflammatory affection was superadded ; and after
confinements; that is, in precisely the same conditions as the
venous clots. Moreover, the clots are often found in both
situations in the same patient, as in Cases iv., v.,vi., and vn.f

With regard to the secondary, or immediately inducing
cause : it has not been satisfactorily shown in any one instance
that the clot was preceded by, or attributable to, disease in
the coats of the vessel. The discoloration and roughening,
where it was present, was evidently due, as in the case of the
veins, to the presence of the clot, and was not the cause of it.1

It appears, from the above related cases, and others which
have been recorded, that the clots begin to form, in some
instances, in the smaller branches of the vessels ; and that in
these instances there is often some obstruction to the circu-
lation in the artery, caused by inflammation, pulmonary
apoplexy, or other cause which must tend to promote the
settling of the fibrine. In other cases the affection commences
in the larger branches, or in the main trunk ; and in these
the spot at which the first deposit takes place is usually at or

* Baron, Archives Generates de Medecine, ii., p. 1. appears first to have direc-
ted attention to the subject. Paget, Medico- Chirurgical Transactions, ix and x-
Omerod, Medical Gazette. Virchow, Archie, w. 225. (In the case related here,
the blood in the heart was fluid.) And Handbuch der Speciellen Pathologie, Bd. i.

f Virchow, Froriep's Notizen. xxxviii. 3-3. remarks that in only one case out of
eleven, in which clots were found in the pulmonai y arteries, did he fail to disco-
ver them in some other part of the venous system.

% Kidd, Dv.blin Journal of Medcal Science, xxii.. 376, attributes the affection to
inflammation of the pulmonary artery. Baron alludes to the absence of an in-
flammatory condition of the vessel in the case described by him. Nevertheless,
in some other cases, to which he refers, he conceives that inflammation of the
wall of the vessel led to the formation of the clots.

I860.] Formation of Clots During I

near the root of ;. In this situation the pulmonary

artery breaks up at once into a number of branches, which
radiate off from it, at different angles, to the several parts of
the lung. Consequently, a large extent of surface is presented
to the blood, and there are numerous angular projections into
the current ; both which conditions are calculated to induce
the coagulation of the fibrine. It must also be remembered
thai the rate at which the blood travels through the pulmonary
arteries is subject to considerable variations, depending, partly
upon the alternating contraction and repose, and the varying
force of the contraction, of the right ventricle, and partly
upon the vicissitudes of respiration ; and both these, sources
of disturbance become more marked in those enfeebled states
with tendency to fainting, in which we have found that the
fibrine has a peculiar tendency to settle. In such states the
circulation in the vessel must always be feeble ; and, probably,
the current is sometimes absolutely suspended in certain
portions of the artery, or in the main trunk, for short periods,
Moreover, the venous blood seems to exhibit an increasing
tendency to coagulate in the body as it approaches the lungs,
and therefore may be presumed to acquire the property in the
greatest degree in the pulmonary arteries.

At any rate, the clots which we find in ordinary post ??wr-
tern examinations are more common and larger in these
vessels, and in the right cavities of the heart, than in any
other parts of the body. Frequently they are of firm consist-
ence, while the blood in the veins, and in the left side of the
heart, is quite fluid.

Yirchow attributes the formation of these plugs in the pul-
monary arteries to the lodgment there of small clots, or frag-
ments of clots (" emboli") which have been formed in the
veins, and have been wafted with the blood through the right
cavities of the heart, towards the lungs. These fragments, he
thinks, become detached from the ends of the clots which
project into the great venous trunks ; thus, in any case where
the end of a clot, formed in one iliac vein, projecting into the
vena cava, a portion may be washed off by the blood flowing
against it from the other iliac vein, and, being carried into
the pulmonary artery, may lodge upon one of the projecting
angles of the vessel, and constitute a nucleus for the formation
of a plug. It is not improbable that this may sometimes
occur. It must, however, be remembered that the surface of
the venous clots is usually quite smooth, and therefore not
very likely to be dismembered by the slowly flowing current
of the blood; secondly, that in many cases, as in No. t., n.,
in., there was no reason to suppose that the pulmonary clots

124 Forwifn,,, of Clots During Life. [February,

were preceded by clots in the veins; and thirdly, the effects
of a preternatural* tendency of the venous blooa to coagulate
are, for the reasons thus given, likely r< be exhibited in the
pulmonary arteries as well as in other parts of the system.

The pulmonary dots undergo the same - as those in

the veins, provided the patient survives. They may soften
in. andv.)* or become firmly adherent to the vessel and
disappear, leaving scarcely a trace behind (as in Case vn.) ;
or be converted into threads or hands, stretching from one
pare of the tube to another. I do not know an instance in
which they have caused obliteration of any of the pulmonary
vee : though it is probable that this may take place occa-
sionally in the smaller branches.

The plugging in the pulmonary arteries does not appear so
easily to induce inflammation on the exterior of the vessel as
it does in the case of the veins of the limb. It is not usually
attended with pain or uneasiness, or any symptom which lead,
with certainty, to a diagnosis. Hurried, oppressed breathing,
with faintness, occurring without any other obvious cause,
would make us suspicious. of this affection, and should. induce
us to auscultate in the situations in which a bruit, orginating
in the pulmonary arteries, would be most likely to be distin-
guished. I am not aware that a bruit, produced in this man-
ner, has yet been recognized, though it probably would have
been discovered had attention been directed to the point
during the life of any of the patients.

It is indeed a remarkable feature in the affection that the
pulmonary arteries, one or both, in the main trunks, or in the
larger branches, may be blocked up to a considerable extent
without causing any sign of obstruction to the circulation, or
of affection of the lungs, or, indeed*, without producing any
Lptoms whatever. In Case vn., it was clear, from the size
of its remains, that a clot m me time have occupied

nearly the entire calibre of the main trunk of each of the
pulmonary arteries; yet there had been no symptom of such
condition observed during the life of the patient. In Case i.,
the patient appeared to be in her usual heal h till the moment
of the fatal seizure. In this, and other parallel cases that have
led, there can be no doubt that the clots were
forming for some lime b< ith, and that sufficient blood

found its way by the side of them into the lungs to maintain
the circulation and supply the wants of the system.

The sudden death is probably caused by a slight exertion

* In the case related by Dr. Kidd. lor. rit.. one of the clots was softened in
the mM'l'e. and the tissues around the artery, on one side, were condensed and
indurated.

L860.] Ibrmatkm of Clots During I L25

following a period of repose. During the repose we n
judge the clots are increasing; and the ensuing exertion,
causing a greater demand for oxygenated blood than can be
supplied through the impeded pulmonary vessels, induces
fainting, which is fatal. The extreme suddenness of the fatal
seizure' in the d the idea thai ii may have

beeen caused by some displacement of the clots, producing
more complete occlusion of the vessels; bul thisis opposed by
the facts that the clots are usually mor< adnerenl to

the walls of the vessels, and Bhow no sign of such displace-
ment having taken place.

ill. Svdd usion of tie wry Arte*

: By Draper Mackinder, M. D.

Two cases were detailed which had recently occurred in
Dr. Mackinder s practice. In the first, the patient was thirty-
two years of age, and had been delivered of her second child
after a natural and easy labor. Seventeen d srwards,

while apparently in good health, she rose up convulsively,
said she was choking, and died. On subsequently examining
the body, a large, branching, fibrinous plug was found com-
pletely - up the right pulmonary artery, audits imme-
diate ramifications ; while the entrance to the left pulmonary
artery gave lodgment to a large and tolerably firm concretion.
The heart was rather thin, and the lungs were slightly i

ed ; but there was no further trace of disease about the
body.

In the second instance, the patient had an easy labor, and,
for a few days afterwards, all appeared to progress favorably,
when she imprudently left her bedroom and exposed herself
to cold. Shortly afterwards she was seized with difficulty of
breathing, gasping, and cold clammy sweats, from which death
relieved her in twenty minutes. Permission to make a post
m examination could not be obtained, and hence it could
only be surmised that the fatal event was due to the plugging
up of some important but smaller vessel than those found
obliterated in the first example.

Dr. Graily Hewitt stated that an elaborate essay on sudden
death during the puerperal state had been recently published
in the Memoirs of the Imperial Academy of Medieme, of
Paris, but the author of that essay had not thrown any
considerable light on the interesting question of the cause of
death under these circumstances. The case of the Duchess
de Nemours, who died from plugging of the pulmonary
artery, would be in the recollection of the Fellows of the Society.
From personal inspection of the clot he was able to state that in

126 I of the [February,

that case the >cup\ed the pulmonary artery and several

of its ramifications, and was so firm that it could not have
been formed subsequently to death. B ;! >se c

in which sudden death the puerperal s, con-

nected with the presence of coagula in the pulmonary artery,
he would hazard the following sup i as to th

which lead to the coaguh The blood v Itered in

the pregnant woman or coagulation, in thefirst place;

and, in the second place, the maintenance of the recumbent
position, usually rigidly enforced by the medical attendant
during several days after labor, favored the stagnation of the
blood in the heart and chest. It was not unreasonable to
suppose that these circumstances had much to do with the
occurrence of this fatal accident.

Dr. Priestly recommended that in all < -iddr-n death

from occlusion of the pulmonary artery, an attempt should
be made, not only to give an ace; count of the thoracic

organs, but also of the condition of the uterus and appen-
dages, more especially of the blood and lymphatics.
The researches of Virchow on this subject had conclusively
shown the connection between emboli formed in the uterine
veins, and plugs found in pulmonary arteries ; the value of
reports on such cases would therefore be greatly enhanced if
the investigation were carried further than the immediate seat
of obstruction. He thought it not improbable that in chloro-
anaemic conditions of the system, when there is an increase
of tibrine in the blood, a very small amount of acrid material
generated in or near the uterus, and added to the blood circu-
lating in the vessels, might cause deposition of the tibrine,
and consequent occlusion of the vessels. Obstet. Soc, London.

On Inflammation of the Thoracic Duct. By Dr. J. Worms.

The occurrence of this disease has been anatomically
proved by Andral, Gendrin and Velpeau. Dr. Worms has

had the opportunity of observing it in a man, forty years of
age, in the military hospital of Gros-Caillou. The patient
was aroused, in the night of the loth of December, 1858,
by a violent pain, seated deeply in the abdomen, and radia-
ting towards both sides; during the following days, this
pain subsided somewhat, but violent fever set in. On the
fourth day acute pain in the muscles of the fore arm super-
vened, the member becoming red and swollen ; then the
thighs and the calf of the legs became equally painful, and
the evil increased from day to day.

I860.] Thoracic Duct 127

The patienl entered the hospital on the 25th of Dec<
ber; the sclerotica was slightly icteric; the lips, tongue,
teeth, and skin were dry; the pulse fall, hard, and eighty
In the minute ; the abdomen tympanitic, bu1 do1 painful.
The left arm could riol be moved; the anterior and posi
rior side of the fore arm was the Bea1 of considerable
tumefaction, and of intense pain. The superficial reins oi
the whole limb were much distended, and painful on pres-
iure; they presented the peculiarity thai it was impossible
to make the blood which they contained j toward

shoulder; whilr.cn the contrary, less rest was

encountered in making : iward the back of the hand.

This circumstance led to the supp an obstacle

existed to the venous circulation; in examining the whole
venous Pound except in

the left subclavian, which was hard, and rolled underneath
the finger. All the other large vein much distended,

and the patient complained o\' an almost intolerable pain
which exa< tly followed their track. The patient was treated
with sulphate of quinia in combination with camphor, in
order to combat the general septic condition, and applica-
tions of camphorated alcohol were applied to the tumefied
arm.

On the twenty-sixth, an aggravation of all the symptoms
had taken- place; the emaciation had made rapid progress;
the patient's look was unsteady: the sclerotica was much
more icteric, and the patient was in a state of drowsiness,
when not aroused by words. The swelling of the arm was
much increas

During the following days the patient became gradually
worse; the icterus became general, and assumed a shade
approaching to green: the intellect wras troubled; the
nations became involuntary, and convulsive move-
ments of the muscles of the lower jaw supervened. The
patient died on the thirtieth of December.

Autopsy. All the tissues of the left arm were colored
yellow; the aponeurosis was sheathed with an organized
fibrinous exudation; all the veins were distended by vis-
cous blood, which was completely discolored, and resembled
clear bile. From its passage on the first rib to its junction
with the internal jugular, the left subclavian vein was very
adherent to the surrounding cellular tissue, and was oblit-
erated by a yellow and hard fibrinous clot.

The whole venous system was distended with uncoagu-
lated blood, and the intestines were much distended by gas.

128 Thwack Duct [February,

ALout the caecum, and in a portion of the ascending colon,
dec]) ulcerations of the isolated follicles existed, without the
glands of Peyer being enlarged. The spleen was triple its
Dormal size, and its tissue reduced to a pulpy ma*

The entrance of the thoracic duct into the left subclavian
vein was surrounded by an indurated cellular mass ; the
duel was rilled with a Large quantity of phlegmonous pus;
the receptaculum chyli measured five centimetres in diam-
eter; its walls were colored light yellow, and adhered to
the surrounding cellular I of the whole

duct were thickened, and quite opake, the internal coat was
softened, deprived of epithelium, and presented small and
red ecchymotic spots.

The vertebral column was healthy. Numerous swelled
glands surrounded the receptaculum chyli; some of the
lymphatics joining it also contained pus. The glands from
which these vessels proceeded were white and softened in
the part in which the lymphatics originated ; the opposite
part was hypera?mic and harder. The other viscera, and
especially the liver and biliary ducts, presented nothing re-
markable.

As there is no reason to assume that the pus was carried
into the thoracic duct by one of the branches which unite
to form it, the disease consisted evidently in a true lym-
phangitis of the thoracic duct, and of the receptaculum
chyli. The 'inflammation was propagated to the subclavian
vein, and caused there the formation of a clot; this explains
the symptoms of stasis of the venous blood in the upper
extremity of the left side. In regard to the intense icterus
which supervened during the last days, M. Worms looks
upon it as a general ecchymosis, produced by the alteration
of the blood which was not renewed any more by lymph,
and by the stagnation of the circulation caused by a phys-
ical obstacle ; the icterus had been thus produced without
any participation of the liver. Gazette Hebdomadaire, May
6, 1859.

[860.] Pulmonary Consumption. L29

Tlu Causes of Pulmonary Consumption, and its Treatment by
Superficial or Endermic Applications, and tk* Inhalation of
the Nutrient Elements of the Blood and Tissues. By II. IV
Dewees, M. D., of New York.

The title of tliis elaborate article well indicates its con-
tents. The author's conclusions arc:

1. That pulmonary consumption may be a disease origi-
oating in the blo< d, or in the tissue of the lung itself, or
from deranged n< rv >us actions.

2. That tubercle is a product, t)re witness of blasted "ceil
growth," originating from the ijhperfection of the nutrient
materials, or from a disturbed elective action inherent to
the tissues themselves.

3. Thai ravages similar to those effected by the pressure
and offence of tubercle, may ensue, without being caused
by the evolution of, although attended with, tubercle, in
portions more ov less distant.

4. That structural changes arise from the abnormal influ-
ence of the nervous system.

5. That in some, phthisis is hereditary, and in others is

self-induced.

(j. That it may waste every fiat-cell, without great atten-
dant loss of strength, whilst at other times fat is not so
entirely consumed as muscular fibre is degenerated and
rendered less contractile.

7. That it accompanies, or alternates with, fatty degen-
eration of the liver and of other organs.

8. That it may be ineurrent with albuminuria, diabetes,
or that the eruptive diseases may be its developing point.

9. That pregnancy may afford a certain arrest in its
progressive ravages; Or, by increasing the albuminous com-
position of the blood, the liability to certain tuberculous
dyscrasia might be rendered greater.

10. That the "colliquative" diarrhoea, attending tuber-
cular phthisis, may be preservative.

11. That the enti lining with oil of the true chyle corpuscle-
is a most important step towards future assimilation.

1 2. That follicular laryngeal disease may be at the bottom
of tubercular degenerations and disorders of the digestive
system.

13. That the pulmonary and skin surfaces afford a vast
channel for remedial application and nutrient supply.
American Medical Monthly, May and June, 1859.
9

130 The Nature, Seat and [February,

On tin Nature, Seat and Relations of Neuralgia. By C. II.
Jones, M. B.Cantab, F. R. B., Physician to St. Mary's

Hospital.

The prevalent opinion respecting the nature of neuralgia
seems to be that its existence implies an excited or over-
active condition of the sensory nerves. Romberg uses
neuralgia and hyperesthesia as convertible terms, and
states "In hyperseathesia we find that not only the irrita-
tion is increased, but that also the irritability of the nerves
of sensation generally^ exalted both during the paroxysms
a^s well as in the intervals." It is \cry evident that we can
have no knowledge from actual observation of the state of
the effected nerve or nerves during the neuralgic attack.
We must form our conclusions as best we may from con-
sideration of the attendant circumstances, the juvantid, and
the relation of the disorder to others. For the moment let
us put aside all cases of neuralgia which may be regarded
as dependingon a local irritation of any kind either direct,
as a splinter imbedded in a nervous trunk; or remote, as a
worm in the bowels ; or on demonstrable poison generated
in the system, or received into it e. g., that of gout or lead.
There remain then all those cases in which the disorder is
dependent upon no ascertainable cause, except it be malaria,
a draught of cold air, exposure to damp, overwork of mind
or body, or some cause of exhaustion. These form a group
which may be distinguished as Non-organic Neuralgia.
Now, in these the existing debility or prostration is at least
very often almost as marked a symptom as the pain. It is
also more abiding and unvarying, and the conviction be-
comes wrought in the mind of the observer, that it is the
fundamental state upon which the pain is, as it were, en-
grafted the appropriate soil without which the seed would
not grow. It is proved by experience that, unless this
debility and prostration can be removed, and replaced by
healthy vigor, no real progress can be made in the cure of
neuralgia. The task is like that assigned to Sisyphus, the
patient's and doctor's hope is worn out by ever-recurring
relapses. The debility seems in a special maimer to affect
the nervous system. The brain is languid and dull, and
inapt for mental labor; sometimes its function actually fails,
and wandering or delirium occurs. Stimuli are beneficial,
often very remarkably so, though their effect is temporary.
Fresh, pure air, good food, sufficient repose alternating
with exhilarating employment, supplemented or aided, if

I860.] Relations of Neuralgia. LSI

heed be, by nerve tonics, are the real remedies, and just in
proportion as they increase the general tone and strength
docs the patienl attain complete recovery and immunity
from relapses. On the other hand, ju Lrely do all

causes of debility confirm, Incr nd render in1

the malady.

Now, it may be fairly argued thai when the symptoms of
debility, and especially <>i nerve debility, arc bo apparent,
and have so distinct a relation to the particular symptom,
this musl be itself of like essential character. It can hardly
be that the morbid slate of the nerve affected can be greatly
different from that which prevails so generally throughout
the system, especially when we consider the means which
avail for the cure of both. Romberg's metaphori< \\ ex-
pression, ing of anaemic hyperesthesia (1. e., neural-
gia), that "it seems as if pain were the prayer of the nerve
for healthy blood," is, in ad probability, exactly true. The
nutrition of the nerve being ill-performed, its structure un-
dergoes sonic molecular alteration which conditionates pain.
What is true of neuralgia from this cause I believe is true
of ad cases belonging to the non-organic class. Electrical
disturbances, damp, cold, malaria, seem to me all to act in
the like way as far as we can judge viz: by deranging the
molecular nutritive actions of the nervous structure, and so
impairing its function. There are several circumstances
which seem to me strongly to support this view. One is
the very frequent co-existence of numbness with the neu-
ralgia pain, especially in highly sensitive parts, as the
fingers and hands. One cannot say in what the condition
producing numbness differs from that producing pain; but
it is clear there is no opposition between them ; both are
often present together, and the numbness commonly re-
mains as the more permanent condition in the intervals of
the paroxysms of pain, and even after they have ceased to
occur. Sow, numbness is evidently a failure of functional
action. Of the same import is the occurrence of various
degrees of muscular paralysis, which is often associated
with neuralgia, evidently as an analogous affection of the
motor nerves. It yields to the same treatment. The phe-
nomena of myalgia may also be referred to an illustration
of the nature of neuralgia. Here we have a manifest in-
stance of the relation of pain to debility; the sensory nerves
of the muscles express pain because they are weak ; what-
ever increases the debility increases the pain, and vice versa.
The relation of ague to neuralgia is worth considering in

132 The Nature, Seat and [February,

respect to this question. It is certain that neuralgia may
be a manifestation of malarious influence just as much as
ague, and thai the two may replace each other. It may
also be affirmed that in neuralgia (non-organic) from other
causes, the pain-causing condition of the nerve must be the
Bame as in malarious neuralgia. Now, in an ague tit there
is no doubt that the vaso-motor nerves are in a paralytic
state, consequently it is probable that in a neuralgic
paroxysm the sensory nerves are similarly affected. Lastly,
we may allude to the cure of neuralgia by Faradization as
an illustration of its nature. The pain of a sensory nerve
and the paralysis of a motor may both be removed by the
stimulus of the interrupted current. This surely indicates
that both states are similar.

Even in organic neuralgia, it seems to me 'a matter of
much question whether the nerve affected is in a state of
exalted excitability, or simply of deranged and disordered
nutrition. In lead poisoning, the motor nerves of the
muscles are certainly paralysed, the pains are diminished
(Romberg) "by pressure and friction," and the whole phe-
nomena are indicative of diminished, rather than of in-
creased, vital actions. The curative action of the sulphuret
of potassium bath is only intelligible by regarding it as a
peculiar stimulus to a great sensory surface, which is re-
flected from the nervous centres on the paralysed nerves
and muscles. That it does produce muscular contraction,
at least in some cases, is, I believe, certain. In gouty neu-
ralgia, if we take colicky and spasmodic affections for
examples, the disorder is much more of an asthenic than
hypersesthetic character. The pain and suffering attending
a characteristic outbreak of gout in the foot have much
more the features of hyperesthesia than the colicky disor-
der. That a nerve which receives for nutrition, blood
poisoned by uric acid should be disordered in its acting,
and thrown into a state conditionating pain, is very intelli-
gible, but it can hardly be regarded as having its irritability
exalted. On the other hand, the nerve lying in a focus ot
inflammation, by reason of the active hyperemia, would
seem really to be in a state of hyperesthesia. Its condition
is analogous to that of the nerves of one posterior limb in
Brown Sequard's experiments of tranverse semi-division of
the dorsal cord, where hyperesthesia is produced in conse-
quence of paralysis of the vaso-motor nerves, and the
resulting hyperemia.

Again, when neuralgia results from the impaction of a

[860. ] Relatio w of 'Neuralgia. L88

Bpiculum of bone, the development of a tumor, or the like,
in ;i nervous trunk, although severe pain may be produced,
it does ii>t seem very clear thai the nervous irritability is
necessarily exalted i. e., that the nerve filaments, either
on the distal or proximal Bide of the irritant, are more
sensitive than they would be naturally. In fact, one would
rather expect thai the normal function of the nerve would
be interfered with. In a case of neuroma recorded by Mr.
Toynbee in the Pathological Society's Report for L851, the
only symptom was a diminution of the power of hearing.
In the case recorded by Dr. Denmark, where severe neu-
ralgia was produced by a fragment of a bullet imbedded in
the radial nerve, no mention is made of the painful parts
so unusually sensitive. The same may be said of a i
recorded by sir B. Brodie, in which a femoral aneurism
produced pain at the inside of the knee. The following
case, from tin1 Dublin Medical Journal^ May. 1848, bears
decidedly on this point :

C. M . aged twenty-seven, widow, mother of four

children, had a neuromatous tumor developed in the course
of the median nerve, of the size of an almond, in conse-
quence of the nerve having been divided an inch above the
wrist by broken glass. Ef anything, even her dress, touched
the tumor, severe pains shot down to the hollow of the
palm of the hand, and upwards to the shoulder. She com-
plained much of numbness and coldness of all parts of the
hand supplied by the median nerve. The nerve was cut
across, and the neuroma removed. Fifteen months after
the operation, she was quite free from pain, and observed
nothing abnormal, except a remarkable eoldness of the
fingers supplied by the median nerve.

In some eases, however, it is certain that the peripheral
nervous filaments are truly hypersesthetic, as in the case
related by Romberg (p. 37 44). In this, however, the
hyperesthesia may be accounted for by the increased supply
of blood sent to that side of the face, the arteries pulsating
Btrongly and the eye being bloodshot and prominent. The
same explanation may apply to many other eases where the
neuralgia is complicated with hyperesthesia. The hypere-
mia is conditionated by paralysis of the vaso-motor nerves,
whieh run in company with the sensory, and this very eir-
eumstance is a further reason for viewing the fundamental
condition of neuralgia as one of paralysis rather than
excitement.

From the considerations which have been advanced, I

L34 Tin Nature^ and [February,

am led to conclude, thai in uralgia

utially impli ' eriug of the vital | ad func-

tional action of the nerve, uol an in are,

howi in which the painful parts are not

manifi stly hyp< y< t ex< and

intolerant of the leasl pi La th< clearthatthe

excitability of the nervous apparatus is morbidly increa
yet I question whether the term hyperi properly

applied to them. En the d to, any, even the

least excitem< d1 be pain. This

certainly implies an un< bility of the nerve-structure,

a rei o be thrown into the pain-causing conditi

but by no means a real inci power. Jt is by

no means clear that a part in this state would appreciate
two poh parate at a smaller di o each other

than it would when healthy. I should not regard such a
condition as identical with that induct < I by partial division
of the spinal cord, a.- in Brown Sequard's experiments, or
by strychnia poi .. 1 think it pi that in these

cases the morbid action is seated more ] lly tovt i

or in, the cutaneous terminations of the filaments; while
in ordinary n< uralgia the larger raniificatn ns of the trunks
are affected.

From the preceding di usidera-

tion of the question what is the real seat of neuralgia in
the nerves or in the centres? Obviously, this is no easy
question to answer. According to the law of eccentric
phenomena, every sensation of which we are conscious is
referred to the peripheral termination of the sensitive fibres,
(so Romberg writes.) Bowman and Todd add that the
sensation is referred to those parts, and t< nb'> to

which the fibres irritated are distributed. According to
this view, then, all appreciation of sensations as referred to
any point in the course of the nerve is out of the question.
An irritation, wherever Bel up, must he felt at the peri-
pheral extremity of the fibres implicated, and never in any
[art of their intermediate course. But there are facte
which are strongly opposed to this exclusive dogma, and
which seem to prove that a sensation may he referred to
various points in the course of the nerve-fibre. If we hit
our funny-bone, although no doubt pain and tingling are
felt at the peripheral distribution in the fingers, yet the
chief agony is in the trunk of the almar nerve at the part
struck, and certainly not merely in the skin covering it.
The circumstance dwelt on by Valleix, that the specially

1 stiii. I /.' ' f A uralgid.

painful points in nerves affected with neuralgia are always
those where the nerve becomes superficial, is also a pn
of a being referred to other points besides the

terminal. The same may be said of the pains which
patients describe as shooting down along the track of a
nerve as the sciatic. These certainly are nOl Located merely
in the skin which covers in the nervous trunk.

From these considerations, I am led to admil the possi-
bility of very numerous exc< ptions to the law of eccentric
phenomena, and to believe thai pain in a nerve may really
indicate by its situation the seal of the irritation or other
morbid action. This is a conclusion of some importance to
the local treatment of neuralgia. It justifies our empirical
habit of applying sedative remedies as near as possible to
the seal <>t* pain. Bu1 of course we cannot affirm, in any
case of pain involving the trunk of a nerve, thai the morbid
action may not be central; the law of eccentric phenomena
holds true so far as that central disordermay certainly give
rise to peripheral sensation. The only means of certainly
distinguishing the site of the pain-causing action is division
of tli e affected nerve, [f this arrests the neuralgia, we know
the disorder is seated peripherically ; if it fails to do bo, we
know we have to seek more centrally. In a very large
number of cases, I fear it must remain problematic as to
where the real seat o\' the disorder is. If the pain being
specially refei red to some intermediate spot injection of
opium at that part (subcutaneous) should give more relief
decidedly than the same dose at a distance, it would afford
ground for believing that the cause of the neuralgia was
localized in that spot. In the ordinary way of rubbing
sedative liniments on the cutaneous surface over the-seatof
pain, we have no means whatever of proving a local action
upon the suffering nerve, hut rather the reverse. For take
the ease of the sciatic nerve, where pain is acutely felt at
the hack of the thigh, and notably between the isehiatic
tuberosity and the great trochanter: if this is relieved by a
sedative application to the covering cutaneous surface, we
are sure that the chief action of the remedy must he on
cutaneous ramifications of the gluteeal, lesser sciatic nerves,
and branches of the external cutaneous and othernerves on
the trout of the leg'. These will convey impressions to the
spinal centre, not far from the part where the roots of the
sciatic are implanted; so that if the neuralgia were of cen-
tral origin, it is very conceivable that the morbid action
might in this way be heneticiallv modified. But, considering

136 New Mode of Dressing [February,

the depth at which the sciatic nerve lies from the surface,
it seems quite impossible that the aconite, chloroform, &c,
should penetrate so far through the skin, tat and fascia, or
even muscles. There exists some evidence to show that
any strong impression made on the centre (such as cauter-
izing the ear, galvanizing the columna nasi,) through inci-
dent nerves may put a stop to some neuralgias.

The relations of neuralgia are of course very different
according to the cause which gives rise to it. If, however,
we take the commonest kind which arises from cold.
malaria, debility we must allow that it manifests a y^vv
close affinity with non-febrile rheumatism. Rheumatic am!
neuralgic pain are frequently so yvvx similar, that they are
only to be distinguished by the action of remedies. Iodide
of potassium cures the rheumatic, quinine and iron the
neuralgic ; while often it occurs that in the same case, after
having begun with the former, we have to resort to the
latter to complete a cure. The beneficial action, noticed
by several recent observers, of muriate of ammonia in neu-
ralgia, can scarcely be dissociated from its remarkable and
positive remedial action in muscular rheumatism. The
interesting but obscure phenomenon of rheumatic paralysis
is closely similar to, if not identical with, the paralysis or
paresis of motor nerves which so often forms a part of
neuralgi. Catarrh is allied to neuralgia by the similarity
of its causes, the manifest implication (sometimes to a grave
extent) of the cerebro-spinal nervous system, the resem-
blance of its inflammatory actions to those sometimes
accompanying and depending on neuralgia, and in a large
number of cases by its "juvantia." If exhaustion aggra-
vates a neuralgia, so does it also a catarrhal flux ; while
rest and toning means have an opposite effect. The affinity
between neuralgia and ague in malarious cases is strikingly
apparent; the two disorders so evidently replaces each
other, that there can be little doubt that the difference is
only one of situation ; the sensory nerves being affected in
one case, the sympathetic system in the other. The thera-
peutic effects of arsenic and of quinine in ague and in com-
mon neuralgia, rapprochent the two disorders not a little.

A New Mode of Dressing in the Wounds of Amputation. By

M. Laugiee.

The objections made by the author to the ordinary manner

ink).] /// the Wounds of Amputation. L87

of dressing stumps with the roller and adhesive strips, are,
that the bandage does no1 fulfil the indication of causing
the flaps to unite from the bottom, that its compression,
which must be moderate for fearof producing strangulation
of the Btump, \ ields to the weight or the limb, placed on the
pillow or bed in such a position as tends to separate the
lips of the wound, and that on account of iN becoming
loose it lias often to be re-applied. The inconveniences of
the adhesive strips arc that they push hack the fleshy portion
of the Haps, and thus tend to favor the protrusion of the
bone and the formation o\' a depot of pus : they sometimes
cause erysipelas, and i\o not give an equable Bupporl to the
part, which should he made to heal from the bottom toward

the edge of the wound, or from behind forward.

With a view to maintain all portions of the flaps in accu-
rate apposition, and to bring about immediate union. M.
Laugier proposes to place under the bandage two plates of
cork, of two lines in thickness, and of a length and width
sufficient to permit it to embrace nearly the whole stump
from its base to its apex, and allow it to extend about two
and a half to three inches over the free extremity of the
Btump. Its edge is then digitated and pierced with a num-
ber of openings to receive a piece of tape, which brings the
opposed surfaces together at the end of the dressing. Pre-
vious to applying the cork, the stump is encircled by thick,
circular pieceB of amadou or tinder, which serve the purpose
of rendering the pressure more easy and efficacious, and
keeping the digitations of the cork from the parts. A
pledget of lint, spread with cerate, is then placed on the
wound, and the opposite portions of the cork are approxi-
mated by tying the pieces of tape. No sutures are used.
The stump i> thus enveloped in a firm case, which keeps
off pressure from the wound, and permits the patient more
easy and free motion. At each dressing, it is not necessary
to take it off: the tapes are untied, and cleanliness is
effected.

The advantages claimed by M. Laugier are, that the
dressing causes union from the bottom of wounds made in
amputation of limbs in their continuity, it sustains the
fleshy portions against the bone, insures the direction given
to the lips of the wound, does away with the inconveniences
of adhesive plaster, and. finally, it protects the stump from
exterior shocks, and gives greater latitude to the move-
ments of the patients and the amputated limb. Journal de
Med. de Bordeaux, June, 1859.

138 Osteoplastic Prolongation [February,

Pirogoff's Osteoplastic Prolongation of the Bones of the Leg,
with JExarticulation in the Tibio-Tarsal Articulation By
Gustav C. E. Weber, M. J)., Professor of Surgery in
the Cleveland Medical College, etc., etc.
Case I. On the 2d day of October, 1857, J was called
upon by my friend Dr. Roeder, to sec a little boy of eight
years, whose right toot had been badly smashed, a few hours
previous, by the wheel of a railroad ear. The bones of the
metatarsus and tarsus, together with the surrounding integ-
uments, to within one quarter of an inch of a line drawn
in front of the ankle joint, from one to the other melleolus,
were literally crushed to a jelly. Thus the question as to
a primary amputation was very easily settled, and the
removal of the foot in the tibo-tarsal articulation agreed
upon. The tuberosity of the oscalcis was uninjured, and
consequently Pirogoff's operation was proposed. A few
hours after the infliction of the injury, the boy having
sufficiently recovered from the shock, the operation was
performed with neatness and celerity by Dr. Roeder, with
my assistance. We followed Pirogoff's original plan of
dividing the calcaneus vertically, modifying it, however, so
far that we removed with the malleoli the articular surface,
together with a thin section of the tibia and fibula, also in
a vertical direction. This vertical division I recommended
instead of the oblique division of the bony structures in
question, because it seemed to me that after coaptation
disarrangement of the osseous flaps would more easily
occur when the line of union of the flaps formed an obtuse
angle with the line of action of the muscles of the calf of
the leg. Possible spasmodic contractions during reaction
seemed to me capable of pulling the remaining portion of
the heel upwards and backwards along the oblique line of
division of tibia and fibula. AVre experienced no trouble
in bringing the posterior flaps forward, and adapting the
osseous surfaces. Three arteries were tied, four strong
sutures passed, a few adhesive strips applied, and the stump
adjusted by means of a roller to a concave splint, the lower
end of which was moulded so as firmly to surround the
stump, leaving only the most anterior part of it uncovered.
This particular splint appeared to me essential to secure
the entire rest of the wound, and avoid the tearing through
of the sutures if the muscular contraction should be great.
The reaction after the operation was very slight. The
whole wound seemed to heal by first intention, when on the
fourth day, without a known cause, tolerably profuse

I860.] Of the Bones <>/ the Leg.

hemorrhage occurred, which, however, was arrested by the
use of additional compression more firmly applied. When,
twenty-four hours after this accident, the compresses
removed, we found the lips <>{' the wound in tne soft parts
separated by coagula and suppurating. For aboul two
weeks, suppuration was extensive. 1 1 diminished gradually ;
and six weeks from the day of the operation the little
patient came walking into the Amphitheatre ofthe College
building to present bimself before the class. The stump
was perfectly sound: the union between the boi
fectly firm ; and the shortening of the extremity only three-
fourths of an inch, accurately measured.

Case II. A German Laborer, aged fifty-eight, a lover of
the narcotic effects of alcoholic Liquors, was admitted, on
the 10th of October, into the hospital wardsofthe City
Infirmary, with gangrena of both feet. The extremities
were both tumefied, bright red and very painfal to within
four inches beyond the malleoli. There was complete nior-
tiiieation of the right foot up the tarso-metarsal articulation.
The toes ofthe left foot were attacked with superficial gan-
grene, and covered with dark-colored bullae. The general
condition of the patient appeared tolerably good for so
much local inflammatory action; there was only slight
febrile disturbance. Ordered locally extensive scarifica-
tions, glycerine and cotton, internally light antiphlogistics.
During the first few days after his admittance, the gangre-
nous process slowly extended. The swelling and other
symptoms of inflammation, however, diminished. Symp-
toms of* delirium tremens supervened, which lapsed into
those of a typhoid condition. Continued local treatment
with glycerine and cotton. Applied linen soaked in a
strong solution of chlorate of lime over the sloughs. Gen-
eral treatment : opium, cinchona, and acids. About ten
days from the time I first saw the patient, the line of demar-
cation, and the process of suppuration commenced on the
right foot, a little above the line of amputation of Chopart.
On the left foot the destruction of tissues remained super-
ficial and limited to points somewhat beyond the toes.
The general condition of the patient improved gradually,
so that on the fifteenth day after the exposure of the cold
causing the mischief, amputation at the ankle joint became
indicated. I selected Pirogoff's operation. In the presence
of the class and several of my colleagues, the patient was
placed on the operating table under the influence of ether,
and the original plan of Pirogoff followed out.

140 Osteoplastic Prolongation [February,

In trying to bring about the coaptation of the Haps, I
met with obstacles. The contractions of the muscles of the
calf of the Leg were so powerful that, even by a forcible

and continued extension and counter-extension, it was
impossible to bring the posterior and superior margin of
cut surface of the calcaneus to a level with the posterior

and inferior margin of tibia and fibula. I therefore
was obliged to take another slice from tibia and fibula,
(in a vertical direction to the axis of the bones, for the same
reason which I gave in the description of the Case No. 1.)
When this piece of the bones, about one-fifth of an inch in
thickness, was removed, the coaptation required still some
force. However, I succeeded in inserting the posterior
superior margin of the cut surface of the os calcie upon the
posterior inferior one of tibia and fibula; and, using the
latter as a fulcrum, and the calcaneus as a short lever, I
easily described with it the part of a circle necessary to
bring the flaps into apposition. A few sutures then secured
the equilibrium of both forces acting upon the fulcrum:
For better security, the splint, before described, was applied.
The case progressed favorably without much local and
general reaction: part of the wound healed by first inten-
tion, part by granulations, so that within eighteen days
after the operation, the stump seemed sound and well.
Upon closer examination, I found the calcaneus still movea-
ble. On the twentieth day two painful abscesses formed,
one situated upon the anterior aspect of the stump, -and
one internally, near the insertion of the tendo Achillis.
When these abscesses healed again after a few days, several
new ones appeared in succession in the cicatrix, one of
which remained discharging for five weeks. On the sixty-
eighth day, the stump was perfectly firm, although still
tender, so that yet for two months the patient was unable
to bear bis weight upon it. The shortening was one inch;
and now with only a round thick-soled boot, firmly laced
to the Lower extremity, the patient can walk without much
of a limp.

The superficial sloughs of the left foot became detached
in the course of the treatment of the stump; and the defi-
ciency, upon the application of a simple ointment, was soon
restored by granulation and cicatrization.

Case III. Mr. A., from Ontonagon, Lake Superior,
came in the early part of April, 18.58, to our city, and
placed himself under my care with caries of the metarsal
and tarsal bones, caused by injuries inflicted with an axe,

I860.] Of the Bones of tin- Leg. \\\

some eighl months pervious. His general condition had

Buffered to such ail extent, and the disease of the hones was
so extensive, that amputation was at once decided and
agreed upon. The whole loot was swollen to an unsightly
shape; the integuments around the ankle were thickened
and hardened ; and the movahility of the joint lessened.
Fistulous openings were leading down to the carious bone
everywhere, on the dorsum and the planta pedis. With a
sound 1 could push through and into almost all the hones
of tin4 tarsus in evevy direction. When introducing the
sound through an opening oxer about the junction of the
astragalus with the scaphoid, I could traverre backwards
and slightly downwards softened bony structure until 1
reached resistenl hone. I concluded that the hone of the
heel was still sound, and PirogofPs operation practicable;
consequently this operation was performed lege authoris.
When sawing through the os calcisjust behind the susten-
taculum tali, I found my anticipation as to its condition
verified. The malleoli, however, appeared spongy, and the
articulating surface soft. I therefore removed with them
a piece of the lower portion of tibia and fibula, about a
quarter of an inch thick. The contractions of the gastroc-
nemii and soleus were not very powerful, but still the coap-
tation of. the flaps impossible. I then removed a wedge-
shaped piece from the remaining portion of the calcaneus,
after Shuh's proposition, yet to no purpose. I divided care-
fully the insertion of the tendo Achillis. This seemed to
loosen the tension occasioned by an attempt to bring the
posterior flap forward somewhat, but not sufficient to
achieve the object, Besides, when I brought the flap for-
ward as much as possible, its circulation seemed at once
entirely interrupted. I was then convinced that the
extremely thickened and hardened condition of the integu-
Inents was the obstacle hindering the adaptation, and that
only the removal of the bony contents of the posterior flap
would finish this operation to the benefit of the patient.
After a tedious dissection, the calcaneus was taken away,
the arteries were secured, and the flaps united by sutures
and adhesive straps.

Notwithstanding severe hemorrhage on the fourth day,
and excessive suppuration for nearly two months, the patient
obtained, at the end of three months, a sound and useful
stump, to which he adjusted an artificial foot, perfect for
locomotion and symmetry.

Case IV. A Swiss laborer, aged fifty-one, came on the

142 Osteoplastic Prolong* [February,

20th of December last, with frozen icet, into the hospital
ward of the City Enfirmary. His left foot was gangrenous
up to the tarso-metatarsal articulation, the line of demarcation
distinctly visible at that point all around the foot. The
right foot and leg were extremely red and tumefied, with
mortification extending up to the line of Chopart, and appa-
rently spreading.

Poverty, privation, had air and had liquor had influenced
the patient's constitution in such manner before the acci-
dent, that the symptomatic irritation soon after presented
the irritative character. With a dry, brown tongue, weak,
wiry pulse, quick respiration, and an appearance of heavi-
ness and drowsiness, he was brought to the Hospital.
Suitable local and internal applications were made, which
decreased his constitutional irritation materially. Then the
inflammatory process of the right leg also gradually subsi-
ded, and the line of demarcation formed anteriorly to within
one-quarter of an inch of the right ankle joint, and on the
planta pedis, along the line of junction of the calcaneus with
the scaphoid.

Ten days after the admission of the patient, I eonsidered
his genera] condition such as to warrant the removal of the
spoiled tissues. I consequently determined to amputate,
first, the left foot, and afterwards, when the reaction from
this attack had, to a certain degree, subsided, the other.
The simultaneous amputation seemed to me not advisable,
on account of the double shock such a proceeding must
necessarily communicate to his already shattered system.

I performed Chopart's amputation, obtaining sufficient
covering for the bony surfaces, by making the anterior flap
a little larger than common, and the posterior a little
smaller:

In about eight days the stump was doing so well, the man
had so finely overcome the consequences of the operation,
that the second amputation became indicated. The process
of separation had at some points cut nearly through the
whole thickness of soft parts, the gangrenous mass from the
living tissues. The integuments of the ankle joint and its
vicinity appeared perfectly sound.

PirogofFs operation was thus practicable, and neatly
performed by my assistant, Dr. II. K. Spooner, after the
same plan as in Case "No. 1. The coaptation of the flaps
was perfect and comparatively easy. This second operation
exercised apparently very little influence upon the patient's
condition, which remained, with the exception of a little

I860.] Of the B I hi

increase of his symptomatic fever, aboul the same. Ele
progressed favorably until the fourth night, when all at
once Bevere hemorrhage occurred. The loss of blood was
considerable before the nurse became aware of it, and pro-
cure^ the assistance of the bouse surgeon. Tins gentleman
applied ;i strong compress over the stump, adjusted it with
a roller, and placing his fingers over the femoral artery,
awaited my arrival.

When I came, I found the patient very anaemic, with a
hardly perceptible pulse. Ele tossed about and screamed
from pains in his limb. Thebleeding had for some time
id, and tearing that the ban nesa

of the man, I removed them. This was not yet quite done
when the Mood commenced again to flow. Con n of

the posterior tibial arrested it instanter. This fact. would
have ledme to the litigation of that vessel, if the patient's
condition at that time had not forbid all surgical into
pence, or th< chloroform. Examining the stump care-

fully, 1 found the bony surfaces separated from each Other
by coagula, at i*-;^1 three-fourths of an inch. The adhesive
strips having been well applied, kept the lips of the wound
of the soft parts, at a point where the strips lay, in close
proximity, but pulled the anterior flap or anterior integu-
ments of tibia and fibula downwards over their sharp edge.
In the spaces between the adhesive plaster, the wound was
driven apart by coagula. When the compression of the
artery was discontinued, blood trickled tolerably fast out of
the inner angle of the wound. Having satisfied myself that
the hemorrhage could be controlled by pressure, I applied a
small, thick compress, about two inches above the stump,
over the before named artery, secured it by a roller, envel-
oped the stump with another, and adjusted the splint. The
bandage answered the purpose admirably well, and remained
itu for about fifteen hours. During the last three of
these, the patient complained bitterly about excruciating
pains in the extremity, which, together with his strong-
pulse, hot skin, and restless behavior, indicated a general
reaction. Upon removal of the bandages, the stump and
leg presented a sorry appearance. The posterior flap had
entirely lost its position, being drawn backwards and
upwards, at the same time swollen to an unsightly lump, the
space between the flaps filled with decomposing coagula,
and the anterior flap turned downwards ; the whole leg was
tumefied, red, and painful ; the integuments over the edge
of tibia and fibula, as well as at other points on the limb up

144 Cauterization of Tumors, [February,

the knee, were bluish discolored. Whether this state of
things was owing to the bandages, too tightly applied, or to

excessive reaction in tissues whose vitality had been greatly
lowered by a former inflammatory process, and by the
excessive loss of blood, and generally depraved system of
the man. is hard to tell. I am inclinad to believe tne latter
to have been the cause, from the fact that extensive sloughs
afterwards formed where the bandage could not have exer-
cised any undue pressure, and that no sloughs formed where
the pressure was undoubtedly the greatest, as, for instance
under the compress over the artery. Then a real tight
bandage might have secured the splint in such a way that
the posterior flap could not have been retracted. This may
be as it will. At the time the bandage Avas applied we had
to arrest bleeding, and had no other avenue for that object
open to us, the patient being, as remarked before, in a very
critical condition. From the appearance of the whole limb,
I was satisfied that our prospects for union of the flaps were
rather dubious, even if the patient should survive such
alarming symptoms. I left, therefore, the stump to its
fate, and looked alone to the inflammatory process and con-
stitutional disturbance.

For two weeks the patient was at the point of death, but
gradually the inflammatory process diminished, and with it
improved slowly his general condition. The sloughs sepa-
rated, granulations sprang up, covering the cut surface of
the bones and the loss of substance in the soft tissues. In
about twenty-eight days, the patient was ready for a third
amputation, becoming imperative on account of the impos-
sibility to replace the flap, whose vitality during the whole
siege wTas not in the least encroached upon, or to bring it
into any kind of shape for cicatrization.

The left stump, during the height of trouble with the
right one, seemed to sufler some, but healed, ultimately,
nicely.

The third amputation was performed below the knee ;
and also of this operation, the patient, in a comparatively
short time, got up without further trouble.

Cauterization of Tumors.

At a time at which cauterization is extending its empire
and is taking from the bistoury what it had formerly yielded,
it is not uninteresting to see how encysted tumors of the
scalp are treated in some of our hospitals.

i#] Cau 146

Few diseases have so much exercised the minds of

ial cautery, the seton, partial excision with the
razor or bistoury, division of the cyst after perforation, dif-
ferent chemical agents, haw been in turn proposed for the
destruction of these tumors, which, as Cooper has said, are
but enlarged follicles, developed to excess inconsequence
of the obliteration of their neck. The most expeditious
process, that which appears preferable to all those in which
the bistoury lias been resorted to, is : ing of the

tumor, performed, but a short time Bince, by Dr. Robert do
Lamballe. A pointed bistoury, plunged into the growth,
divides the latter in two, from the basis to the summit; the
enucleation of the two halves is afterwards accomplished
with extreme facility. A plain dressing and slight com-
pression suffice tor the rapid cure of the wound, which
leaves hut a Linear scar. This modus operandi is not more
free from disadvantage than other processes of excision with
the bistoury, and for this important reason Mr. Jobert has
returned to the old method of cauterization.

Cauterization, in reality, is not, as certain quacks have
pretended, a new means of destroying wens without any
operation of the knife. Chopart's excellent treatise on this
subject is known to ail as well as the comparative experi-
ments made by this author on the action of the various
causi

\\\ the last century, Tenon having gone on a visit for
some time to the Marquis de Turgot's, relieved several per-
sons there from these cysts, by touching with a straw,
steeped in nitric acid, the central point of the tumor.
Tenon had seen this process employed by an itenerant
practitioner, and, as a judicious observer, he had remarked
that the patients recovered without erysipelas, a common
accident, which it was sought to avoid by abstaining from
the bistoury. But. however, notwithstanding the success
obtained by caustics, the knife was resumed, and, in an
article published in 1836, on wens, in the IXctionnaire de
medecine et de chirurgie fraUgues^ Blandin does not even men-
tion cauterization. Blandin handled the bistoury with
admirable dexterity; but, had he not prematurely died, he
would have renounced it in the treatment of wens, for, at
the end of his career, he one day extirpated a veiy small
cyst from the scalp in a woman of 25 years of age; it was
so trifling that the operation was performed in his consulta-
tion room. The next day the wound became painful, ery-
sipelas set in, and on the fifth day the patient died.
10

146 Cauierization of Tumors. [February,

If caustics were relinquished for so long a time, although
DupuytreD acknowledged their advantages, it is because
caustic potash and mineral acid- were not easy of applica-
tion or constant in their action. In using them, it was
accessary, as Boyersays, to apprise patients that the cicatrix
would be extensive and deformed, lint this is no longer
the case. With Vienna paste, soft or solidified, the eschar
can be mathematically circumscribed and a cicatrix obtained,
which is almost imperceptible. Mr. Guersant, a very short
time ago, destroyed in this manner a small wen in a child
eight vcars of age. lie took a piece of adhesive plaster, in
which he cut a hole in the shape of a myrtle-leaf, represent-
ing in extent half the eschar he wished to obtain : the plaster
was applied to the tumor and covered over with Vienna
paste. At the end of five minutes, the caustic was removed
with a spatula : the skin, which remained hare, was washed,
and. on the eighth day, the cyst fell off with the eschar.

Dr. Robert recently related, in one of his conferences,
that he had removed wens by that method a hundred times;
his process is the same as Dr. Guersant's. That very day,
a woman thus o] crated on in his wards, brought her tumor,
which united with the eschar and reduced to very inconsid-
erable proportions, resembled a flat-headed nail. On the
fifth day the eschar still adhered to the wen, hut its edges
became" inflamed and the elimination took place, leaving a
bleeding wound which healed in three days. ''The eschar,"
savs Di\ Robert, "must be left exposed to the air, patients
must walk, attend to their ordinary avocations, without
resorting to the poultices or emollients; they need entertain
no apprehension of erysipelas or any serious accident what-
ever." This skillful surgeon has cauterized wens as large
as walnuts or apricots: he has removed as many as twelve
in the same person. "The question in this case," says he,
"beino; complicated neither by the number nor the size of
the tumors."

Professor Jobert has also renounced the knife in favor of
cauterization in the treatment of wens, and his destructive
process is more simple than that we have just described ;
this surgeon merely paints the tumor over with Vienna
paste, in a slightly liquid state. He recommends that the
powder employed in this case should be fresh, a precaution
without which the paste is impregnated with the moisture
of the air and acts less quickly. We saw, two months since,
Mr. Jobert cauterize, in a carpenter forty-nine years old,
four wens, three of which were melicerous, and the fourth

I860.] Pru ved by Ergot 1 IT

atheromatous, of eight years' standing. < >ne of these growths
was fluctuant and threatened to burst. All four were cov-
ered with a thin layer of caustic, which was allowed to
remain on for seven minutes and a half. The patient was
taken back to his bed, and, after two hours' repose, he went
out bare-headed. The fluctuanl tumor became hard and
parchment-like, and, instead of coming out, its conte

itne coagulated. Subsequently the eschar fell off and
naught remained but unimportant seal's.

Finally, wens may be removed by perforating ;za-

tion. Dr. Alphonse Amussat, wlio has long used caustics
with great dexterity, lias destroyed a great numberof these
tumors by cauterization applied in the following manner :

Taking a stick of Filhos caustic of the size oi* a. piece of
solid nitral i of silver and sharply pointed, lie perforates the
tumor in the middle and upper part, by communicating to
the caustic a rotary motion. The cyst being opened, the
matter it contains is forced out, and the internal surface of
the - Luterized with the blunt end of the same stick of

lie. When this i^ done, a small quantity of the paste
of chloride of zinc, in equal parts, is introduced into the
cyst and is left there from two to six hours, according to the
degree of thickness of the parietes of the latter; the paste
is then removed and the tumor is left exposed to the air
until its complete cicatrization.

This process, which appears to he less simple than the
preceding, has, according to its author, the advantage of
cauterizing and of destroying cysts of long standing; in
addition to which it transforms them into an imputrescible

har, which falls off while reparation is being performed,
and the falling off leaves after it but a small sore, soon re-
placed by an insignificant cicatrix. Championniere's JowrvUl.

Grave Pneumonia Speedily Relieved by Ergotine.

We recollect having seen Mr. Maisonneuve exhibit with
advantage syrup of ergotine in that form of pneumonia
which is frequently observed in consumptive subjects, and
is attended with sanguineous exhalation. Ergotine is a
powerful hemostatic, and we find, in the Gazette des Hopitaux,
a fresh case of Dr. Thibault, du Pertre (Ille-et-Vilaine),
which seems to prove that the sedative virtues of this drug
may, in certain varieties of pneumonia, make it a useful
substitute for oxysulphuret of antimony and tartar Emetic.

In October 20, 1858, Mr. Thibault was summoned to a

148 / j i um&nia Relh ved by Ergotine. [February,

patient suffering for four days from pneumonia in the first
and second stages. The pulse was lull and vigorous, and
had risen to 95; oppression was considerable, cough mod-
erate and product hi' of rusty sputa. Twenty ounces of
blood were taken from the arm, and phlebotomy was
repeated in the evening. On the following day, eight
leeches were twice applied, at an interval of twelve hours,
to the left side. On the 22d, slight improvement had taken
place, the oppression had decreased, and the pulse had
diminished in frequency. Tartarized antimony was pre-
scribed; but, having been rejected by the stomach, was
replaced by kermes mineral. On the 24th, the patient was
worse, the pulse was small and frequent, at 105; the coun-
tenance had undergone an unfavorable change, much
prostration was present, and the expectoration Lad the
color and appearance of the juice of stewed prunes. On
the 25th, hemoptysis occurred twice, and the patient was
troubled with delirium and carphology. For the purpose
of modifying the character of the expectoration, indicative
of suppuration of the lung, with but slight hopes of attain-
ing his object, Mr. Thibault prescribed the following mix-
ture:

1$ Aqua3, - - - 3 5

Ergotmae, - - - 13

Antimon. oxy. sulphuret, \ 9

Pulveris scil'lse, - - j &

Gum. tragacanth, - 1 3

Syrupi simplicis, - 10 5
F. S. A. To be taken in table-spoonfuls every hour.*
Scarcely had the patient taken three or four doses when
the appearance of the sputa was changed. They first
became rusty, and subsequently merely yellowish, as in
common catarrh. Mr. Thibault was also struck with
another equally singular circumstance, viz: the decrease of
feverishness ; the pulse fell from 105 to 80 and 75, without,
however, acquiring strength or fullness. The medicine
was interrupted and the expectoration again became rusty;
but recovered a more healthy character, when the medicine
had been resumed twenty-four hours. On November 2d,
the patient was rapidly progressing towards health.
Championniere }s Journal.

*Mr Maisonneuve exhibits the syrup of Bonjean, which is prepared by the
addition of a solution of 2$ dr. of ergotine in one ounce of orange-flower water,
to one piwt of boiling syrup. This compound contains eight gr. of ergotine for
every ounce, and is prescribed in tea-spoonfuls four times an hour, in hemop-
tysis. . H- C.

I860.] Transplantation of th Dura Mater. I!

Transplantation of thi Dura Mater as a M Determi

its J' iracter. By M. Ollier,

This paper forms a kind of complement to those we have
already noticed as having been read to the Acad
Sciences upon the transplantation of periosteum. While
Borne experimental results, M. Ollier observes, have led a
certain Dumber of physiologists to regard the dura mater
as a periosteum, clinical observations have not induced
Burgeons to place much confidence in this membrane for
the reparation of osseous parts, which have been removed,
whether accidentally <n- by the trepan. His experimental
resections of the cranium have Led fche author to believe,
with several observers, that there are three sources of repa-
ration to !'< \ osseous substance the dura mater; the diploe,
and the pericraniunl. But in consequence of the various
difficulties produced by the conformation of the region and
the proximity of the encephalic organs, this mode of pro-
cedure has not furnished results precise enough to supply
a clear and definitive solution. lie, therefore, has had
recourse to the mode of experimenting which had furnished
so peremptory a proof in favor of the theory of the forma-
tion of bone by the periosteum, viz : the transplantation of
the dura mater to various regions of the body of an animal
of the s cies. Strips of this membrane, grafted

under the skin, in various regions, have given rise to per-
fectly-constituted hone, possessed of all the anatomical
characters of normal os.-eous substance: and by virtue of
this fact we are authorized in regarding the dura mater, not
only as a protective envelope for the brain, hut as contribu-
ting directly to the ossification of the cranium. This
property of the dura mater does not continue in the same
degree in ail ages, diminishing rapidly in proportion as
growth is accomplished. Very well-marked at the com-
mencement of life, it has hecome much less apparent by
the time the skeleton has reached its complete development,
and is exhibited in a still less degree when adult age is
reached. When transplantation of a fragment of the dura
mater is accomplished in the adult rabbit, only numerous
and independent osseous granulations are produced on its
surface. This influence of age explains to us why the facts
ohserved in a man appear so often contradictory, and why
surgeons usually only obtain incomplete reparation after
trephining. All portions of the dura mater do not possess
the property in a like degree, it being only the external

150 Treatment of the Naus* [February,

surface of the membrane that does so the fibrous folds not
in contact with bone not being susceptible of ossification
on transplantation. The greater proportion of these fibrous
tissues at the base of the cranium, added to the difficulty of
detaching the dura mater there without tearing it, explains
why we obtain in general a more abundant ossification with
strips taken from the convexity, than with the fragments of
the same size detached from the bone. Comptes Hendus,
Tome xlix., p. 206.

treatment of the Nauseau and Vomiting of Pregnancy. By
J. II. Warren, M. D., Tfqxmset.

How much has been written and said upon this subject,
and what a vast catalogue of medicines have, from tl e
most ancient to the more modern times/been recommended
and tried as sure specifics; and how often has the most
aspiring and faithful son of ^Esculapius been obliged to
disgorge his strong faith in them, as the nauseated patient
does the most potent draught administered by his kind
hand ! External applications over the epigastric region
have been often resorted to with a good degree of success.
Perhaps the tincture of opium and brandy, or the tincture
of opium alone, stands at the head of the external medi-
cines, at least as far as my observations have extended, it
having often entirely relieved the nausea and vomiting. I
have in some few instances added one drachm of the tinc-
ture of iodine to one ounce of the tincture of opium, with
benefit. With internal medicines I have had but little
success in relieving this distressing complaint. The most
efficient I have tried, is the pill of nitrate of silver and
opium, recommended by our distinguished and learned
iriend, Prof. W. Channing. But even this little pill has
failed in my hands of accomplishing the desired result.

Of late, applications to the os uteri have been recom-
mended, with a slight show of success; upon what scientific
principle, J leave others to discuss, as my intentions are
only to mention some, and the success I have had in the
use of them. Various agents have been suggested. The
tincture of iodine has been favorably spoken of by some
authors. I have applied it to the os in a few cases only, as
the complaints of the patient, of a metallic taste of the
iodine in the mouth, show it to be about as great an annoy-
ance as the sickness we endeavor to remove by its use. 1
can conceive, however, that this agent might be of vast

I860.] And Vomiting of Pregnane*/. 151

value in cases of scrofulous disease in this organ. Other-
wise, I should have but little faith in the use of it, so long
as we can have recourse to other agents less objectionable
in their effects, and equally as potent as the iodine, in
assuaging the distress of (his un] complaint, and

more especially if there exists any inflammation of the
mouth and nock of the womb, a very common concomitanl
affection uow-a-days, as every practitioner knows, with
pregnancy. What is better here than the nitrate of silver?
Its result in reducing inflammation and ulceration is an
established Pact, and it will prevent nausea and vomiting in
pregnancy, if properly applied to the os and cervix uteri, as
well as iodine, and that without the unpleasant taste in the
mouth.

In passing upon applications to the uterus in these ca
1 would take the liberty of calling attention to the applica-
tion of the tincture of benzoin and chloric ether, which I
have been using witli as good an amount of success, as any
agent I have employed, and it lias the advantage of being
very simple. L would particularly recommend it where
there is much neuralgic pain and excessive leucorrhoeal
etion. 1 have found nothing so beneficial in these last
named accompaniments, as this preparation. By adding a
few grains of acetate of morphia to this, it will also be found
a wry efficient remedy in painful menstruation, and will
seldom fail, in the practitioner's hands, of giving ease and
comfort to the female, during this, her much-dreaded
period, if applied just before or at the commencement of
menstruation. It should be painted upon the os and cervix
once in three or four days; and may be continued through-
out the whole period of pregnancy without any unpleasant
effects. My formula for this preparation :
I Tinct. Benzonii c, 5 ii ;
Chloric Ether, 5 i;
Acet. Morphia, grs. ii. M.
These applications should not only be made to the mouth
of the womb, hut should extend to the neck, if we wish to
gain a favorable result from them. If the silver be used, it
cannot be applied too lightly; a very slight penciling is all
that is required. If applied so as to produce sloughing and
discharges, it will fail of accomplishing our desires. Are
not the good effects of these applications to be accounted
for, from the fact that they form a protecting coat over the
congested and abraded uterine mouth and neck, that may
take plaee in the impregnated uterus, thereby allaying the

152 Treatment of Whoqping- Cough [February,

irritation of the external uterine nerves and vessels, by equal
pressure and protection from all external influences of vagina
and other Bources? I should be happy to hear the result of
the use of these preparations in the practice of other medi-
cal gentlemen.

In addition to the above, I have used injections of Ferri
alunienis, 5 i ; inf. opii, % ii ; aquae dist., S viii. M., with
some benefit. These can be used where it would not be
expedient to employ the speculum. I sometimes substitute
iodide of zinc for the alum. This is more applicable to
those cases where there is slight spasmodic action in this
organ, or in the neck of the bladder. I use five grains of
zinc to the ounce. Boston Med. Surg. Journal.

On the Train* .at of IF r hooping- Cough by Diluted Nitric
Acid. By John Arherley, M.R.C.S., Eng.

I wish to direct the attention of the profession to the diluted
nitric acid, in the treatment of whooping-cough. It has
already been employed in whooping-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
throughout that period, and I can affirm that as the ordinary
duration of whooping-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 remo-
val in less than three weeks, except in cases where its course
has been interrupted by some serious complications.

Any medicine capable of abridging the duration of a dis-
ease, 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 concur-
rence of the profession, and will hold a high place, and be the
cardinal remedy, if not supercede all other medicines in
whooping-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
become aggravated, cr of more frequent recurrence. When
the intervals become lengthened, which generally happens

1860. By Dilute^ Mho- Ami. l.v;

after the second day, the medicine may be given
quently; but it is of importance that tHe acid Bhould be
continued ten days after all symptoms of the disease have
subsided. From the neglecl of this precaution, I bave s<
the cough return with all its former violence when the medi
cine lias been abruptly discontinued; therefore, it should be
given in moderate doses three times a day, after all traces of
the affection have passed away.

The term 1 generally use is the one originally suggested,
viz: diluted nitric acid, compound tincture of cardamoms,
Byrup and water. This is always taken without the slightest
reluctance, as it is agreeable to the taste a great considera-
tion in prescribing a medicine for children, which requires to
be continued tor 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 bed-room 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 attendant ; but from the apparent simplicity in the
fumes of burning nitre-paper, they are readily induced to give
it a trial. Medical Times c& Gazette:

Reproduction of Bone. Dr. E. S. Cooper reports in the
St. Louis Med. and Surg. Jour., (New Orleans Med. News,)
a very interesting case in which he removed seven inches
of the shaft of the tibia, and in which the bone was repro-
duced. One of the reasons given for the particular opera-
tive procedure resorted to, is as follows : "Because com-
plete reproduction of bone is always effected much more
rapidly and with much more certainty, if two extremities of
bone remain after exsection, than when there is one only."

154 Editorial. [February,

EDITORIAL AND MISCELLANEOUS.

American Contributions to Iff rtlical Science.

We cordially give place, in our editorial department, to the commu-
nication of our valued contributor, Prof. L. A. Dugas. The proposition
to establish an American Abstract of Medical Sciences, which shall
be both comprehensive and comjxndious, accessible to all readers
everywhere, strikes us as one of the most valuable suggestions which can
be made towards improving the standard and elevating the character of
American Medical Literature. Foreign journals, both British and Con-
tinental, have the most mistaken views as to the value and importance
of American contributions to medical science, and, blind to their own
interests, but few of them care even to exchange with their American
confreres. Most of them ignore the medical literature of this country
altogether, while others affect to disbelieve the repDrts of American
writers, and chide their more liberal brethren for cumbering their pages
with extracts from American publications.

The Dublin Medical Press, the most liberal of the Foreign Medical
Periodicals, has had recently to defend itself against the charge of im-
propriety, for its frequent extracts from American journals. This
journal has evinced a most appreciative regard for American contribu-
tions, and were the proposition of Dr. Dugas, to establish an annual or
semi-annual abstract, carried out, foreign journals of a less liberal spirit
would be compelled to acknowledge the claims of their Professional
brethren on this side of the Atlantic.

It is true that several of our Monthly Journals, as well as the Bi-
monthly and Quarterlies, have recognized the propriety of such a col-
lection ; hence we have in some of them monthly summaries of the
Progress of Medical Science. These add to the value of the respective
journals, and are of benefit to their readers, but will not answer in the
place of the publication now insisted ou by Dr. Dugas. We offer no
further arguments, as we consider the advantages of the enterprise are
most ably set forth in the following letter of our correspondent, to the
Medical Association, during their session of 1858, at the American
Capitol :

Augusta, Ga., Feb. 10, 1860.

Messrs. Editors : The accompanying communication was sent to
the Medical Association last year, but, from some accident, was never
laid before that body. Having kept a copy of it, I am enabled now to
tender it to you for insertion in your valuable journal, hoping that it may

I860.] Editorial. 156

receive the approbation of your readers, and that Bome one maj bring
the subject before the Association at their next meeting, 1 remain,

fours, very trulj .
L. A. Dug as.

To the President and Members of the American Medical Asso
Hon.
Gentlemen: The object of this communication is respectfully to

direct the attention of your body to the importance of establishing a
medium in which may be concentrated the working of the Medical
mind of our country. This is essentially the land of printing; every
department of our social system has its organ of publicity ; merchants,
politicians, theologians, legislators, agriculturists, naturalists, mechanics,
lawyers, physicians, and even charlatans; all vie with each other in the
endeavor to disseminate their views and principles by means of the great
engine of the press. In no country is there more mental activity among
physicians than in this; in none are there as many Medical periodicals
published ; and these are multiplying in a direct ratio with the increase
of our population. Yet, it is notorious, that the contributions of our
physicians to the common stock of knowledge are less known to the
scientific world at large than those of any other people. The very fact
that we have a multitude of periodicals renders it very difficult, if not
impracticable, for any one, however diligent, to keep pace with the press
and to garner up what may be valuable in the original columns of each
journal ; and the difficulty of establishing and keeping up a system of
exchanges with European publications debars most of our contributors
from the privilege of being read or quoted abroad. While, therefore, the
multiplicity of Medical periodicals has a natural tendency to increase
the number of writers in our country, it correspondingly lessens the
probability of their views becoming known beyond the more or less
restricted limitsof the circulation of their local medium of communication.
The American practitioner cannot become acquainted with the writings
of his own countrymen without looking over a number of journals well
calculated to discourage him, even if he could afford to subscribe to
them all. This difficulty is still more grievously felt by our systematic
writers, who would like to do full justice to their countrymen, and yet
find it almost impossible to get access to complete sets of our periodical*
for reference. Hence it is that no books or treatise can be a faithful
exponent of American contributions. If it be thus difficult for our own
authors to do us justice, it must be still more so for those of Europe,
who supply the reading world with most of its books.

In Europe, neither writers nor readers labor under these disadvan-

156

Editorial,

[February)

tages. The comparatively .small number of their periodicals, and the
semi-annual publication of Retrospects and Abstracts of their coutents,
renders it quite easy for any one of ordinary industry to be informed of
all their useful views and facts. Now, with the exception of the few
copies we send to Europe in exchange for their journals, we may say
that our periodicals are entirely unknown in foreign countries, whereas
several of theirs are reprinted in the United States and extensively
patronized. The writings of Europeans are thus not only brought
directly to our doors, but our own journals cull most assiduously from
them every paragraph supposed to possess the least interest, while oui
local periodicals are actively engaged in heralding the achievements
Europe, those of domestic origin too often remain unnoticed. In addi-
tion to the extensive circulation among us of foreign journals an<
reprints, the publications of Braithwaite and Ranking give a degree of
permanency to their papers, which is denied to our own, inasmuch as
those semi-annual collections are devoted to the propagation of European
views and are almost entirely silent with regard to what is said or done
in America. Take them up, number after number, and you will look
in vain for any evidence of the mental activity to which we have
referred, can it be that we say or do nothing worthy of permanent
record ? Foreigners are perhaps not so much to blame in this matter,
when our own periodicals for various reasons, make such a meagre show-
ing for us in their selections from domestic cotemporaries, while some
of the veriest puerilities of foreign origin will be found going the
round in every journal of the land.

We need a remedy for the evils pointed out, and, for some years
urged, its importance through another channel. I now beg leave to
bring the subject before the American Medical Association, in the hope
that, under the auspices of so authoritative a body, apian may be adopted
that will be effectual, without interfering with the interests already
involved in local journalism. Let a semi-annual work be published by
subscription, bearing the title of " American Contributions to Medical
Knowledge," or any other of similar import. Let it consist : 1st of a
reprint, partial or complete, of all such papers contained in the " original
department" of American Medical journals as may be deemed worthy
of permanent record : 2d of Reviews of American books on medicine
and its collateral branches ; 3d of abstracts from the original matter of
of our journals that may not appear under the 1st head ; 4th of Medical
intelligence, biographical notices, &c, and lastly, of a complete list or
index of the original articles of every American medical journal issued
during the preceding six months. To this might be added, whenever

I860.] Editorial. 157

eonvenient, general indexes of the whole series of the various American
Medical periodicals. The lack of a general index to our journal m
the labor of consulting them exceedingly onerous, and doubtless consti-
tutes one of the greatest impediments to the diffusion of American \i
in systematic works.

The publication of such a semi-annual volume would be of incalcula-
ble value as a book el' reference ; it would be sought with avidity by
European as well as by American writers, and would contribute im-
mensely to the elevation of the medical profession of our country in tin:
estimation of the world. As it would contain none but .American mat-
ter, it would not militate against the other periodicals of our country.
which would continue to be taken for foreign intelligence as well as
from local considerations. The semi-annual proposed would give them
notoriety abroad, without diminishing their local circulation. Let the
conductors of such a publication be men of industrious habits as well as
of competent abilities, whose sole object will be to furnish us a complete
and impartial reflex of the workings of the American medical mind dur-
ing the preceding six months. If well conducted, such a work would
enable us to become acquainted with the views of men of ability in every
section of the country, and would at once become a standard book of
reference throughout the world. Writers might then enjoy the satisfac-
tion of contributing to the literature of their own immediate neighbor-
hood, and still feel that in doing so, their labor would not necessarily be
restricted to the field of their local periodical. With the consciousness
that merit would entitle their papers to a place in the proposed national
work, they would be actuated by an incentive which they do not now
experience, and would strive to do themselves credit abroad as well as at
home. Such a work, I repeat, would not conflict with the interests of
existing periodicals, because it would publish no paper that had not al-
ready appeared in a local journal, with the exception of reviews. Phys-
icians would naturally continue to support the journal of their own sec-
tion, and take, also, the national work for more extended information, as
they now do the reprints of European retrospects.

For the purpose of carrying out these views, I would now respectfully
submit to the consideration of the Association the following resolutions :

Resolved, That a committee of be appointed by the Chair for the
purpose of drawing up a plan for the publication of a work designed to
carry out the views above expressed, and also of securing the services of
suitable persons to conduct its publication by subscription.

Resolved, That the members of the American Medical Association
will use their influence in promoting the success of such a national work.
I am, very respectfully, your ob't serv't, L. A. Dugas.

158

Editorial.

[February,

New Journals. We have received copies of the following new-
Medical Periodicals, not heretofore noticed in our pages :

1st The Chicago Medical Examiner, a monthly journal, devoted
to the educational, scientific and practical interests of the Medical Pro-
fession. Each number contains sixty-four pages of reading matter, and
is edited by N. S. Davis. Professor of Principles and Practice of Medi-
cine and Clinical Medicine, in the Medical Department of Lind Uni-
versity, and E. A. Steele, M. D., of Chicago. " The Chicago Medical
Examiner is the property of its Editors, and as independent of all
schools, clubs or cliques, as any other* medical periodical in the United
States."

2nd. The Kansas City Medical <$* Surgical Review pp. 48.
Edited and Published by G. M. B. Maughs, M. D., and T. S. Case, M.
D., in Kansas City, Mo. The January number contains an original
communication from each of the Editors. 1st. "The Medical Topo-
graphy of Kansas City and the adjacent country, by G. M. B. Maughs,
M. D.;" and 2d, " On the Origin of Malarious Diseases, and the action
of Malaria in the System, by T. S. Case, M. D." The editorial, selected
and miscellaneous matter are highly interesting. We cordially wish its
editors full success in their new enterprise.

3rd. The Dental Cosmos : A Monthly Record of Dental Science.
Each number contains about fifty-six pages of reading matter, contributed
and selected principally in reference to the Dental Profession ; but there
will be found in its pages much that will interest medical men, and
which, as general practitioners and as surgeons, should engage their
attention. American Dentists, we think, were the first to take the
initiative in founding colleges for regular instruction in their department
of science, and consequently American practitioners of the Dental Art,
as a general thing, are better instructed and stand higher, as a class,
than the Dentists of any other country on the globe. The establishment
of State and National Dental Associations will, of course, tend still fur-
ther toward the elevation of the Profession, and render scientific, a
branch of practice which, up to a recent period, has been proverbially
empirical, and often, doubtless, highly injurious to society.

The Dental Cosmos is published in Philadelphia, by Messrs. Jones
and White, and is edited by the following gentlemen : J. D. White,
M. D., D. D. S., J. H. McQuillen, D. D. S., and George J. Zeigler, M.
D. The work is well illustrated in several of its numbers, and of ex-
cellent typography. The ability with which it is conducted will doubt-
less secure it an extensive patronage.

Italics ours-

18G0.] M\ )us. L69

It affords us much pleasure to plaoe the al journals upon oui

exchange list, and we Bhall, from time to time, draw from them for
benefit of our own readers.

Epitome of Braithwaite's "Retrospect of Medicine a ry.

We, ha^ 1 the title page and speoi ts of the al

valuable work. " The design of the author is to enable the practitioner
to refer at once to the modern treatment of all varieties of disease to
refresh his memory in cases of y and to speedily acquaint

himself with si sific applications as would oth /aire con-

siderable research to acquire from the original volumi s." To be edited
by Walter Wells, M. D , and published by Charles T. i , of New

York It will be issued in five parts, at one dollar each, making, when
completed, a large octavo volume of over 1500 pa
r The cream of Braithwaite's Retrospect must be rich indeed. The
work cannot fail to secure an extensive patronage.

The Microscopist'S Companion A Manual of Practical Micro-
scopy. l>y John King, M. D. We have received specimen pages of
the above work, now in process of preparation. On the appearance of
the book, we will furnish our readers with a more exteuded notice.

Dr. G. W. Spence recommends, in the Lond.
/'. December, the following formula for a paste of

chloride of zinc : " Dissolve fifty grains of prepared chalk
in two drachms (by measure) of commercial muriatic acid;
dissolve a hundred and fifty grains of sulphate of zinc in
two fluid drachms of boiling water. When required for use,
mix the two solutions, and the result will be a paste weigh-
ing nearly an ounce, and containing about one-sixth of pure
chloride of zinc."

Leather and Metal The following is said (Alg. Pob/tech.
Zed. and Druggist,) to be a very efficient method for fasten-
ing leather upon metal : " The metal is washed with a hot
solution of gelatine, and the leather, previously steeped in
a hot infusion of gall-nuts, pressed upon the surface and
allowed to cool. It then adheres so firmly that it cannot be
separated without tearing."

Cancer. M. Sedillot, of Strasburg, strongly recommends
(Ibid.) the use of the actual cautery for destroying epithe-
lial cancers ; removing as early as possible (under chloro-
form) the healthy parts immediately surrounding the cancer.

160 Miscellaneous.

Sickness of Pregnancy. Dr. C. E. Bagot calls attention
(Dublin Med. Press, Oct. 12, 1859) to the employment of

calomel pushed to Blight salivation as a most successful
mode of relieving this sometimes intractable and dangerous

ition; a practice winch he recommended in 184(j. In
that year he had under his care a woman labouring under
that extreme form of Bickness from pregnancy which placed

life in the most imminent jeopardy. I had tried all the
usual remedies suggested in Buch cases, and found them one
after another to tail in producing any relief. Although
there were no symptoms whatsoever which would make me
suppose that any inflammation was either the proximate or
remote cause of the sickness, I resolved to try the effects of
mercury, and having had some experience of the powers of
calomel in allaying other forms of vomiting, I fixed on the
administration' of "this preparation, steadily persevering in
it< use until her gums snowed appearances of salavation,
which they did in a very short time. This treatment
resulted in" the best effects. Immediately that slight sali-
vation took place, the vomiting, previously so persistent, at
once ceased, food remained on the stomach, the patient
rapidly recovered, and was in due time safely delivered of
a full-grown infant.

The sicknes of this patient, Dr. B. says, was of the very
worst form, her symptoms were so urgent tliat lie despaired
of her existence being prolonged ; lier prostration of strength
was excessive ; her emaciation extreme ; her pulse a small
thread ; she had no tenderness in the epigastrium ; neither
bad she pain in the region of the womb, nor the least uneasi-
ness on pressure over that organ ; she bad no febrile noi
inflammatory symptoms, and yet the most complete rebel
followed, the" exhibition of the mercurial pushed to slight
salivation.

In two subsequent pregnancies this patient suffered
eqally from the same urgent symptoms, and on both occa-
sions she was relieved by the same medicine.

Jsfemoma. According to Prof. Parker, (N. Y. Med.
Press,) neuromatous tumors are divided into three classes :
" 1st. Those which are formed upon the trunk of the nerve ;
2d. Those connected more particularly with the extremities
of the nerve, (painful tubercle,) as upon the fingers, toes
in fact, all situations where there are terminal branches ;
and, lastly, the neuromata of stumps."

SOUTHERN

MEDICAL AND SURGICAL JOURNAL

(new series.)

Vol. XVI. AUGUSTA, GEORGIA, MARCO, 1S60. NO. 3

ORIGINAL AND ECLECTIC.

ARTICLE VII.

An Essay on the Adaptation of Climate to the QmsumpUve, for
a permanent residence; embracing an Examination of the Cli-
mate of certain loccdities of frequent resort ; and also, an In-
eestigation of the degree of adaptedness of the Pacific Climates
of the United States. Presented to the Medical Society of
the State of Georgia, at its annual meeting, held at At-
lanta, April 13th, 1859. By William Henry Doughty,
M. D., of Augusta, Ga. (Ordered to be printed.)

(Continued from February No., Vol. 16, page 100.)

A COMPARISON OF THE ENTIRE PACIFIC COAST, WITH THE STATE

OF FLORIDA, ADOPTING THE MOST ELIGIBLE LOCALITIES OF

EACH, WITH THE VIEW OF SHOWING ITS GREATER

ADAPTEDNESS AS A RESORT FOR THE CONSUMPTIVE.

The remaining period that of cold or of the declining
temperatures extends from October to March inclusive ;
thereby embracing the winter season, and the coldest and
most variable, of the spring and autumn. In so arranging
this period, our design is not only to embrace those months,
which, although strictly speaking, do not belong to the
winter season, yet have some degree of identity with it,
but to present to the reader a connected history of the
entire period, during which depressions of temperature,
periodic or non-periodic, may occur ; and also to represent
them in such a manner as that the relative merits of both
sections may be fully exposed.
11

162

J)oughty. An Essay on the Adaptation [March,

Proceeding to the comparison, we take up first the differ-
ence of the successive months of the period.

1

1

Decline from

1

Oct. 1

OctoNovlNovtoDecH ntoFeb|Febto Mh|Mh to Ap

San Diego. Cal., (5 to 6 yre)

Cft 50

-8 58 1 -5 22

|< ' 20

f 1 37

12 73

t5^2

Ban Francisco, " 3 to 5 "

67 91

-3 60 1 -3 1 1

t* 18

tl09

t26-

Ft Ynncouver.Or, S to G "

53 30

-6 79 -10 LO

tl10

|2 48

t248

" Marion, Fla., 20 "

71 88

-70 76 -6 86

-0 23

f291

t340

|544

King. " 16 "

70 56

-7=37 -4 64

-0 07

-02T

t615

t7^ <)5

,l Barrancas," 17 "

70 (<8

-9 06 | -5 45

tl97

f6 23

t6 71

By comparing this table with the corresponding table of
advances in the other period, it will be observed that the
mean temperature of the month occupying its leading
column, is uniformly higher, except at Fort King, than that
of the other. This is a fact which perhaps is true generally
of the climate of the United States, the exceptions to it
being found in high northern latitudes, or where the verti-
cal confrigf^ation alone is sufficient to prevent it.

This table of course presents only a part of the period of
an actual, declination of heat, at the Florida posts, and at
most of those of the Pacific, because the highest monthly
mean temperatures are recorded in the summer season, and
from which to this month a decline occurs. At Florida,
the highest summer mean is in the month of July, but on
the Pacific, this varies at the different posts August having
the highest at San Diego, September at San Francisco, and
July at Fort Vancouver. Hence at the latter, the culmina-
ting point varies with the latitude. These things being so,
the commencement of the actual decline of temperature
varies at the two places, and is of longer or shorter
duration. Upon the eastern and western coasts of Flo-
rida, as represented by Fort Marion and Fort Barrancas,
the decline continues until the month of January, but
at Fort King, intermediate to them, it is still further
protracted to February this month here affording the
lowest monthly mean. At San Diego, on the Pacific, the
monthly means continue to decline to December, and thus
give a shortened period of five months' continuance. At
San Francisco, the means cease to decline after January, so
that with the highest mean in September, it occupies only
four months. At Fort Vancouver, also, it embraces a period

I860.] Qf Climate to tk > L68

ol' five months from August to I December inclusive. Eence
the whole time occupied by a decline of the monthly mean
temperatures al Florida is six months, and in some instac
seven, whilst od the Pacific coast, of the three stations, the
greatest length is five months, and the Leasi four.

The character of this decline in th State of Florida is at
its commencement quite sm l( rapidly increases after

the passage of the last sunn. months; so much, so, that
the decline from September to October a1 its three stations,
will average more than seven degrees. The same rate is
preserved from October to November, and that from No-
vember to December is about five and a half degrees.
Indeed the progress of the decline from the summer to the
fall months is not only rapid, but very abrupt, that from
September to October, being suddenly increased to fully
three and a half times that from August to September.
Moreover, this elevated monthly decline is preserved until
the month of December; and the actual a lount of declina-
tion from September to December, is at Fort Marion
21 34 at Fort King 19 63 and at Fort Barrancas 22
90. But December, having been reached, the retreat to
January is very small, being only one-third of a degree at
Fort Marion one-eighth at Fort King, and 1 % at the
other post. The decline to February at Fort King is also
very small.

Again, the reaction from these low winter means begins
in January at the two opposite posts : at Fort Marion, it : 4
firm and steady to the spring season, the greatest monthly
advance being from March to April ; at Fort Barrancas, it
is much more rapid, and preserves an average advance of
over six degrees from February to April. And at Fort
King, where the reaction is postponed to February, from
thence to April, a similar rate is also maintained.

Of the Pacific stations, two give a similar record to these,
namely, the most northern and southern. At San Diego,
the fall of temperature from the mean of August is even
greater than at two of the southern stations, but that from
September to October is less ; so that the whole decline

164 Doughty. An Essay on the Adaptation [March,

from August to October scarcely equals the latter. From
October to November, it becomes again greatly increased,
exceeding that at Forts King and Marion, although less
than at Fort Barrancas ; and from this month to December, a
further reduction of 5 22 occurs, after which the reaction
begins. At Fort Vancouver, the measures of monthly de-
cline are even more irregular and abrupt than this, and in
the passage from November to December, which has the
lowest mean for the year, shows a decline of 10. The entire
retreat from the mean of August to December is at San
Diego, 21 98, and at Fort Vancouver, 29 05. These two
posts, then, although differing from each other, and also
from those of Florida in the measures of heat experienced
by them, nevertheless present great analogy with the latter,
both in regard to the irregularity and abruptness, and also
to the extent of the declining temperatures.

"With the remaining station of the Pacific, the most inter-
esting comparisons are to be made. And this post differs
almost as widely from those of its own section as it does
from the others. The period of decline here embraces only
four months, from October to January, and the character of
the monthly decline is uniformly small to the period when
the temperatures begin to rise. The greatest difference of
the successive months is only 3 60, and the actual fluctua-
tion in the means from the highest mean of the dry season,
to the lowest winter ["mean is only 8 31, far less than half
of that of the least of the Florida posts. After the lowest
mean has been attained and the period of reaction begins,
in February, an advance, as uniform and small and gradual
is preserved to the spring season. In fact, the whole series
of the monthly advances and declinations for the year is
characterized by such a degree of uniformity of temperature,
and such small ranges in the monthly fluctuation, as to
render its temperature condition far superior to any other
single station with which we are acquainted. Hence the
portion of the coast represented by this post, is possessed of
much more uniform features than the stations of Florida,
and in the limited decline from the higher summer means

I860.]

Of Climate to the Consumptive, frc.

to those of winter, manifest an additional superiority

them.
2d. The general range of the mean temperatures,

165

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106 Doughty. An' Essay on the Adaptation [March,

mean the two being characterized by greal and unusual
extremes directly opposite in their nature. December of
the same year, gave a mean nearly eighteen degrees lower
than November, although it was but little less than its com-
mon mean. At Fort Barrancas, in December, 1845, the
mean was more than ten degrees below the average, and
yet tlte January mean was above its average. Again, in
1852, the mean of January was 44 16, nine and a half
degrees below the average, whilst that of Fehruary was
above its common mean. In such data as these, which are
only to be had by a period of lengthened observation, the
true character of climate is made to appear, and although
they are to be regarded in the light of occasional phenom-
ena, nevertheless they exert a controlling influence in all
investigations, seeking uniformity and regularity of seasons.
Such investigations are not confined in their practical bene-
fits to medical subjects, but are in no less degree important
and beneficial to the agricultural bearings of the climate.
It recpiired a number of these examinations of the strictly
local features of the State of Florida, to arrive at the con-
clusion that tropical fruits could not be successfully or
profitably cultivated, north of 28 lat. one of the principal
reasons for its impracticability, further north, being the con-
tinental or variable nature of the climate, or in other words,
a want of permanence in the temperature of successive years,
as well as in the parts of the same seasons. The neglected
remains in East Florida of the beautiful orange groves that
formerly flourished there, abundantly attest the variability
of its climate, and the failure of the inhabitants to renew
the attempt at their cultivation, is sufficient evidence of
their want of belief in its stability. For some years, these
groves yielded abundantly, for the repay of the husbandman,
but the cold changes and depressions of temperature occa-
sionally felt here, have caused them one after another to
disappear, and sometimes collectively, so that at the present
time, no particular pains are taken with them. There are
instances on record, where some of the oldest orchards were
blasted in a single season by the severity of the cold, the

18(10.] Of Climate to th< - L87

oldest trees being killed to the roots, and some of which
never spronted again.

Throughoul the extended period under consideration, the
temperature condition ^ this State is liable to the mi
signal fluctuation. And whilst the general range of the
Individual months for the entire year may be stated to be
very great, ye1 thai of the tall and winter months is much
greater than all other* From its commencement in 0<

the range at Fort Marion is observed to be very
more than donble the greatest range of any post of the
Pacific, and from thence to February, it steadily increi
to 2(>c 39. The range of March is 8 \a p than that of

October, although less than that of February. The m<
ores of heat experienced at this post arc those generally
recorded throughout the State, although they are here
possessed of a greater general range. At Fort Barrancas,
on the Gulf coast, the ranges of the two fall months are not
ho extensive as at Fort Marion, but upon the accession of
the winter months, a similar degree of fluctuation is pre-
served to the spring month. Of the three Florida posts,
Fort King gives the shortest ranges for the individual
monthly means, although still great the lowest range he-
ing 4 90 in January, and the greatest 10 59 in February,
The extreme range of the winter mean is also less than the
others that of Fort Marion being 15 44 of Fort BarranZ
cas 9 64, and of Fort King 7 64.

Mr. Blodget, whilst contrasting the range of the winter
means in the extreme northern, southern and western por-
tions of the United States, elicits the fact that the range at
the south, as at Fort Moultrie, (16 7), at Fort Jessup, La.,
(14 8), and at St. Augustine, Fla,, (15 4), is greater than
at Hancock Barracks, in Maine, at Fort Brady, Michigan,
Fort Mackinac, Mich., and Fort Winnebago, Wisconsin
whose maximum winter ranges were respectively, as follows:
7 1 (17 years), 7 2 (31 years), 9 4 (24 years), "and 9 4 (16
years). The greatest winter range at Fort Snelling, in a
period of thirty-five years, was just equal to that of St.
Augustine, and was nearly a decree less than Fort Moultrie.

168 Doughty. An Essay on the Adaptation [March,

It may be of interest to some readers to know the conclu-
sions drawn from these comparisons by the writer referred
to. lie says that " the posts of the western interior are
seen to be exceptional, and to have nearly as great a range
as those of the south, yet it is clear that low temperature
alone, beyond a certain limit, has the effect to diminish the
range of non-periodic oscillation, and to render the climate
more equable. If this outlined result shall be found to be
sustained, it would point to the conclusion that the great
non-periodic variations of temperature are confined to the
temperate latitudes mainly, or are only intruded into the
arctic regions in the summer and in connection with a cer-
tain degree of heat, and certain conditions characteristic of
temperate climates. The most striking range is shown at
Charleston, (Fort Moultrie), and in the absence of support-
ing observations, its accuracy might be doubted, but the
extreme dates, which are 1828 for the high temperatures,
and 1831 for the cold extreme, are also the dates compared at
St. Augustine, Florida, withnearly the same range* At Augusta
Arsenal, Georgia, the same dates give a range of 14 3, and
at Fort Johnston, "N. C, a range of 16 7, or precisely the
same as that observed at Fort Moultrie." Finally, in ref-
erence to the winter data of this State, we may remark that
these are startling facts to those accustomed to regard it as
the most desirable winter climate or residence for the con-
sumptive. And if the contrast was stated in its most posi-
tive manner, that the range of variability of the winter
means at St. Augustine, for twenty years, was as great as
at Fort Snelling, in the extreme north-west, in thirty-five
years, it would scarcely receive credit. Yet so the record
proves it, as absurd as it apparently is. One other circum-
stance we would call attention particularly to before closing
our remarks, namely, the time, that intervened between the
g reat oscillations which determined this excess in range
they occurred within three years of each other thus de-
monstrating the truth of the remark already made by us,
that the existence of a severe or mild season of one year,
affords no clue to the probable character of the succeeding

* The Italics are our own-

18(10.] Of Climate to the Consumptive, $c. 169

one. The risk, therefore, of such precariousness of seasons,
DUght to l)e taken into account in the estimation of a proper
climate for the consumptive. If a change of climate be
necessary, let him repaii to such an one as Is stable ami
permanent in character, and not where he may perhaps he
surrounded with changes similar to those from which he
retreated.

Widely different from this record is that of the Pacific
coast. Indeed, so great is this difference, that we deem it
wholly unnecessary to do more than present a few promi-
nent points. The greatest range of any month at San Diego
is 6 95 in Octoher, and the greatest recorded range of
either of the winter months here is only 5 46. At San
Francisco, three months Octoher, November and March
give a range of 6 00, but the winter months proper give a
limited range less than at San Diego. At Fort Vancouver,
the greatest ranges are recorded, hut they do not approach
those of the Florida stations. In reference to the range of
the winter means, we shall simply give the following quo-
tation: "On the Pacific coast the periods are insufficient to
show what the range of the winter may be, but the greatest
recorded in periods of six years is four degrees. It is undoubt-
edly less than that for any other districts, as, at Key West, years
next succeeding each other frequently give a greater range, and the
greatest in fourteen years is 8 2 degrees."*

Here, then, greater stability and permanence of climate
is manifested than in Florida the ranges of the winter
means, as well as those of the individual months from Oc-
tober to March, being much less. It may be proper to
remark further in regard to these features of the peninsula
of Florida, that the wide ranges here given are not exclu-
sive to the posts selected as proper exponents of its climate,
but that the northern portion, in any part of it, may be
characterized in any series of years by similar extremes.
In other words, this extremely continental character is the
controlling form of its climate, and constitutes no exception
to the general rule of the American climate variability

The italics are our own.

170

Doughty. An Essay on the Adaptation [March.

and changeablenese. The protection of the Pacific coast
from such continental influences by the long and elevated
mountain ranges, and its almost exclusive exposure to the
mild impressions of the Pacific waters, (which, like all other
waters, resist sudden changes of temperature, and are slow
to partake of their nature,) serves to secure to it a sameness
or uniformity of temperature condition, from which but
little departure may be expected in successive years, and but
slight differences in the natural thermometrical status of the
months immediately succeeding each other. It is not free
from non-periodic changes, but the character of such
changes is vastly less objectionable, as far as the present
records extend, than those of the Eastern States. In the
middle latitudes of this coast, near and south for some de-
grees, of San Francisco, so far as the variation of the
monthly means is concerned, there arc two periods of the
year, at which they vary most, the other portions indicating
thus far a comparative exemption from them. The periods
referred to embrace the later fall months, and approaching
and earlier spring temperatures, and the fact, as observed,
we have elsewhere stated to be due to the lost action and,
balance of the sea-temperature at this time.

3rd. The extreme single observations of the individual
months.

October. I November.

Obs. Pos. Obs. P.
Ht. Lt. R.lHt. Lt. R.

Obs. P.
Ht. Lt. R.

January.

Obs. P.
lit. Lt. K

Februa

Obs. P.
Ht. Lt. R.

Obs. P.
Ht. Lt. R.

San Diego, California

San Francisco, "

Fort Vancouver, Oregon

Fort Marion, Florida.. (13 years).
Fort. King, " 5 " .

Fort Barrancas, " 10 " .

ol re I re

on; TO | in

87 471 74

38 36) 71

251 341 53

34| 521 82

23 60 83

29| 511 74

43 69

51 61

59| 84

61 85

561 76

31 49 75

35 44 84

19 42 61

21 63 86

24 61 86

101 66l 78

re re

341 41

30 54

19 42

26 60

11 75

291 49

84 34

80 34

SO 21

88 32

93 27

86! 34

Decidedly the most interesting features of the fall climate
in its relation to the consumptive, is at that period of it,
when the low temperatures begin to intrude upon the
higher ones. This period, as we descend the Atlantic-
coast is postponed later and later, until having reached the
peninsula of Florida, we observe that it does not influence
the means until the month of October perhaps the middle
of the season. The advent of it marks the beginning here

18f;o.] Of Climate to the Consumptive. 171

of those non-periodic oscillations, which stamp its climate
with uncertainty and irregularity. A.s an evidence of the
irregularity produced by these non-periodic visitations, the
date of tin1 first appearance of frosl is so uncertain, that at
Fort Marion, in L849, it was not noted, until December 6th,
in 1852, in December L8th, and in [853, in December 30th;
whilst in the above table, the lowest extreme in thirteen

years in October, approached that point very closely, and
in November, the temperature was reduced within two de-
grees of the freezing point. In the latter, during thirteen
years, temperatures below 40 were recorded six times.
Looking still further at Forts King and Barrancas, we ob-
serve that the freezing point was attained at the first in
October, and at the second, it was low enough to produce
a killing frost. November, at these posts, gave still farther
reductions, so much so that iee was probably made the
extreme being four and three degrees respeetively below the
freezing point. The low temperature of 31 was noted
only onee in five years at Fort King, but, although isolated,
it is a significant occurrence when regarded in connection
with its southern latitude. November, however, gave in the
same length of time, temperatures below 35 every season.
Fort Barrancas gave the low extreme of 36 only once in
five years, but in a period of seven years, November in five
of them, gave figures below 36. So that whilst frost may
not be expected every season in October, yet it is not at all
unusual in some parts of the State, and in November, it
forms properly the rule of the climate. At some periods,
even ice may not be unreasonably looked for in October,
and that too in some of its central latitudes. It is said that
" in five years of a period of twelve the formation of ice
occurred so generally as to destroy vegetation liable to be
so cut off, before the close of October in the States border-
ing the Gulf, and it may be safe to assume that in the half
of any period of years this will occur at all points north of the
30th parallel"* In regard to the liability to frost and ice in

*The italics are our own.

172 Doughty. An Essay on the Adaptation [March,

November, the same author continues : " There are no ex-
ceptions to the liability in alternate years, at least for any
point except the south of Florida, from Fort Brooke to Key
West, and at the mouths of the Rio Grande and the Colo-
rado of California."*

On the Pacific, frost and ice make their appearance in the
northern portion in October, and at points remote from the
coast in September, 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." The
lowest recorded temperatures at both of these places, as
given in the above table, in October, are not low enough to
produce a deposit of frost under the most favorable circum-
stances. This, however, cannot be stated as the invariable
or absolute rule, for Mr. Blodget gives on page 291, of
his work, the 14th of October at San Diego, as the earliest
date of its appearance, and the 27th of October, as the
earliest at San Francisco ; although in searching the record
we have been unable to find temperatures low enough to
produce it. So far as its earlier or later appearance at the
two sections is concerned, it is later on the southern part of
the Pacific coast than in Florida as a general rule. Hence
the degree of cold usually experienced at the latter, in Oc-
tober, is greater than at the former. The opposite extreme
of these two months equals in excess the one just remarked
upon, and though non-periodic in their occurrence, are of
no less significance. And if the two greatest extremes here
given for these months, should occur in the same month,
which is by no means impossible, the system would find
itself subjected to high summer temperatures coincidently
with the low winter ones. The greatest extremes on either
hand are recorded at the middle post, which in five years
gives the extraordinary range of 68 the temperatures
ranging from the freezing point to blood heat in October,
and in November within ten degrees of the last. The pos-
sible range of these months at all of the Florida posts ex-
ceeds those of the Pacific stations.

See Blodget's Climate, Ac, page 290.

I860.] Of Climate to the ( bnsumptwe, $c. 173

But the lowest extremes of cold, as continued from the

later fall temperatures to those of the winter months,

ume still greater severity. Id December at Fort Marion,

the lowest is 23 that of January, Btill lower, 21, and that
of February but little advanced to 26. December in six,
out of thirteen years' observations, gave temperature!
low and lower than 32, and four times below 80. So that
nearly one-half of a series of years would give low extremes,
ranging from 28 to 32. In January, at the same place,
in the same length of time, there were ten years that gave
observations below 40, and six of them were at aud below
30. February also showed, in a similar period, nine years
below 40 seven of which were even below 36. In March
also in seven of twelve years' observation, the lowest ex-
tremes ranged from 32 to 40. At Fort King, in Decem-
ber, during five years' observations, all of the lowest
extremes were at or below 36, and two of them gave 27.
In January, at this post, four out of live years indicated
extremes extending from 24 to 30 ; and in February, three
of the five, gave them varying from 11 to 27. In March,
also, four years gave a range from 27 to 38. At the other
post, in December, in seven years, they extended in five of
them from 18 to 28, and the highest recorded in that time
was 37. Throughout a period of ten years at this post,
in January, the lowest extremes were at or below 34, and
two of them gave the extraordinary record of 10 and 18.
In February, for ten years, they were below 34. In March,
also, extremes of seven out of nine years were still below
40. The opposite extreme during these various periods of
observation, were above 80 at all of them, throughout the
season, except at Fort Barrancas in the three winter months.
The resulting ranges for the winter months were at Fort
Marion from 59 to 63; at Fort King from 61 to 75; and
at Fort Barrancas from 49 to 66. The range of March,
also, at all of them, was about the same as those of the
other months.

Of the winter months, at the two southern posts of the

174 Doughty. An Essay on the Adaptation [March,

Pacific it will be observed, that in December the lowest
extremes are above those of Florida, and also that the
highest are many degrees below the latter, so that its ranges

are reduced thirteen degrees and more, under those of the
latter. January and February also show still higher figures
for the lowest extreme, and together with the highest,
produce monthly ranges twenty-two and thirty-live degrees
less than those of the same months in Florida. March also
reveals the same general relation. It thesf follows from
the comparison, that both the higher and lower* extremes of
temperature are more excessive in the State of Florida,
than at this portion of the Pacific, and also that its fluctua-
ting capacity is much greater. Moreover, the frequency
with which these low extremes are met with in this State,
is far greater than the present record in the south of Cali-
fornia will admit for it.

It is impossible to give a thorough representation, or to
convey a perfect idea of the true character of the non- .
periodic changes which are common to the climate of
Florida, by means of statistical tables like the above. These
are so sensible in their appearance, and so palpably uncom:
fortable and disagreeable to the senses, as to force their
observation upon those, who are in no wise, directly inter-
ested in their discussion. Hence in addition to the statis-
tical data, accumulated by scientific investigations, which
in some respects are deficient, we have the writings of more
disinterested observers. And there is no reason that they
should be excluded fron\ notice in this comparison, since
they alone can furnish the full severity of those vicissitudes
alluded to. In the various meteorological registers, we have
the temperatures given at particular hours of the day, which
can enable us inferentially only to arrive at the lowest
attained degrees, and where sudden changes occur give no
correct account of the exact period at which they occurred,
or of their rapidity. These latter are furnished by amateur
observers particularly, because it is their apparent charac-
ter, which renders them particularly noticeable in their
minds. We may then be indulged in the presentation of

18G0.] Of CttmaU toth Consumptive, 17.r>

the following Incidental foots, which have a direcl bearing
upon this climate- particularly the extremes of temperature.
<< It is evident," says one, "thai the coasl of Florida ha
much milder climate than the interior; for Port King,
which is more than half a degree Bouth of St. Augustine,
has nevertheless a much moresevere clii . iwill be still
fcrther shown. In February, L841, the fi i\ was so severe
on Pease Creek, in lat. 28, for several nights in succession,
thick ice was formed, and the horses' hoofs clattered
pn the frozen ground, as loudly as at the north in the severe
cold of November. NTo observations were made with the
thermometer. This frost must have extended several miles
lower, or at least to lat. 27c, as it is seen that on the western
coast, (in a milder climate) at Sarrasota, (lat. 27 20'), the
thermometer was down to 30." Further on, he continues,
"it appears, then, that the winter climate of the coast on
the Gulf is more severe than that of the Atlantic coast, and
that of the interior is more severe than either. The eastern
coast is warmer in winter than the interior, in consequence,
.do doubt, of the Gulf Stream passing northward through
the Straits of Florida. But whatever the cause, it is cer-
tain that the cold of the interior is much more severe than
on the coast, and that the winter weather is colder on the
western than the eastern side of the peninsula. Scarcely a
year passes at Tampa Bay without ice, and the bodies of
Ihe orange trees are all seared from the effects of the cold
winds." (DeBows Review, page 342.)

Again, the writer (Dr. Kitchen) in the Nashville Journal
of Medicine and Surger}- , to whom we have already referred,
spent the greater portion of the wunter of 1855-6, at Mid-
dleburgh in the interior. " The site of the town is a sand
hill, and immense pine forests surround it, Which serve to
shield it from severe winds." The hours of observation
were " 7 A. M., at 1 P. M., and soon after sun-set." " The
thermometer was under cover, but exposed to the North,
East and West winds. The temperature of St. Augustine
was noted down for me by a friend, at the same hours and
under the same circumstances." " The following is a con-

176 Doughty. An Essay on the Adaptation [March,

densed statement" of his "observations for the winter."
December was mild and pleasant, as was the case " almost
throughout the 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 and severe
change of temperature, amounting to twenty degrees in one
hour." "The extremes for the month at 7 A. M., were 30
and 71, and at 1 P. M., they were 57 and 87." January,
1856, was characterized by frequent and violent changes,
and by blustering winds ; in fact, there was much weather
that would be called extremely disagreeable in any country.
The thermometer indicated a condition of the atmosphere
below the freezing point on nine different mornings, and
ice two inches in thickness was formed." "The extremes
of temperature at 7 A. M., were 20 and 68, though on one
occasion the mercury was seen at 16, in a thermometer
which hung in a more exposed situation than mine. At 1
P. M. the extremes were 38 and 80." There were also
nine days on which a heavy fall of rain occurred. "Feb-
ruary was more pleasant than January." There was ice on
two mornings; but "four rainy days" only. "The ex-
tremes at 7 A. M., were 22 and 63, and at 1 P. M., 40 and
80. "March was distinguished for copious rains, dark
clouds and high winds. Only eight really pleasant days
were seen within four weeks, and it has never fallen to my
lot to see heavier rains than fell on six different days. Some
frost occurred as late as the 28th of the month." At St.
Augustine the temperature was about the same as at Mid-
dleburgh. The December extremes were 32 and 84
those of January were 22 and 76, and those of February
23 and 82. "At both places the mean temperature of the
coldest winter day was 34." He next particularizes the
daily changes observed, which have been furnished in
another part of this essay. In eleven of ninety-two consec-
utive days, the changes of temperature in the morning,
amounted to "from twenty to thirty degrees." "On one
occasion, the mercury fell forty -six degrees " in twelve hours,
and "on another thirty-eight degrees in the same length of

1m>0.] Qf Qimatb to ik Consumptive, c. 1 . 7

time." We would observe, just here, thai perhaps one of
the strongesl comments and severesl criticisms, thai could
be made upon the winter climate of Florida, is the conclu-
sion arrived a1 by Dr. Kitchen. " The winter," he writes,

--was excessively cold, yel it was uniformly sp, and the atn
phere for a long time was without humidity, in fact, just
sue}, a climate as Dr. Drake, in his great work, recommends*
Fort Smiling being suggested by him asa suitable location."
Here then was the singular anomaly of an invalid seeking a
uniiorm and equable warm winter residence, but finding in
its stead, a climate as rigorous and severe as thai of the far
north-west.

Enough has perhaps been said upon this point to enable
pur readers to apprehend correctly the varying winter cli-
mate of this State, but we desire to offer an additional
survey of the great winter extremes of temperature, as
given in Mr. Blodget's work, commencing at page 144.
" In February, 1835, nearly the whole area of the eastern
United States was swept by a simultaneous refrigeration,
reducing the temperature on an average fifty degrees below
the mean for that month in Maine nearly Gb ; in New
York 556 to 60 ; at Washington 53 ; at Augusta, Georgia,
62 ; in Northern Florida, 65, and at Key West, 22."
Also, "at the 30th parallel these great oscillations may
reduce the temperature to a point only 10 above zero in any
winter-month, and reduce the mean by at least 12." In the year
1800, " Snow and hail fell the whole day on January 10th,
at St. Mary's River, Florida, and on the 11th, the snow was
five inches deep. The lowest temperatures were 10th, 37 ;
11th, 28 ; 12th, 34 ; In the winter of 1830-31, the means
of January and February, at Tampa Bay were reduced 5,
and at the close of 1831, a second depression occurred, which
reduced the mean of December at St. Augustine, 5 below
its average. February, 1835, gave a single extreme of 11
at Fort King, and reduced its mean 5 4. It was during
this month of this year, that " a large inland area of the
north of Florida was also helowr zero, its limits being about

*The italics are our own.

12

178 Doughtit. An Essay on tnk Adaptati [March,

the 29th parallel." For four days, 7th to the 10th,
sively low temperatures were experienced near Jacksonville,
the temperature at 2 P. M., of the 9th, being* 36, and at 7
A. M., of the 8th, w,as at 8. "Ev 3 shed their

om this frost, and began to show new leaves again
on the 20th March following. The orange trees were split
to the roots, and of course were killed root and all."

tin, in 1843, the lowest of January at Fort King- was 23 ;
of February 18, and at Fort Brook, it retreated to 38 in
March, reducing its mean 5 below its average. These

erne temperatures were i iced again here in 1845-

46. In December the lowest observation at Tampa Bay was
34, audits mean was reduced 6 ; and at St. Augustine, the
lowest was 23, and ithad its mean reduced 7 ; and at I\
cola, it was 21, with a reduction of 102, in the mean.
In the winter of 1851-52, in the Central and Southern States
January was 6 to 10 below the average, with severe effects
on the sub-tropical vegetation." The lowest observation at
Pensacola was 10, and at Key A\rest 49 the mean of the
month at the first was 95 belowT the average, and at the
latter o0-). On the 13th January, snow fell at Jacksonville,
Florida, through the entire day. "In 1854 a similar
instance of severe cold occurred, which was more general
however, occurring on the interior and Pacific coast, and
also in England. At Fort Sneliing and the north*
the thermometer fell below the freezing point of mer-
cury," and at Fort Ripley, " the mercury receded entirely
into the bulb of the thermometer, and fifty grains placed in
a charcoal cup were completely frozen." This was the year
which furnished the lowest depressions of temperature recor-
ded for most of the Pacific posts in the winter season. At
San Francisco, the lowest measure was 27, and at San
Diego,, 31Q. At Fort Barrancas, in Florida, the lowest of
this year was 27 in December, and those of January and
February were 30 and 32 respectively. At San Fran-
cisco the extreme data were recorded one month later than
in this State, in January ; the lowest measures of December
and February, were 38. This is the only instance, that

180:).] Of

specifying the Low measures of
Pacific, and whilst il show.-; \ ery unequivocally its liability
non-periodic changes, yet, although so general as
alter the temperature condition <A' the climate of
'|and, taking- the whole season into view, it was nol so
i posts of Florida mentioned. Moreover at
t Brooke, Tani] , the minimum tempe-

rature oi' December was less than at San Francisco in the
month.

ther on this subject, we find in the Patent Office
>orts for 1857, a summary of tfte meteorological condi-
tions of San Francisco and St. Augustine, which we may
Lpare with profit. This is oi' special interest because it
prolongs the period of observation at the Pacific post,
>nd that embraced by the different tables, and moreover
rds an insight into the concurrent refrigeration at both
places.' The lowest extreme at San Francisco, in January
was 36, and the range of the thermometer for the month
30 : at St. Augustine, the lowest was 19, and the range
. In February, the lowest was 38Q, at the first, and
. at the second the range however was greater at the
. In March, the lowest at St. Augustine was 41Q, and
at San Francisco, 47 the ranges were as 38Q to 28.
The lowest of April was also one degree less than at the
Pacific station, and the same is true of October. The
est of Xovember at San Francisco was 46, and at St.
Augustine 39 ; the ranges were as 24 g to 44^. December

Ian Francisco however was below the other.
. Finally, the following statement of the daily ranges of
the thermometer, and some of the more prominent features
fof the months of this period, at San Francisco, and War-
rington, Florida, is of additional importance in this con-
nexion.

War - -Monthly Range, StP Mean

Daily Range, 11^.7 Highea Daily Range, 2U. (There we 7 d tys, with a range of 15" and
over.)

Sua Francisco, Cal , in November, 1-57 & 1858. Lowest Extreme, 4(3 'Monthly Range 263
'.[ i , 1 >aih - High >t Daily Range, 18*. (.'. .5 days per month, for the

2 years, gave a daily range of 15 3 and over.)

f The data from which they are calculated, may be found in the Patent Office
Reports for 1857 and 18

180 Duouhty. An Essay on the Adaptation [March,

Warrington, December, 1857. Lowest Extreme, 41, Monthly Range, 33a Mean Daily
Range, 15e4 Highest Daily Range. 26J, (8 days.) (Thercwsre 10 days with a range of 20 and
over, the most of winch changes took place in 7 hours.)

San Francisco, December, I >' & 185"8. Lowest Extreme, 30- -Monthly Range, 29c
Mean Daih Range 7*.5 Highest Daily Range, 15. (1 day.) (7 days, per month, gave a daily
range, amounting to 10?.)

Warrington, January, L857.-Low< Monthly Range, Daily

Range, 13 J.8 E ' h< ; I aih Range, 85. (I day \p sev< a houn meter at and below

32 on 9 observations 5 days gave a r 20, ,3 of th< m in 7 hours.)

Ban Francisco, January, 1057 & 1858. Lowest Extreme, 36p Monthly Range, 30 'Mean
Daily Range, 7"*.3 Highest Daily Range, ]A-(i day.) (8 days, per month, gave arange (daily,)
of 10J and over.)

Warrington, February, 1857. Lowi ie, 36' Monthly Range, 89 a Mean Daily

Range, ! .0~- Highest Da ly Range, -27J. (1 day.) (On 11th, there was a difference of 27, in four-
t( en hours.)

(San Francisco February, 1857 &, ] a Monthly Range, 88 Mean

Da 'y Range, i.6~- Highca' Daily Range, 21Q. (t day.) (17 days in February 185', gave a
range of 10- and upwards 8 days only in 1859.")

Warrington, March, 1857. Lowest Extreme, 4H- Mon:', 39a -Mean Daily

Range, 9 .2 -High st Daily Range. 2LJ. (9 days with a rang* . upwards.)

San Francisco, March 1 57 & lw58. Low 12 -Monthly . -Mean

Daily Range, 10o.5 -High r Daily Range, 20. (2 days.) (An average of 9 days, per month,
with a daily range of 12s . upwards.)

The mean daily range for the live months is at Warrington, 11-. 7, and st San Frj
8a.7.

It thus appears that the Lowest extreme of every indi-
vidual month of the period, except December, at
this Florida village, for this year, was below by many
degrees that at this "Western city, in twice the length of
time. Moreover the monthly ranges of the thermometer
were far greater, as well as the mean daily ranges. And
as to the incidental occurrences given in the above, we still
observe that they were greatly more severe and extreme in
Florida. The record here given of Warrington in Florida,
may perhaps be assumed as that characteristic of the
greater part of its Northern section, not excepting even the
Atlantic coast, and this assumption is supported by the
irregular, continental features already brought to light. A
portion of the warm season, June, July, and August, per-
haps, are the months which so far as we are able to judge,
give the least daily range in Florida, and this arises partly,
if not chiefly, from the precipitation which occurs at this
time, the fall of rain, as is well known, by the giving
out of sensible heat, exerting an influence towards the
mitigating of extremes. We speak reservedly on this
point because the limited inspection of the daily temperature
phenomena in this State, prevents a positive expression of
opinion. On the Pacific coast however, as shown by San
Francisco, the daily range throughout the year may be
stated at about ten degrees, and is subject to material varia-
tion at two periods only at the time, embraced in the

18G0.] Of Gimate to the Consumptive^ L81

substitution of the Beasons, There are reasons, which
present themselves to the mind, why certain parts of the
Pacific coast have a less daily range, than the peninsula of
Florida. They at'*' found in the circumstances, proper to
itself and derived from the sea, already alluded to and
discussed, which conspire to produce a uniformity of tem-
perature condition.

Winds and Weather. Equally irregular with the tempe-
rature o\' the peninsula of Florida, is its course and method
of circulation of the atmosplfcere, upon which latter,
the former is to a greater or less extent dependent.
The Rame general causes, due in most cases to the surround-
ing topography of land and sea, which operate to produce
an extreme variability and extensive fluctuation ofitsther-
mometrical status, are at work also to render uncertain,
both as to force and frequency, the character of its winds.
We have already seen, that it is possessed of no general
atmospherical circulation, similar to that which is found
upon the western coast of the continent; but that, occu-
pying as it does, what has been termed the transition belt
between a tropical and a temperate clime, it derives its
chief el histological characters from local circumstances,
which vary in themselves at different seasons of the year.
Thus, in the summer season, the temperature of the atmos-
phere over the laud is elevated much above that of the
neighboring waters, and consequently the circulation of the
air is toward the land, and surpasses in strength and con-
tinuance the ordinary sea-breezes of sea-shore localities.
But in the winter or period of low temperatures, in the
absence of this great distemperature, this continuous ten-
dency toward the land is subverted, by a " natural rever-
sion" towards the warmer waters of the Gulf of Mexico
particularly. This natural reversion cannot be taken in an
absolute sense, because we know that it holds a direct
relationship to the temperature of the winter both of the
State, as well as of the continent. If the season throughout
the United States, be characterized b}^ a general refrigera-
tion in which this State participates, the preponderance of

182 Doughty. An Essay on the Adaptation [March,

land winds will be strictly maintained during its contin-i
imnce, and hence but little benefit will be derived by its
proximity to the warmer southern waters. But if the
winter season lie mild and warm, the sea-winds obtain a

The Mime wh son may be

characterized in the months which compose it. by both of
these conditions, tor as the various months are warm or

L, so will the manner of circulation of the air con'
to it the sea-winds in the warmer ones, and the continental
in the colder. Like the temperature, the circulation differs]
somewhat upon the two coasts the eastern, having

iter prevalence of easterly winds than the western, but
loth are subject in like proportion to northern and north-
ern winds. Nevertheless western winds of some
strength are not imfrequent upon the eastern sh

At Fort Marion, as the higher fall temperatures decline,
the frequency of the south-cast winds is reduced in favor
of those from the north-east to north-west ; the latter,
having their greater prevalence in those years, in which the
low -temperatures .set in early. Of the single winds, we
believe that the north-east are most frequent, and have
sometimes a very great relative force. In October, during
four years' observation, the north-east, east, and north-*
v, est were most frequently recorded, and November pre-
sented but little difference the principal, being in an
increased number of winds, dwe west and north. In the
warmer days of these months, the southern winds were
recorded. In December, in the same length of time, the
north-east and north-west were the predominant o-
but they also had a similar proportion from the west,
south-west, anel north, in the two preceding. In January,
north-east and north-west were still ascendant, but
also a greater frequency of the west wi
During February, of four years, the predominant i
varied amongst those from the north, north-east, ^

north-west although during this time, the south-west
and south winds were often recorded. March gave a similar
record with February the north, north-east, west, and

aorth-wesl win ' oftene rved. Neverthel

the soutlierii winds were increased over the winter months.
iiiuation of the monthly records of the winds,
both here and at all other par ninsula, clei

prove the uncerl I their prevalence. No calculation,

. can be made as to the probable
it of the
em . for the whole period ipied in a

sral conflict of the continental or northern, and the
anic or southen ices, in which each at irregular

rains a temporal
y independent of the peninsula Ltse

mbraced within the limi
the mon to the north temp, r

s a more uniform circulation. The south and >
winds in I'.- ate, preserve a constant ascend...

over the north and east, and the severity of the latter,
experienced in Florida by the sudden and extremi
tions of the temperature, is counteracted 1;.

, .warm influence of the Pacific. To the southern
it tins is i. ticularly applicable, for thepro-

ing and counteracting agents are more active here. I
in the vicinity of Fort Vancouver, or on the coast of '
. The situation of Fort Vancouver, in the impel
valley of the "Williamette River, seen res to it irregular"
both of temperature condition and atmospherical ci
lation, similar to those noticed in Florida. But at
hern part of the Californian coast, greater regularity
dns, and the ter of the winds in general are tl

which, in a sanative point of view, are most desirable. The
northwest wind, which is found to blow frequently here
in the winter, is of a totally different character from the
Le wind in Florida; at the latter, it is cold and dry, a
teral rule, whilst, at the former, coming as it does, over
a water surface of higher temperature than the land, it
must bring warmth and moisture. The north-east winds
also differ at the two pla

184

Doughty. An Essay on the Adaptation [March,

\

Of the weather the following* is a summary for the winter
months:

December.

Days.
| Fair, Cl'v. Rn'v.

January.

do.

Fair, Cl'y. K'ny.

February.
do.
Fair Cl'y. Rn'y.

>:<>go, Cal.

19.8

li.2

74

21

10.

3 2

IT 11.2 ;

7.6

" Francisco, "

16. 4

14.6

11.3

16

15

95

15

13 '

9.5

Fort Marion, Fla., (4 y.-s)

18.6

12.5

7.2

19 5

11.-)

5.5

174

10.* 1

5.4

" King, " (5 " )

20.8

7.4

2.8

20.3

5.9

4.8

20.4

8.0 :

4.4

" Barrancas, "(3 to 4 ")| 16.2

| 15.

7.5

16.5

14.5

9.5

12.5 |

6.0

The respective means are as follows :

Fair Days

San Diego
" Francisco
Fort Marion

" King

" Barrancas

19.26 -Cloudy

10.8 -Rainy

6.06.

15.' 6

14.2

10.1

1.46

11.6

6.03

20.5

5.43

4.0

16.13 "

14.0

7.66

We have already shown the varying degree to which the
wet season, as evidenced in the amount of precipitation, of
the Pacific coast is established in its different latitudes.
The farther north we proceed, during this season, it is
found to increase so rapidly, that at San Francisco the
measurement is nearly double that at San Diego, and at
Fort Orford on the coast of Oregon, it is four times that
at San Diego. As a consequence, the relative number of
fair, cloudy, and rainy days, must correspondingly differ.
Between the divisions of the weather at these higher latitudes,
and those of the State of Florida, no comparison need be
made, for the direct relationship at the former, between the
frequency and the duration of the precipitation, determines
such a large proportion of cloudy and rainy days, and so
reduced a proportion of fair days, as to render them incom-
parable. Farther south, however, we find a much greater
resemblance and less contrast between the two sections of
the continent. San Francisco gives a higher proportion of
cloudy and rainy days for each individual month, than
either of the posts of Florida ; although a general predom-
inance of fair days is preserved. An average of one-
third of the months is occupied here in rainy days, and
nearly one-half in cloudy; whilst, on the western side of
the peninsula of Florida, which indicates the highest pro-
portion, the average per month, of rainy days is only 7.66.
Nevertheless the average number of fair and cloudy days
differ but little from the proportion here recorded. At.

1800.] QfCtimaU to the Consumptive, ,v. 185

Fori King, as compared with San Francisco, there are a
much greater number of fair; and less than half the num-
ber of cloudy and rainy days.

The proportion of lair days at San Diego, very nearlj
equals those of this central southern post, bul still hastwice
its number of cloudy and one-third more of rainy days.
The record at San Diego, is however superior to both of
the other stations of Florida : as compared with Fort Bar-
rancas, it has a Larger proportion of fair days, and a smaller
number of cloudy : and the ratio of rainy days just equals
those of Fort Marion. At this part of the western coast,
the general preponderance of fair weather is as marked as
in the greater part o{' Florida, and in many respects the
record is very similar.

As tending to a more correct apprehension of the state of
the weather during the period from October to March, we
present the following facts, taken from the meteorological
reports for 1857 and 1858 for Warrington, Florida, and San
Francisco." The record is made up of daily observations at
7. 2, and 9 o'clock, which were designed to show the rela-
tive state of the weather, as to the amount of cloudiness.
It embraces one year at Warrington, and two years at San
Francisco. At Warrington, in October, there were four
cloudy days (entire cloudiness,) twenty-one fair, five partly
cloudy and fair, and one cloudy and rainy. At San Fran-
>, the means of the two years, were, 11.5 fair 3 cloudy
14.5 cloudy and fair 0.5 cloudy and rainy, and 0.5 rainy.

At Warrington, in November, there were, 16 fair 6
cloudy 6 cloudy and fair and 2 cloudy and rainy. At
San Francisco, the means were 11.5 fair 6 cloudy 9
cloudy and fair 2 cloudy and rainy, and 0.5 rainy.

At Warrington, in December, there were 14 fair 8
cloudy 6 cloudy and fair 1 cloudy and rainy 1 fair and
rainy. At San Francisco, the means were, 10.5 fair 4.5
cloudy 13 cloudy and fair 0.5 cloudy and rainy, and 1.5
rainy.

At Warrington, in January, there were, 14 fair 7 cloudy

* See Patent Office Reports for 18o7 & 1858.

186 .Doughty. An Essay on the Adaptation [March,

and 10 cloudy and fair. At San Francisco, the means were,
Hows: 12 fair 5 cloudy 7..") cloudy and fair 2
cloudy and rainy 2 rainy, and rainy and fair.

At Warrington, in February, there were, 7 fair 3
cloudy 18 cloudy and fair. At San Francisco, the means
. 10.5 fair 1.5 cloudy 8.5 cloudy and fair 3.5 cloudy
and rain}' 3.5 rainy, and 0.5 rainy and fair.

At Warrington, in March, there were, 13 fair 2 cloudj*
10 cloudy and fair 5 cloudy and and 1 rainy. At

San Francisco, the means were, 9.5 fair 2 cloudy 17.5
cloudy and fair, and 1.5 cloudy and rainy.

This series, though comprising the record of so short a
period as one and two years respectively, is nevertheless of
great value, and aids materially in the endeavor to elucidate
the probable daily condition of the weather of the two
places. It will be perceived, that whilst the two fall mo
at the Florida station, have a larger number of days that
are entirely fair ; yet the proportions of cloudy, cloudy and
rainy, and rainy days are about th . At San F

cisco, the largest number of days in these two month
well as in the winter months, are recorded as cloudy and
fair, or such days as are clear and free from cloudiness
one or other of the hours of observations, and have a
tain amount of cloudiness at the others. Thus the n
observation at 7 A. M., may be with a clouded sky, and
remaining, at 2P.M. and 9 P. M"., be fair and unclouded.
In December, the post ol Florida still has a greater num-
ber of fair days but also has twice the number
of unbroken cloudi nCiy and fair d<:

San Francisco are twice as great as at "Warrington, bul
ratio of cloudy and rainy, and rainy d >ut the s:

In the month of January. Warrington has two moi
fair; two more of cloudy, and a L; number ol

and fair days, than San Francisco : but it has no record of
rainy days at all. In February, we find the fair days in
Florida reduced below those at the post the cloudi

greater, and the cloudy and fair more than twice as great :
usual proportion of the latter has been replaced by a

).] Of i limate to tl<> i

ater number of cloudy and rain} da; . and oi

those upon which there was a fall of rain a1 som< period of
the day, the remainder being fair.

This examination, among other things, affords an insighl
into the character of the wel season a1 this part of the
Pacific coast. We are apt to associate the idea conveyed
by the term, wet season, with a state of continuous ra
tor lengthy periods clay and after day. But the dailj

rd which we have before us proves differently, fordu
the two years' observations of the wel arcely a

rainy season, embracing more than two days occurs, and
heiu-e a large part of the precipitation which takes place at
this time, must fall in those days which Ave have termed
cloudy ami rainy. Between this series of daily statist]
and the records already given of the proportion of rainy
day- to each month of the wet season on this coast, there
appears some discrepancy. Such ho - not really the

. for the proportion of rainy days in the monthly com-
putation embraces all upon which a fall of rain occurs.

ter whether it occupied only a part or the entire day.
In conclusion, we think that we e ied in assuming

for the southern part of the Pacific coast an equal deg
of general fairness of weather with tl e of Florida

during the period of low temperature the idea to be con-
veyed by the term general fairness, relating simply to the
amount of out-door exercise to be had.

Bain in Inches. The mean fall of rain is Marion,

for the autumn. 9.56 inches, and for the that

of the entire year is 31.80 inches. At Fort Barrancas, the
mean of autumn is 18.71 inches, and of winter, 11.72
inches : that of the entire year, 56.98 inches. We have no
record of the precipitation at Fort King, or at any of the
interior places of the northern section; but, upon exam-
ining the autumnal hyetal chart in the Arm}- Meteorolo-
gical Register, we find the entire gulf coast, and at 1
three-fourths of the entire Northern division, represented
by a measure of twelve inches at this season. The only
portion of the State, that is not included within the dark

188 Doughty. An Essay on the Adaptation [March,

shading, is a narrow strip extending from the Georgia line,
southward along the Atlantic coast to Fort Pierce. The
measurement of this portion is ten inches, and Fort King
is embraced within its limits. In the winter season, the
middle and eastern parts of this section still have an
amount of twelve inches ;' whilst its more southern part,
together with all of the central latitudes of the peninsula,
have it reduced to eight degrees. At the extreme southern
point of the State, the measurements of this season, are
only half as great as those of its northern latitudes, and
two-thirds the middle ones.

On the Pacific coast, at San Diego, the mean fall of
autumn is 1.24 inches ; of winter, 5.90 : the mean annual
quantity is 10.40 inches. At San Francisco, the fall mean
is 3.37 inches, and the winter mean 11.38 inches : that of
the year is 23.59 inches. At Monterey, an intermediate
post, the autumnal mean is 1.65 inches the winter mean
5.9 inches, and that of the year is 12.20 inches. At posts,
Del Chino and Jurupa, between Monterey and San Diego,
the summary is, the fall mean 1.67 the winter mean 7.42,
and the annual mean 13.77 inches.

From this statement it is evident, that the whole northern
area of Florida, except a small part adjoining the Atlantic
ocean, although enjoying at this season the least precipi-
tation for the year, still has measurements larger than that
part of the Pacific, embraced between San Diego and San
Francisco. And this fact shows the precise signification of
the term " dry. winter," that has been applied to it: it must
have a strictly comparative meaning, and be used only in
contradistinction to the larger precipitations of the summer
and early fall. According to our present calculation, we
are justified in assuming that, notwithstanding the existence
of the wet season at this reserved part of the western
coast, yet its ecpiivalent in the amount precipitated, is
scarcely equal to the normal general measurements of the
dry, northern part of the State of Florida.

As to the more intimate characters of this precipitation at
the latter place, we cannot do better, than present to our

I860.] Of ( Umate to th ( 'onsumptm , ,\ c. 1 89

readers the following quotations from Mr. Blpdget. Be
says: "The autumnal distribution of rain in Florida is
more difficult of explanation than thai for any other dis-
trict, from its great irregularity,* and from the inadequacy
of the periods of time during which the observations b
been made, to reduce the prominence oi the differences
arising from this irregularity, and to establish any definite
rule of the relations of the several months." Again,
from these results it is evident thai a comparatively dry
season succeeds the profuse rains oi' Augusl andSeptember
in Florida, and the portion of the Atlantic States bordering
it, and also that this dry season does not extend westward
beyond Pensaeola."-f "By reference to the general tables it
will be seen that there is a marked tendency toward the
development of a winter dry season, even in the States next
to Florida,and that in Southern Florida this is quite decided
and almost as fully developed as in the recognized tropical
climates. As before remarked, however, there are great
irregularities, and often quite contradictory results for
single years.' " The winter dry season here referred to for
tropical Florida, cannot be taken in that absolute sense,
given to the dry season of the Pacific slope, which is "the
close of vegetation for most of this region because of its
aridity," but only in contrast to those heavy precipitations,
which occur at this time in the lower part of the Mississippi
Valley. " Comparing Baton Rouge, as the central point of
this district of profuse winter rains, with the posts of
Southern Florida, the contrast is at once apparent," He
continues : " The first approach of this dry season in Florida
is made in October, and from the minimum, which
appears to occur in November, there is a partial resumption
of the rams apparent in mid-winter, to he followed by other
months of less rain. But as a whole, the winter, from
October forward, is a dry season on the peninsula of Florida,
and to some extent on the South Atlantic coast." " The
irregularities in this succession of the months are not sufh*-

* The Italics are our own.
x The Italics are his.

'

190 Doughty. An I n the Adaptation [Man

cient to change the character of this district as one of con-
stant precipitation, however, nor is it rigidly any the
identified with that of equally distributed rains in the
general sense in which the term is used. But in Florida a
different designation applies, though we are yet unable to
say precisely what that designation should be. It appears
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 cither may be interrupted by ex
char'' r than th rring in any other kn

district"* Yet again, he remarks in relation to these
" winter rains and their partial periodicity," as presented
by the contrast of Florida and lower Texas. " It is diffi-
cult to account for these features satisfactorily upon any
received principles of winter distribution of atmospheric
humidity, unless we suppose these extreme southern points
to be more nearly assimilated to tropical districts in regard
to rain than they are in temperature. In truth, they 11
the neutral latitudes, which afford the anomalies of Africa
and Asia, and which appear to be controlled, by the configuration
of the districts, and by accidental or anomalous atmospheric
movements resulting from peculiar relations of the sea and
areas ."f

The concluding point of the comparison that of their re-
lative humidity of atmosphere will next engage our atten-
tion. We . have in an early part of this article, stated that
the positive hygrometrical condition of the atmosphere of the
State of Florida could not be given by us, the sum of our
information in regard to it being entirely confined to such in-
cidental facts and circumstances as are found in scattered
fragments throughout the promiscuous writings of others.
Some of these incidental allusions have already been given,
sufficient perhaps, in some cases, to convey a good general
idea of the probable degree of dampness incident to some of
its seasons. Thus, we have alluded to its humidity as com-
pared at all times with more northern regions ; the heavy

* The Italics are our own.
t These are ours-

I860.] Of Climate to the Consumptive, $c. 191

dews of winter ; the extreme difficulty experienced in pre-
venting the oxidizing of surgical instruments; the moulding
of books; the rusting of keys "in one's pockets" in the sum-
mer ; and the luxuriance of such vegetable fungi as find their
habitat in localities of moist situation. Besides, we have
spoken of the prevalence of the paroxysmal fevers as indicative
of its dew-point they being universally recognized as the
necessary supplement to a high temperature and a high dew-
point, and as sources for this moisture we have referred to
own internal topographical sufficiencies, as well as those of
adjoining seas, the winds being employed as :'ul

agents in its transfer from the latter to the land-atmosphere,
very level character of the entire peninsula, and its slight
elevation above the level of the sea, materially increase the
transporting power of the wind?, and favor largely the pro-
duction of a moist atmosphere even throughout the entire
northern section. Furthermore, in relation to the circulation
of the atmosphere it cannot fail to be observed, that the
winds from only two points of the compass, north and north-
, are from a quarter that will warrant the supposition of
a dry character for them. From northeast to west circum-
ltially, they are either derived solely from over water
surfaces, or have in their pathway a continued expanse of
ocean surface. On its eastern side, those particularly from
the Atlantic individually, are able to induce a state of sul-
triness aud oppressiveness of the weather by transporting
the humid atmosphere of the Gulf stream ; and in the case of
the northeast, which courses along the coast line, and thus in
some measure avoids the warmer atmosphere of the Gulf
stream, a corresponding degree of humidity is produced. It
was under this apprehension of its characters, that Dr. Forry
remarks of St. Augustine : " the chilly northeast blast, sur-
charged with fogs and saline vapors, sweeping around every
angle of its ancient and dilapidated walls, often forbids the
valetudinarian venturing from his domicil." And again, "if
the wind be cold and damp, like the northeast winds of St.
Augustine, the system of the pulmonic is especially liable to
all the irregular action of the capillaries generally imputed to
the operation of these causes."

j

1(. 2 Doughty. .1// Essay on the Adaptation [March,

On the western side of the peninsula, the south and south
west winds, though differing from those upon its eastern in
point of temperature somewhat, have undoubtedly a simil
hygrometrieal status. For in both cases, they originate in
maritime sphere and are subjected to no previous conditions
by which they could be made to part with their dampness.
And here we would inquire, who will essay to place the limit
for its extension inwardly? >hall we assent to the ignorant
presumption, that it is confined entirely to the sea coast, or its
immediately contiguous land areas ? The temperature of these
winds, as determined at the coast line, may be lost before they
reach the more interior parts, but the contained vapor of
water is assuredly borne over its entire superficies, although it
may not be so apparent there, on account of the increasing
capacity of the air for moisture, caused by the elevation of tem-
perature natural to the central parts through a large portion
of the year.

As furthering our apprehension of the degree of humidity
of atmosphere induced by these winds, we shall submit a fe
abstracts from the hygrometry of the winds that prevail a
New Orleans.* These will also furnish some idea of the state
of the north and northwest winds in this latitude, in regard to
dryness or remoteness from saturation.

At new Orleans the degree of drying power of the north-
west was 11.29 ; north 10^.06 ; north-east 9.2S ; east 8.84 ;
south 8. 21 ; and southeast 7. 56. Now the east wind here
will probably correspond in absorbing capacity with the east
and west of Florida ; the southeast here will correspond with
the southwest of the latter, and also with the southeast : the
north and northwest winds in Florida, will probably have a
superiority in this respect over those of Louisiana being at
the latter more closely confined to the immediate atmosphere
of the Mississippi Yalley. The amount of moisture contained
by these various winds (saturation being 1000), at Xew Or-
leans, was N. W. .677 ; N. .698 ; K E. .763 ; E. .768 ; S. E. .720.
It is quite likely that the various proportions assigned to
these winds also afford a near approximation to those of

* See Southern Medical Reports, vol. ii.. p. 149. Dr. Barton's Report of Lou-
isiana.

I860.] Of CUninic to the Consumptive, c.

Florida, except the north and northwest, whose evapon
power at the latter has already been assumed as greater than
at the former. The average amount of moisture at New Or-
leans, 'superinduced -by all of the climatological agents there
operating for eight roars, was from October to March inc
sive at sunrise over .850; at midday .685, and at 9 P. M. .808.
(Saturation being 1000.) And the degree of dryness on the
tliemometrie scale was during the same time, at sunrise 4*.:
at midday 11.91, and at 9 P. M. 6.29. The extreme damp-
ness of the atmosphere of the City of New Orleans is mt
greater than that of the interior towns of Florida, and is at all
times more sensible to the feelings. But with a proper allow-
ance for the difference of the lefcal topography we may estimate
the comparative difference in regard to moisture between
them.

In the summer season, during the months embraced by the pre-
cipitation of rain, the humidity of the atmosphere is very great,
probably much greater than at any other period of the year,
notwithstanding the increased capacity of the air for moisture.
One of the chief indications of the actual quantity contained
in the atmosphere is the regulation of the daily range of the
thermometer, and another that we may mention is the oppres-
sion felt by the animal system under the associated heat and
moisture.

In conclusion, in view of these various circumstances-, we
think we may safely assume a high dew-point at all times for
the State of Florida. It differs in the interior in the winter
and colder months from the warmer ones, but the diminution
1 is probably more apparent than real, and like the fall of rain,
the dryness of the winter is only to be taken in contrast with
the extremity of the summer and fall, and not as expressive
i of an absolute real condition. During those warm winters,
common to this State, and characterized by an increased preva-
lence of the southern winds, the dew-point probably varies
from that obtained during the cold ones, to which it is no less
; liable.

We deem it useless to reproduce here the various circum-
stances which have induced us to assume a moderate dew-
13

194 Doughty. An Essay on the Adaptation [March,

point for the State of California and the southern part of the
Pacific coast. Those who may wish to array the evidences of
the humidity of the two sections side by side, are respectfully
referred to the several places where the discussion was carried
on. The southern part of this coast is the only portion which
can lay claims to superiority in this regard over the State ot
Florida. And the numerous determing causes of its relative
humidity being found to be far less than at the latter, and
having also the general testimony of the most prominent
writers and authors in its favor, we think that we cannot err
materially in assuming that it is less injurious in this element
of its climate to Consumptives. With the following quotation
from Dr. Thomas M. Logan's letter to Dr. Fenner we close
our remarks on this part of the subject. "The winter and
wet season have passed away without the prevalence of either
the rains or the morbid affections which the experience of the
last year led us to anticipate. Indeed, such has been the un-
precedented mildness and dryness, that I know not at present
whicli to commend most, the salubrity or the pleasantness of
the winters of this portion of the Eureka State."*

We have thus demonstrated that on the southern part of
the Pacific coast, as represented by San Diego and San Fran-
cisco during the period of heat, the difference of the successive
months, or the rate of advance from month to month to the
highest monthly means, together with the whole amount of
augmentation of temperature from the lowest to the highest
mean, is less than in the State of Florida ; that the position
of the spring mean is more uniform even to the extreme
northern limit of this coast ; that the variability of the monthly
means is also less, the mean possible range of the monthly
means in Florida from April to October, being 8. 96 ; that in
April and May, the single extreme monthly observations are
more variable and extreme in Florida, thus creating a greater
possible range of the themometer ; that the daily range on the
southern half of the Californian coast from May to September,
is as favorable as in Florida ; and furthermore, that the winds
of the Pacific coast are more uniform in their occurrence and

* He wrote from Sacramento City.

I860.] Of Climate tq the Consumptive, c.

prevalence than in Florida, where they are irregular both in
force and frequency.

During the period of cold the rate of a declination of tem-
perature a1 San Francisco is much less and more uniform than
in Florida, which resembles the exl reme northern and southern
parts of the Pacific coast. An extensive general range of the
means of the winter months and season also characterizes the
climate of Florida, much more so than of this coast. The low
temperatures are generally experienced at an earlier date in
Florida than at its southern part, and are commonly much
more severe in the winter; the highest and lowest extremes
are more excessive; the possible monthly ranges of the ther-
mometer much greater; and it also has a greater frequency of
the occurrences of the low non-periodic extremes. On the
southern part of this coast the daily range of the thermometer,
as a general rule, is less than in Florida, and in the history of
the daily records of temperature, sudden and abrupt depres-
sions in the winter months in short periods of time as a day
occur more frequently at the latter. The winds of the latter
are still more variable and irregular, and the general fairness
of the weather is about the same at both sections. On the
south of this coast, the amount of precipitation at this time
scarcely equals the normal general precipitation of the northern
section of Florida.

If now we associate the various meterological conditions
incident to each, we will readily perceive the superiority of
the climate of the southern part of the State of California
over that of Florida. The conjunction of a high summer tem-
perature, tropical in character, with an oppressive dew-point
and forcible winds, in the period of increasing temperature
in Florida ; and of an average high dew-point, with extensive
monthly ranges of the thermometer, constant variations of the
monthly means, sometimes extreme in character, the want of
uniformity in the successive declination or* the monthly means,
the excessive range of the winter means, the variable and ir-
regular character of the prevalent winds, with their changing
hygrometrical conditions, the extreme character of the non-
periodic oscillations of temperature and precipitation, the

196 Urinate to th Consumptive, $>c. March,

frequent extreme daily ranges of the thermometer common to
tlie winter, and their liability to occur in periods of shorter
duration in the season of declining temperatures, render the
climate of this State wholly unadapted to those who require a
climate warm and equable, free from exi either hand,

and whose various climatic features are reliable and uniform
in their character and occurrence. The temperature of the
Pacific coast in the vicinity and south of San Francisco for
some degrees, is at all seasons much more uniform and equable'
than that of Florida, am ated conditions of atmos-

phere, a moderate dew-point^and uniform prevalence of
westerly wind-, more desirable. These various circumstances
are convincing to our minds of the greater adaptedness, or at
any rate, of a less degree of unadaptedno>s to the Consumptive.
Of course, we must be understood as entertaining this opinion
in a qualified sense, because the limited record on the western
coast prevents the definite settlement of the question. A longer
record here is alone adequate to it, that at Florida being suffi-
ciently extensive to warrant the belief that its controlling and
distinguishing features of climate have already been exposed.
If in conclusion, we are asked to state the most favorable
localities on -i, we must reply, that we can do no more

than remark, that they are to be found somewhere between
San Francisco and the southern boundary of the State of
California. Most probably in some of those "sheltered valleys
along the coast," which are said " to enjoy a delicious climate,
equally removed from the chilliness of the exposed points of
the coast and the heat of the great valley between the coast
range and the Sierra Xevada." In further answer to such an
inquiry, we would add, that our object has been simply to
institute a general investigation of the Pacific climates, in
order to exhibit the comparative merits of its various sections ;
hence, with even a short record, our results must be only
general in their nature, and before being acted upon must
quietly await their confirmation or rejection by the profession.
And whatever may be hereafter determined in reference to
the truth or falsity of these results, we shall be equally satisfied,
having no desire but to see the real merits of the various sec-
tions noticed fairly exposed.

I860.] The "Relations of Belladonna and Opium, 197

So far as our labors Lave related to this coast, we shall
amply repaid if they shall succeed in eliciting such attention

as will lead to its correct apprehension by means of more
thorough examinations of it. Already numerous : ;ators

are engaged in the solution of the problem of its meterological
relationship to various of its prevaling i - though dif-

mt from the Held entered and pursued by us, and we are
encouraged to hope that but few years will be allowed to
elapse ere the public and professional mind Bhall be made
fully acquainted with its true relationship to diseases of all
characters, and particularly to phthisis pulm >nalis.

On the Relations of Belladonna and Opium, and on Poison-
by Belladonna. By James Seaton, L. II. C. S. Edin.,
L. A. C.

The following cases, which occurred in my practice in Sep-
tember, 1858, will, I hope, prove interesting to the Profession,
as illustrating the symptoms produced by belladonna in poi-
. and showing the relation which exists between
that poison and opium. I was led to the use- of opium by the
perusal of a paper read by Mr. Benjamin Bell, before the
Medico-Chirurgical Society of Edinburgh, and which appeared
in the Edinburgh Medical Journal of July, LS58.

Two .young men having gathered about a pint of the ripe
fruit of the atropa belladonna, which they found growing in
an old quarry a few miles from Leeds, on their arrival home
they distributed them among their friend-, believing them to
be innocuous. The cases which follow were the result of
their imprudence. The berries appeared to be ripe, were in
size a little less than a small cherry, and were described to
have a mawkish, sweet taste.

There resulted from this distribution of the poisonous fruit,
ten cases, all of which came under the observation and treat-
ment of ^>h\ Seaton. Seldom does any one practitioner have
the opportunity of treating ten cases of poisoning by Bella-
donna. This treatment consisted in emeries, purgation with
castor oil, followed by repeated small doses of Laudanum,
varying from 5 to 12 drops every two hours in accordance ,
with the violence of the symptoms an t^ the age of the patient.
"We transfer the account of the only fata! case (which includes

198 The Relations of Belladonna and Opium. [March,

report of post mortem appearances,) and then give the remarks
of the author.

S. W., aged 14. About seven P. M. on Sept. 12th took
berries, bnt the exact number is unknown. Had the same
symptoms as already described. At three A. M. on 13th she
vomited. At seven A. M. was ordered castor oil, and tinct.
opii m viij. to be taken every two hours. At eleven A. M.
the dose was increased to mxij. every hour up till four o'clock,
after which she took no more medicine. From four till seven
P. M. she continued delirious, but having intervals of complete
unconsciousness; alter seven she fell into a state of total
insensibility ; at ten, she was incapable of being roused, and
at twelve P, M. died in a comatose condition. The pupils,
at the moment of death, were. so widely dilated as to render
the iris scarcely visible.

Post-mortem, thirty-seven hours after death. The external
appearance of the body was that of a subject of scrofula.
The limbs attenuate'd, and considerable swelling of the face
from carious bone. The superficial vessels of the brain were
slightly congested. A section of the organ showed the vas-
cular points to be scarcely, if at all, more developed than
natural. The ventricles were empty, the substance firm, and
the arachnoid perfectly glistening and transparent. Both
lungs were entirely adherent to the walls of the chest, the
result of old pleurisy. Structure of the heart pale and flabby ;
valves healthy, and the cavities filled with fluid blood. The
blood in the large vessels was very dark coloured, and flowed
out like water on their being divided.

The stomach was partially distended with gas, and con-
tained about an ounce and a-half of yellowish fluid, and a
small piece of undigested apple. The mucous membrane was
somewhat paler than natural, except two or three small spots
of very slight congestion, situated near the pyloric orifice.
No appearance of inflammation was observable. The mucous
membrane of the intestines was also perfectly healthy. A
number of seed were found scattered over the surface of the
duodenum and jejunum, and near the middle of the latter a
whole berry was seen. The contents of the bowels were of a
black colour, owing to the patient having been taking iron
medicinally up to the period of her death.

It would appear, from the above cases, that the violence of
the symptoms did not correspond with the number of the
berries taken, as J. W., who had only two, was very alarm-
ingly ill ; while IT. W., who had eighteen, escaped with
rcely any bad effects. The reason probably is, that while

60.J The Relations of Belladonna and Opium, 199

in the one case the berries were completely absorbed, in the
other they were vomited before sufficient time had elapsed for
their diges ion. The h'rsl symptom appears to have been dry-
ness of the uioutli and throat ; next, indistinctiveuess of vision
and dilated pupil ; and, afterwards, in the more s<
delirium supervened. I found in one man, who had only
swallowed one berry, the dry month and fauces without
affection of vision. The Indistinctive ' vision was the

mo vmptom ; in all the cases it existed to i

or less degree for several days, and the boy C. O.'s vi
continues defective up to the present time. The delirium was
of a busy, restless, vivid characterful generally rath<
ing than otherwise. The patients appeared to think that
they were pursuing their ordinary occupations; one hoy
appeared eager in flying a kite; another pulled tables and
chairs about, thiuking he was working in a coal pit ; while
the woman, E. \Vr., appeared to be remarkably busy with her
ordinary household duties. All their movements were of a
quick, excited character strikingly resembling delirium tre-
mens. There was no very marked vascular excitement, the
skin was, in most of the case.-, moderately cool, and the pulse
rapid, but without power.

The remarkable tolerance of opium in these cases would
appear to bear out the conclusion at which Mr. Bell, Dr.
Graves, and others have arrived ; that opium and belladonna
mutually counteract eacli other. In none of the case
which delirium was present, were the symptoms allevii
until sleep was obtained ; and, after sleep, the patients, felt
comparatively well. The pupils were widely dilated so long
as the delirium continued, and, when sleep was obtained,
were either contracted or reduced to the natural size.

With regard to the fatal case, I may mention, that she was
decidedly scrofulous, and had been under treatment for several
months for disease of the bones of the face. It will be
observed that she took much less opium than several of the
cases which recovered, and that, at the moment of death, the
pupils were very widely dilated.

The post-mortem appearances are chiefly valuable for their
negative testimony. The condition of the brain appeared to
be as nearly as possible perfectly natural ; as was the mucous
membrane of the stomach and intestines. The only thing
which was abnormal was the remarkable fluidity of the blood
in every part of the body.

53, Kirkgate, Leeds.

of Poisoning by Atropine.

[Marcli,

of Poisoning by Atropine. By C. Holthouse, F. U. C.
S. Surgeon to the Westminster Hospital, etc.
As a 'pendant to the interesting of poisoning by

adonna berries, published in the last number but or
the Medical Times and Gazette, I forward you the notes of
the following case of poisoning by a solution of atropine,
which happened to one of my own children.

nine o'clock on Sunday morning, the 17th of last-
. my second child, a hearty little boy, 3 years and 8
i lis old, was brought to my bed-room by the nurse, who
she did not know what was the matter with him, but
eemed very giddy, and could not stand. I had never
a ease of belladonna poisoning before, and the bed-
\ blinds being down, I did not at first notice the state
of the child's pupils, or recognise the source of the symp-
is ; while all that could be gathered from the nurse was,
that hearing what she supposed to be quarrelling between
and his brother, who were alone together in the break-
fast-room awaiting our asseu blin at breakfast, she took
him into the kitchen, and on setting him on his feet he fell
lifted him up, and told him to run along, but
he again fell, and appeared to have no power of standing.
Cm observing this, she immediately brought him up to me.
His face Avas at this time flushed and mottled with white,
his eyes brilliant, and his manner and appearance altogether
strange and excited, while the expression of his coun-
!ice was quite maniacal. He was evidently unconscious,
and very irritable, striking his mother when she took him
from the nurse. On placing him on the bed he imme-
diately began to pick at the bed-clothes, and to grasp at
senary objects. About live minutes afterwards, the
nurse returned with two bottles, which my eldest boy told
In1!' his brother had been playing with. One of these, a
half-ounce stoppered bottle, which was quite empty, I imme-
diately recognised as the one in which I kept a solution of
atropine, of the strength of two grains to the ounce, and
which the day before had contained from a drachm and
a-halfto two drachms of lie solution, the bottle being not
quite half full. The cause of the symptoms was now but
two apparent: I rushed with the child to the window, and
the fully dilated pupils at on< irmed my suspicion.

.Dr. Fincham was now sent for, but long before his-ariival,
and in about five minutes niter the discovery, I administered
twenty grains of the sulphate of zinc, and on the arrival of
the Doctor some mustard and water was also given : but

three quart* ur elapsed from the giving the

vomiting t<M>!^ place. The quantity oi
fluii lied did not exceed that given with the zinc,

te effort, and no subsequent retching

ild be produced by mustard and water.

[ deserves mention that a little of the fluid the child

nited, too small to excite notice at the time, accidentally

. which within an hour of the* time had fully

ted the pupil. As no more vomiting could

emed probable that all the poison which was not

id had been ejected, stimuli - ere had recourse

. brandy and water, ether, and ammonia, one or other

vhich were given every quarter o an hour; fhere was,

jreat difficulty in getting the child to swallow.

attempt to do so producing paroxysms of suffocation,

which appeared to threaten his existent od deal of

what was put in the mouth was thus wasted. During the

ile of this time till one o'clock, P. M. the Child was

nsible, the pupils were widely dilated and immoveable,

the eyes open, and the lids not winking on passing the

in front of them ; there was occasional jactitation.

the skin was pungently hot and dry, and covered with a

resembling that of scarlatina, which the child

[uently scratching; the pulse was 170, and souic-

ble.

From one to two P. M., brandy and milk was given from

to time ; an enema of two drachms of spirits of tui-j

. an equal quantity of caster-oil, andsix ounces of gruel,

also administered, and brought away a small quantity

of fteces. lie vomited once during this period, and i

evidently becoming more consciou made efforts

ik, and said --papa;'* his face was less red, and
expression more natural.

From two to five P. M. The symptoms during this
period exactly resembled those of delirium tremens. There
was incessant rambling delirium, great restlessn isp-

ing at imaginary ob donal screaming from

fright. The character of the delirium varied; sometimes
child saw ol hich frighten . . andtheutn

>untenance, and he clur
nurs ., or threw himself violently in different di

tions ;- if to escape ; this kind of delirium prevailed

I of this period ; towards the latter
halt', te delusi e of a more and, his

talking a intelligible, he mentioned the na

Ca8( of Poisoning by Atropine. [March,

bis brothers, his nurse, and "mamma," and grasped at hia
. as hia whistle, which he blew in imagination; and lie
drew imaginary aketches with his pencil, and was very busy
two or three tames in putting into his mouth and' eating
imaginary currents, etc.

A mixture of egg and brandy, with milk and sugar, was
! him al intervals, and just before five he was

sick for the third time (a portion of the fluid so ejected
was aaved for analysis.) Aiter this he fell into a quiet.
Bleep, and bo remained till 6 P. M., his pulse having fallen
to ! Ik bia -kin being still hot, hut no1 so red.

From six to seven P. M. Great restl and return-

ing consciousness characterised thia period; he recognised
me by Ay voice, kissed me, and jumped out of bed, and
Baid he wanted to ride on my shoulders an amusement he
was occasionally indulged in. The skin was Less hot and
red, and there was very little delirium. lie refused to take
any kind of food or drink.

.From seven t< eight P. M. the; estlessn<

and when quiet lie sucked his thumh (a habit he all
indulged in when well,) he sneezed and rubbed his nose
frequently; consciousness increasing, hut intermittent; he
recognised my watch, put it to his ear. and remarked. " it's
ticking;" but on giving it to him again a minute after-
wards, it was not recognised, and he put it in his mouth.

From eight to ten P. M. there was more restlessness than
for the last hour or two, and a constant motion of the hands
to the mouth, as though eating something. Taking advan-
tage of this action, a small piece of bread and butter ^was
put into his hand, which he ate greedily; hut there was a
difficulty in getting him to drink, lie miked frequently
about persons and things which he fancied were before
him. At a quarter to ten his bowels were moved, the
evacuation smelling strongly of turpentine; he alao p;
water for the first time. A powder, which was ordered by
Dr. Fincham, containing two grains oi' calomel, and frv
jalap, was now given him.

From ten t> twelve 1'. M. he lay on the bed tolerably
quiet ; he winks a little when the candle is put close to his
frace, but he sees nothing be ha.- just said. 1 can't

Bee Mamma."' At a quarter past eleven he took, with some
difficulty, a saline mixture ordered by \h\ Fincham, after
which his bowels acted to a greater extent than before, and
lie also passed water again (both saved for analysis.) When
bis mother lay down on the bed beside him, he raised him-

I860.] < of Poisoning by Atropfr

self voluntarily, and kissed her twice. Al midnighl be
took a little milk and brandy, and fell into a quiel sleep.

July 18. From twelve to two A. M. He slept quietly
till a quarter pasl one, when be awoke,.and, before be could
be raisecj in the bed, he had a violenl and somewhat
motion of a waterly character. Alter this he took a small
quantity of milk, and a teaspoonful of brandy, with som
resistance ; out his thumb in his mouth, and again went to

sleep.

From two to four A. M. lie slept very quietly till four,
when his bowels were again moved slightly, and he made
water also (saved for analysis.) Though his pupils are
much dilated as ever, lie can now distinguish objects, tor
he told his mother he could see her; and he also took acup
of milk from her hand, and a little bread and butter. A
dose of the saline mixture was also given him, which lie
would not take without the usual resistance.

From four to eight A. M. lie slept peacefully the whole
of this time, lying on his hack with his eves and lips a little
apart, and awoke well. lie remarked that he could see "gan-
mamma" over the chimney, (a photograph of his grand-
mother, and he ate with evident relish a basin full of bread
and milk. As the morning advanced he said, more than
once, that he wanted to have his clothes on, and before lie
was dressed he was running about the room in his night-
gown, playing with his toys. His difficulty in seeing small
objects, which were near him, was row the most prominent
feature remaining of his illness; and his attempts to make
out the letters of a newspaper which happened to be in the
room, putting the paper first in one position and then in
another, and eventually throwing it from him in disgust,
were highly amusing. The dilation of the pupil gave his
face a singular expression, and they did nor recover their
normal size and movements for nearly a we<

It will be seen by the above notes that some of the fluid
vomited just before live P. M., which was the third and last
time the child was sick, and also some of the alvine dejec-
tions and urine voided at half-past eleven, P. M., and at
four, A. M. (mixed together) were saved for anah
Having submitted the same to Dr. Marcet, that gentleman
very kindly furnished me with the following report :

Laboratory. Westminster Hospital. July 22, 1859.

k* My dear Holthouse, I received from you on the 18th
instant the following

////;/' ' '/' . [M;

" 1st A six ounce bottle containing ~>l ounces of a mix-
ture of urine and nearly Liquid

"2nd. A second bottle smaller than tin

id a half drachms of a fiuid,

Bra. and 4th. Bottles containin nneeted

with this

.lit of the examination of I - sub-

:
mixture of urine and ; analysis

a tiuid which by direct with the

ably the pupils of a white mouse, without, 1
exerting on the animal any other pi ical action: It

contained, therefore, a \ 11 quanti

2nd. The vomited fluid yield by the sj

. atropine, inas-

dilated the pupils of a white ni<
although eadily as in

" Fours very truly, W. Mai

- i
lat

This paper contains the results of the labors of !'
more than twenty-fi
important portion of the treatment la.

The first rule to b tion

Q, OS

at least a large diminuti

diminution

of the t; -

-
or barley ; er grains ;

and rch :

tils, and common beans ; cl

:aiine drinks. Tha

:i]iR'ii should he

I for a length of time than

unfavorable,

very numer-

her kinds ommended;

and they can be prescribed boiled, broiled, or roasted, oi

ked in any other way. with all the condi hat may

30.] Hygienic Treatment of L dfettitus. 2').",

Stimulate the appetite; avoiding, however, the use of flour

n the sauces. Liver should be prohibited, as well i
Itinous preparations. Fresh and salt-water fish offer a
for the table of the patient. Other animal fi
. as oysters, muscles, snails, lobsters, prawn, frogs, etc.,
he employed every day with advai i all

the forms thai culinary art has devised, are way useful.
Although milk is but little suited for glucosuric persons,
^ood fresh cream is, on the other hand, allowable.
Che( sc of all kinds should he forbidden. The list of iegui
allowabl irably large; it need only he remarked I

forty bodies (oil, butter, grease, < tc.,) should be
in more than ordinary quantity in their preparation ; that,
in the sauces or dressings, the yellow of eggs and C]
should replace the proscribed flour; and that, whate
they may he, those legumes should always be avoi
which are very feculent. Mushroons and truffles may
employed.

From time to time, in moderate quantity, the following
fruits can be used : apples, pears, cherries, raspber
strawberries, pine-apples; but always without the addition
of sugar, and only when the urine is not saccharine.

Before speaking of beverages, we must notice a matl

-the replacement of bread and pastry,
cuts affected with glucosuria complain bitterly of being
deprived of bread and feculent food; if the desire for such
can be diverted, it is always well. For seventeen years
that I have employed gluten bread, it- not

been denied: and it is an adjuvant which has been very
important in a large number of cases of glucosuria. S<
have pretended to find in gluten bread a cure for gluco-
suria : such was never my opinion. I sought simply for an
article o\' food which might replace bread without having
its inconveni or patients, and I believe this is such an

article.

Some patients support, without any great annoyau
abstinence from bread and starch food; for such gluten
bread is not required; but, I am bold to say, tl
exceptional cases. For such, one or two cakes, in the
course of the day, answer instead of bread. Some, indeed,
whose attack is but slight, can. by simply diminishing the
amount of starch ingested, or by the employment of alkalies
or energetic exercise, cause a return of the urine to
original condition; such have no need of gluten bread].
But these cases are by no means serious, and are unfrequent

206 Hygienic Treatment of Diabetes MellUus. [MarchJ

Beverages. Wine plays an important role in the treatment
of ghicosuria, and I firmly believe that I have rendered a
great to such patients, by substituting alco-
holic be -incut articles of food, as in demonJ
strating that abstinence from such articles was indispensable
to them. The old red wines of Burgundy and Bordeaux
are preferred; yet all \\h\ wines, that are rather astringent
than acid oi ry well. As regards quantity. I
do not give less than a litre (about one quart apothecary's
measure) in twenty-four hours ; and for vigorous men, who
exercise much, it is sometimes proper to give still largei
quantities. Beer i - vrery unfavorable, and the dextrine
which it contains explains this action. I proscribe saccha-
rine liqueurs, but I grant freely the use of a small glass of
rum, brandy, or kin at the principal meal. Cotiee
is useful for almost all patients affected with glucosuriaj
and, if not contraindicated, I prescribe at least one cup after
the principal meal. It should be taken without sugar; but
a little rum, brandy, or cream may be added, ^ome patients
take two or three cups a day.

Wine and water is preferable to all tisans. Sometimes it
is well to take an infusion of hops or of bitter vegetables.
Under any circumstances, it is well for patients to drink
with great moderation. A quart of pure Bordeaux wine
will allay the thirst of the day, if the regimen suggested is
followed.

Lemonades, etc., sought after by patients with much de-
sire, are very detrimental ; they do not appease thirst better
than cold water, and they contribute to the saturation of
the free alkali of the blood, which prevents, as Chevreul
has long since proven, the prompt destruction of combus-
tible alimentary material incessantly introduced into the
circulatory apparatus, from the digestive apparatus. I for-
bid them absolutely. Mialhe has also insisted, with as much
earnestness as reason, against the use of acid drinks.

Patients should drink small quantities at a time ; large
quantities of liquid ingested at once may contribute to keep
up the abnormal secretion in the stomach, with referei
to which I have so much insisted. They should always eat
slowly. This is for a double reason ; first, to avoid indL
tions, which are to them more unfortunate than to other
patients; secondly, to favor the return of the stomach to
its ordinary dimensions. To attain this end, also, we may
employ a band of flannel, slightly tightened about the region
of the stomach.

>.] Hygu nic Tn aim nt of Diah U s M< llitus.

Clothing. I have shown thai sudden chills were per-
nicious to patients afflicted with this disease. Hence the
propriety of employing good flannel underclothing. This
also serves to re-establish the functions of the skin, which
should be active. Hence, I always prescribe flannel gar-
ments, covering the whole body, so as to keep up gentle
moisture (A' the skin.

Exercise. Patients who have had the for some

time experience spontaneoi ation of

bility, some icompanied with pains in the tlu.

legs, and articulations, which arc increased by the slighl
work or smallest exertion ; it is difficult to u to

exercise, our as so >n as, from a suitable regimen, their
es begin to return, they musl use exercise. Walk

lie whole body by sonic manual labor, or some
mastic recreation, are of undoubted utility. Ti.
eise should be pi ive; if too violent, it will determine

injurious curvatures; neglected, it will retard the complete
establishment oi !ngth, and, consequently, the cure.

bathing and Hydrotherapeia in the Treatment of the
bathing, when it is aided by exercise in
Bwimming, is useful; but the advantages of sea-bathing,
when it can be supported, are more constant and greater.
To determine diaphoresis in difficult eases, I have sometimes
loved hydrotherapeia : but the patients should be con-
tinually under supervision in the use of such treatment, as
in badly employed, it may produce serious accidents:
but when wisely directed, and seconded by a regimen Intel-
ligently adapted, it has rendered me excellent service.

[t is that the treatment should be only gradually

aband uied, and when the glucose lias disappeared from the
urine. It is proper always, then, to augment the quality and
quantity of the calorifacient articles of food. Good beer
may be taken after each repast; three or four spoonsful of
oil during the day; these are the articles which I
would require during the use of sea-baths, or the employ-
ment of hydrotherapiea. There must be no caloric; it is
accessary that a supply of calorifacient articles at least equal
to the loss should he furnished.

By way of resume as to the indications and contraindica-
tions for hydrotherapeia in this disease: When the glucose
disappears, or is diminished, so that fseculent articles can
he more largely employed, and there is daily increase of
strength, hydrotherapeia and sea-bathing are most efficacious
methods of treatment in glucosuria -f when, on the contrary,

Ttiabi tic Cataract. [March,

under such treatment, the glucose increases, the strength
diminishes, etc., these methods aggravate the disease; for
we are abstracting caloric from a machine which is already
too much impoverished. L. II. S.

Europeenne and Am. Med. Monthly,

On Diabetic Cataract By John V. France Ophthalmic
Surgeon to Gi ipital, and Lecturer on Ophthalmic

Surgery.

I Leg to offer, in confirmation of views recently pro-
pounded in this .Journal and in the Ophthalmic Hospital
Reports, some additional evidence relating to the above
subject.

There may possibly exist scattered cursory notices of
cataract in association with diabetes of earlier date, hut Dr.
McKenzie, of Glasgow, was, I believe, the first to indicate
a connexion between those diseases. "I have in three
instances,*' he say.-, speaking of the causes of cataract in
1840, "seen lenticular cataract attack women, of from 18
to 25, labouring under diabetes mellitus." "I have, also,"
he adds in 1854, -> met with the same complication in males
at a later period of life." So Dr. M. Duncan, of Edinburgh,
in a foot-note at page 15 of his translation of "Braun on
TJraemie Convulsions," recognises a similar relation in the
sentence "In diabetic patients there is a tendency to
cataract" Dr. Duncan lias favored me, in a private letter,
with the information that his remark was drawn forth bj?
the singular coincidence of having three poor diabetic
patients at' one time, labouring simultaneously under cata-
ract. Xot being interested particularly in the subject, he,
unfortunately, did not take further note respecting the
latter disease ; but the occurrence attests in a striking man-
ner the connexion between the two maladies.

Valuable testimony to the same effect is afforded by Mr.
Wilde, of Dublin, in a late communication to this periodi-
cal intended to impugn my observations (a.) For, while
controverting the proposition, that Wk According to the
latter authority it would seem that there was a special
disease of the lens set up in patients labouring under
diabetes," he virtually confirms it by adding, " I have seen
patients labouring under diabetes where cataract also*
existed ;" for reiterated examples of so peculiar a compli-
cation do establish the fact of connection.

(a) No. 493, December 3, p. 564.

I860.] Diabetic Cataract 209

The accuracy <>f my descriptioo of these cases is disputed
lame author. On this point 1 will merely say, in
the first place, that it' the counter-statemenl is founded on
two or three instances only, and those quoted from memory,
they are insufficient grounds of objection; while, if on
ral, then al least they proportionally help to justify th<
obnoxious term "Diabetic Cataract," by raising the numeri-
cal frequency of the affection.

The distinctive characters which this class of cases pre-
e, however, an after-question to that >gnising

them as a class ; and I would not attempt to dogmatise
upon it, though entertaining a strong conviction, that the
description L have given will be found in the main corr
It certainly applied to, or rather was drawn -'from, those
examples which have fallen under my own special obser-
vation and care ; it derives independent support from Mr.
Walton's interesting ease, in the Medical Times and Gazett
of the 12th nit. : and is further corroborated by the follow-
ing, not less interesting, which lias since been communi-
d by the kindness of my friend Mr. Veasey, of Woburn.

lie writes: " Your remarks on cataract associated with
>etes, recall to mind a case resembling the general out-
line which you sketched in the Ophthalmic Hospital
Reports." He then goes on to relate the history, of which
the subjoined is an abstract. The patient was a poor mar-
ried woman, aged 31, the mother of three children! Dia-
betes had existed tor some time in an aggravated degree.
Her countenance was worn and anxious, the eyes sunken,
the lips and skin parched, the tongue dry and chapped, the
breath sweet; yet the urinary disease had been disregarded
until the sight began to fail. Both eves were the seat of a
soft, bulging cataract, and dilated pupil ; but vision was
still useful; there was no inflammation. Operation "was
long delayed, and when at length keratonyxis was performed
in the County Hospital, no impression appeared to have
been made on the lens, and the corneal wound healed
badly, leaving a weak eye. Three or four months after this
operation the poor woman, now wholly blind, besought me
t - operate. The needle was introduced through the scle-
rotic, and a complete division readily effected. Xo inflam-
mation ensued, and absorption was just perceptible, when
constant sickness with general failure of power, precluded
all further attempts, and that scanty vision which had
returned was shrouded in death." It is evident that the
disease in this ease (related by a most intelligent practi-
14

210 Th Efficacy of Cold Affusion [March,

tioner,) agreed closely with the typical character of diabetic
cataract as observed by myself: and the unfavorable result
of the first operation (though no doubt in a measure attri-
butable to the advanced state of general cachexia, which
primary disease had induced.) illustrates anew with what
caution these cases should be approached in the way of
operative procedure.

The marked concurrence of similar features in all the
examples hitherto circumstantially recorded of this compar-
atively rare affection, points in no ambiguous manner to
the general uniformity of the class. Guided by this indi-
cation, I was enabled in the last case narrated in the Oph-
thalmic Hospital Reports, to recognise its special character,
and anticipate its cause, before any complaint of diabetic
symptoms (which were afterwards conclusively proved) was
made by the patient, Xow, bearing these fact in mind, I
cannot but conclude, that results thus deduced from eases
noted and related in detail are entitled to, and will receive,
greater weight in an inquiry of this nature, than a loose
general contradiction, as if ex cathedra, from however
respectable an authority. In actual practice, at least, it
will be well to remember what seems to be ascertained with
regard to diabetic cataract; and I may be permitted, in
conclusion, to say. that the communication of any instances
which may occur to the readers of these remarks, would be
esteemed a favour by their author.

24, Bloomsbury-square.

On the Efficacy of Cold Affusion to the Head in Narcotism,
By Br. A. Reeves Jackson.

In the first two cases the narcotism was from opium; in
the third from belladonna.

Case 1. On the 6th of March I was called in haste, by
an Irish laborer, who lived about one mile from this place.
to see his son, a child eight months old. The lather told
me that the child was "clean dead," and "kilt entirely,"
when he left home; but was unable to give me any futher
information. On arriving at the place, I found the little
patient in such a condition as almost to justify the father's
expression.

Lying on the lap of its mother, its face was of a deathly
pallid hue; the breathing slow, interrupted, gasping; the
extremities were cold, and the skin covered with a clammy

I860.] To tin Head in Narcotism. 21 I

perspiration. The pulse at the wrist was barely perceptible
in its feeble, thread-like beat.

I Learned from the motherthal she had been in the habit
of administering to the child the preparation of opium
known as Godfrey's Cordial to make it sleep; and that hav-
ing occasion to go to the village, where she expected to he
absenl some Length of time, she gave it, before starting, a
Utile more than usual, in ordvv that it might sleep until she
returned. The quantity given on this occasion, she said,
was about two teaspoonfuls, hut as she made this admission
with great reluctance, it was probably much greater. Shi:
was absent three hours, and when she returned the child
was sleeping soundly, and she made no effort to arouse it
until nearly an hour afterwards, when observing that it was
unusually pale, she made am attempt to awaken it, hut
found it impossible to do so.

Five hours had now elapsed since the dose was adminis-
tered, [t was evident that the child was rapidly sinking,
and that unless relief was quickly had, it would soon die.
The stupor was so great that emetics could not be given
nothing could be swallowed. I had no stomach-pump at
hand, and there was no time to send for one ; beside which,
these means could not rouse the patient, which was to my
mind the prime indication. I remembered that cold affusion
to the head had been used successfully in some published
instances, and I determined to give it a trial, although with-
out the slightest expectation that it would be of any avail
in this case.

Accordingly I ordered the father to procure a bucketful
of cold water, and having the head of the child held over it,
face downwards, tilled a coffee-pot (they had no pitcher),
and [toured from it a steady stream upon the occiput in
such a manner that the water ran off into the bucket
beneath.

I had poured on two or three gallons in this manner,
when suddenly I was started by the child making a long,
gasping inspiration, accompanied by a convulsive move-
ment of the arms. My first impression was that it was
dying. Raising its head, however, I saw that its eya^ were
open, and that its breathing wras rather better than before
the treatment was commenced. The eyes were almost im-
mediately closed again, and somewhat encouraged, I again
poured on the water as before. In a very few minutes the
child began to moan, and the breathing became more dis-
tinct ; continuing the use of this remedy a few moments
longer, it uttered a feeble cry.

212 77 ' ;j of Gold A [March,

I now desisted for a time, with a view of administering
a solution of Bulphate of zinc in warm mustard-water, but
during the time occupied in preparing it the child relapsed
into such a stupor that it was found impossible to rouse it
by ordinary means sufficiently to enable it to swallow.

I again had recourse to the cold water, and with the same
happy effect as before. In a very short time the child was
once more roused to susceptibility, and cried out quite
lustily. AVe now forced it to take a few doses of the emetic,
which, aided by tickling the fauces, produced free emesis in
half an hour. The matter vomited gave but little evidence,
however, of the presence of the medicine.

Very little subsequent treatment was necessary. I ordered
,11 quantities of wine-whey should be given occa-
sionally, and that frictions to the lower extremities be made
with warm infusion of mustard, to obviate the resulting
debility. In two or three days the child seemed to have
regained its usual health.

Case 2. James H , set. 19, a blacksmith's apprentice,
had been subject to neuralgia of the face, for the relief of
which he used the camphorated tincture of opium, or pare-
goric elixir. About the middle of February, 1857, being
attacked with the disease, and not having any of his cus-
tomary remedy at the time, he procured from a neighbor
a vial of laudanum, and being under the impression that
the doses of the two articles were the same, he poured out
a large tablespoonful and drank it. This occurred at ten
o'clock in the forenoon. In a few minutes he began to feel
drowsy, and went to bed. About four o'clock, P. M., one
of the members of the family went up stairs for some pur-
pose, and found him in what was supposed to be a dying
condition. A messenger was immediately dispatched for
medical assistance, and the writer was summoned to see
the cast'.

I reached the bedside of the patient about live o'clock
seven hours after he had taken the medicine and learned
the above particulars.

He was then under the full poisonous effects of opium.
His surface was cold and clammy ; his breathing irregular,
slow, and stertorous respirations eight in the minute; the
pulse full, slow, and very irregular; the' pupils were tightly
contracted and totally insensible to light; the countenance
calm and pale.

I at once endeavored to rouse him by speaking to him in
a loud voice, by roughly shaking him, and by striking him

>.] To /''< Head >'> m, 213

i the open palm. These failing, we took

liim from the bed wit li the intention of moving nim about
the apartment between two assistants, but he was uhabli
bear the slightest amount of milts. Wo tl

placed him on the bed again, and commen ting the

- of his i \\ et to\* els. This also failed

the least token of sensibility. I then dashed cold water in
the face, hoping that I might rouse him sufficiently to
enable him low an emetic, although L thought it

improbable that any of the poison still remained in the
Btomach. Although this caused him to start, and move his
hands towards ; dashing of the

water ceased, he at once bee ible again.

I now concluded to nse cold affusion to the head ; and
having e ig properly arranged, commenced pouring

the water upon the head from a large pitcher' held at a
height of about eighteen inches. The effect appeared
almost magical. Before the pitcher was emptied he opened
his eyes, and evinced. by Iris actions that the treatment was
unpleasant. It was continued, however, and in a short
time he was fully aroused. Nausea and vomiting now
supervened, and the retelling was so violent and long-con-
tinued, that all remaining symptoms of drowsiness were
banished. A cup of strong coffee finally cheeked this and
completed the cure.

\. Mrs. JT ., the wife of a clergyman, had been
suffering several days with severe neuralgia of the rectum,
caused by the irritation of internal hemorrhoids. I had
been using a great variety of remedies, but, as is usual in
such cases, none produced more than temporary relief.

On the evening of May 7, 1858, the pain was unusually
intense, and I ordered a suppository containing one-third of
a grain of sulph. morph. This gave almost entire relief
from the pain, and she passed a tolerably comfortable night.
Xext morning, however, she awoke with headache, an in-
tolerable itching, and nausea and vomiting, which continued
throughout the day, and she positively refused to use opium
in any form again. In the evening the pain returned as
srely as before. I ordered the bowel to he cleansed by
a laxative enema, to be followed by an injection consisting
of a watery solution of extract of belladonna. I used the
Shaker preparation, and laid out a portion containing about
one grain, directing that it be dissolved in two ounces of
water, and thrown into the rectum and retained there.

About midnight I was hastily called to see the lady, and

214 Cold Affusion to the Head in Narcotism. [March,

on my arrival found her surrounded by her friends, who
were greatly alarmed at her condition. She was lying on
her back in bed, completely insensible. The face was of a
brightred color, and somewhat swollen; the breathing slow

and quiet, entirely without stertor: pulse 130, small and
hard. The eyelids were closed. One ag them, the

globe appeared injected and prominent; the pupil- were
widely dilated, and directed forward with a fixed vacant
The patient appeared entirely unconscious, although
occasionally made an apparently painful attempt to
speak. The muscles of the face, particularly about the
mouth, moved convulsively. The arms were also slightly
convulsed. The skin was warm and perspiring abundantly.

The husband informed me that inasmuch as the anoo
enema I had ordered had failed to allay the pain, he thought
to repeat it, and did so in m Fter giving the first.

Tie said he had used a piece of the extract about the size of
a that he thought it was about the same size as the
portion I had used. He further stated that in a short time
alter using it the patient complained of feeling very warm,
of some derangement of the head, and of an unquenchable
dryness of the mouth and throat, with difficulty of swallow-
ing. She also complained of confusion of vision, of giddi-
ness, and of headache of a beating, throbbing character.
These symptoms were followed by a light, good-natured
delirium, a wandering loquacity, and extravagant, ridiculous
actions, together with occasional nausea without vomiting.
and ineffectual efforts to urinate.

Various means were used to rouse her, without effect.
Ammonia was cautiously applied to the nostril.-: she was
spoken to in a loud voice and roughly shaken, but " still
she slept."

My first object was to remove any of the poison that might
yet remain in the bowel : and for this purpose I ordered a
large enema of thin gruel. After this had been adminis-
tered, I had preparations made for using the cold water. A
large tub was placed on the floor near the the bed.

and the patient being placed crosswise on the latter, with
the head and shoulders projecting, and supported by an
-rant, I commenced pouring a -ready stream upon the
back part of the head and neck. In a few minutes she
opened her eyes, but reclosed them immediately. The face
became gradually paler. In about five minutes she made
an attempt to articulate, and pointed towards her mouth.
Some water was put into her mouth, but she could not
swallow it.

Physiological . 1 ctlon of . 1 na sth ti 215

The ase of the cold affusion was now suspended, as th<i
patient appeared to be cold and shivering. She was placed
in bed and lightly covered, in the course of ten or fifteen
minutes her skin became hot, the face was flushed, and she
again fell into a profound sleep. < mce more the <-<>ld water
was employed, and soon she again became conscious. A
piece of ice was now placed in her mouth, and appeared to
afford her much relief, although Bhe could uot articul
with sufficient distinctness to be understood.

The enema was now returned without any admixtui
is, but containing a considerable quantity oi the bella-
donna, as was made evident both ; >lor and odor of
the discharge.

- The patient, although drowsy for some hours, recovered
without the use of any other r

Her vision remained dim and confused about three w<
Amer. Journal Med. Sciences, July, L859.

'ogical Action of An/Esthetics. Before the X. Y.
Pathological Society. By Prof. Dalton.

Of course, Mr. President, I have very little experience
with regard to the effects of these two agents upon the
human subject, although I had the pleasure of witnessing
the first operation in which ether wa i s an anaesthetic

agent. In my own practice, if you may call it such, the
patients have been principally animals. I presume, however,
that there is very little difference in their mode of operation
on animals and on men. When I commenced, I, of course,
d ether; but as ether requires to he given in a very large
bulk, I soon found it very inconvenient, and commenced
using chloroform in its stead, and found it very much more
pleasant tor myself, hecause it was more easily administered
to the animals, and I continued to use it for a certain time.
Very soon, however, I found that the animals would occa-
sionally die, which I attributed to some imperfection in the
mode of administering the agent. I continued the practice.
but still the accident referred to would occasionally occur.
Xot to take up too much time in details, the simple fact is.
that, at the end of six months, from the time I commenced
its administration, I abandoned it. Sometime afterward I
again had occasion to use it; I gave it, but found that it
was followed by the same results. Since that time I have
given it up altogether, and instead of it I have used sul-
phuric ether. I think I may say, without exaggeration,

216 PA. \ of Ancestheti [Marcfy

that I am thoroughly convinced that there is a radical dif-
ference in the danger following the administration of these
two substances. 1 am Bure that chloroform is more dan-
gerous to animals, at least; whether it is so in man or not,

I do not know.
In order to understand I ject thoroughly, it is necei

sary that we should endeavor to ascertain the manner i]
which death results in the fata . ath sometimei

follows without any evident or traceable cause. It maj
occur from ether or chloroform by a very careless adminis-
tration, or from an impurity of the article, provided thai
the patient breathes nothing' but the vapor of the ether o]
the chloroform. Now in these cases, death is not attribu-
table to the ether or chloroform; it is simply due to the
want of atmospheric air. If you give a man a grain ol
opium and then stop his mouth and nostrils, he will oJ
course die; but certainly not from the opium, hut from tin
want of atmospheric air. The same is true of the adminis-
tration of ether or chloroform. Therefore the first tiling t<
he attended to, when we wish to prevent a fata] issue froi
the administration of these substances, is to see that the^
are given mixed with a sufficient quantity of atmospheric
air, and then one cause of death would be excluded.

Sometimes, however, even with all our precaution, w
find the respiration and the heart stopping suddenly am
the patient dead. It is an interesting question to knoi
whether or not death is produced, by the stoppage of respira-
tion or of the heart. My own belief is, that in the ease oi
chloroform, death is produced by paralysis of the heart
My reasons for this view are two-fold.

In the first place, if you moderately etherize or ehloro-
formize an animal, carrying it carefully just up to the poiivt
of insensibility, and then open the walls of the chest a*
quickly as possible, the lungs will of course collapse, anc'
respiration he at an end, hut the heart will continue to heat
for a considerable length of time. If, on the other hand,
you etherize or chloroformize an animal until respiration is
stopped, and then open the chest, you will find the heart
still heating, but very feebly. I have several times per-
formed the following experiment, namely: to etherize an
animal moderately, hut enough to deprive it of all sensibil-
ity, then immediately the chest was opened and the animal
laid aside; another animal was then etherized until death
was produced, and on immediately opening the chest the
heart was found still, while in the first animal it was yet

I860.] P) 217

beating. So far as this bends to show with a greal

deal oi conclusiveness, thai the fetal resull is produced by a
direct paralysis of the heart.

In experimenting thus with animals, i have had occi
tice very frequently, when the anaesthetic is carried
only to the s [ration, that the animals usually

>ver, and expect with confidence thai respiration will
in again; but if, on noticing that the respiratioi
. I find the heart itself still. I know that the animal
is dead, although f have n< fter the circulation U

an end, that it is sometimes re-established in a certain man-
ner which is entirely characteristic, and being one
is very readily r ed. This is, however, entirely una-

vailing; the animal never recov<

In my own experience, then, fatal results have followed
both ether and chloroform. I have killed dogs and catfi
with ether and chloroform, but I am obliged to take a great
deal of pains to produce ti lit with ether, "whereas

death often follows the use of chloroform, notwithstanding
the best precautions. It has been said, that when death
oemrs from the administration of chloroform in the human
subject, that it is attributable to too rapidly or too

abundantly: but while there are undoubtedly many eases
in which injurious results follow from the non-admission of
a sufficient amount of air, still I am of the opinion that the
injurious or fatal results cannot be id ways attributed to
that cause, for the reason that th< dents have occurred

in the practice of our best and most careful Burgeons, who
Invariably exhibit this remedy with the utmost caution, and
yet, when everything appears to be going on well, the
patient suddenly dies. So far, we know of no precaution
which will prevent the occasional occurrence of this acci-
dent.

President: I would inquire of Dr. Dalton whether the
effects of these agents are cumulative?

Dr. Dalton : I cannot say that they are. Anaesthetics
taken in by the lungs enter the blood so very quickly that
I should not think there would be any cumulative effect.

President : In some cases the patient seems to recover so
as to speak, and yet in a few moments dies. Did you ever
see anything of that kind in animals

Dr. Dalton: The onlv thins: that I have seen analogous
to that, is the spasmodic respiration after the stoppage of
the circulation, which led me to believe, when I first saw it,
that the animal would recover. I now know, however, that

218 Substitute for Anaesthesia. [March,

these efforts are entirely unavailing. When once the heart
ceased to pulsate, the animal is dead.

Substituti for Ancesthesia.

The Boston Traveller publishes the following:

de la ( . d'Antin, Paris, i

Monday, Decemb< v 12th, 1859. J

I cannot let this Bteamship leave here and not acquaint
you with one of the most extraordinary discoveries recently
made. Monsieur Velpeau, the eminent surgeon, wh
fame is wide as the world, made the strange communica-
tion. He stated that an honorable surgeon or physician
(he vouched for the gentleman's character,) named Broca
or Rocca, had made the following experiment: He had
placed before the face of a person, between the per.-'

and at a distance of fifteen or twen etres (a

netrt is a French measure of length 0.393,708 inch in
value) a rather brilliant object {an obj u brillanL)

Make the person look fixedly at this object. In a few
minutes the person will squint, and will soon fall into
catalepsy and be spontaneously deprived of all sensibility.

In the experiments made, the insensibility of the patient

so great that the patient's head was alternately moved

from one side to the other, and his whole person was moved.

He had no recollection of any of them when he returned to

lis normal state.

This singular discovery made Mons. Rocca or Broca sus-
pect that this state of insensibility might be as perfect as
that obtained by anaesthetic agents. He determined to make
experiments with it, and found that the state of insensibility
produced, was as perfect as that obtained by the use of ether
and chloroform.

Three experiments out of rive attempts are reported as
successful. In one of these man underwent a sur-

gical operation for an abscess, which required an important
siom The insensibility lasted ten or fifteen .minutes
after the operation. The patient was entirely unconscious
of all that had taken place.

The experiments mentioned by Mons. Velpeau may be
easily repeated by anybody. Their importance in point of
economy and money and life is serious. Chloroform and
ether are both costly articles, and their use is attended with
danger. They have destroyed more than one life, and
medical men are still unable to vaticinate in what states oi

I860.] Sugar >' ('run. 219

the body they may be used innocuously, and wh< n tiny
will extinguish life. Besides, their use in the lesser surgi-
cal operations, such as the extraction of teeth, is generally
considered, out of the city of Boston, to be eminently inju-
dicious. What a blessing this new discovery will prove, it'
time and experiment avouch all its present advantag

Mods. Velpeau, in announcing the new discovery, said
uIt is a strange phenomenon, ^) strange a phenomenon
that I feel obliged to take some oratorical precautions in

aking of it to the Academy of Sciences. I feel obliged
to draw assurance from the talents and honorable character
of Mons. Broca, who'has charged me with the duty of giving
his discovery useful publicity, and at the same time of
assuring his right to the discovery of this remarkable phe-
nomenon."

Mons. Velpeau, therefore, does not present the new sys-
tem o\' anaesthesia for a panacea, but he says to medical
men : " Use it, study it, experiment on it on useful occasions,
and perhaps you may contribute to endow science with a
new means of alleviating suffering humanity."

Spiridion.

Sugar in Urine.

" Sugar in the urine," writes M. Henry Musset, "does

not necessarily imply the existence of diabetes. One may
pass sugar with the urine, and yet enjoy perfect health.
Dr. Blot lias shown that sugar exists normally in the urine
of all women during parturition, of nurses, and of a certain
number of women during pregnancy. Dr. Lcndct has
shown in paraplegic patients that there is a constant rela-
tion between the appearance of the nervous cerebral acci-
dents and the glycosuria. Dr. Itzigsohn relates a remark-
able case of traumatic diabetes, occurring in a blacksmith
who had received a blow on the top of the head. Dr. Todd
has also given a case of diabetes which was observed in a
woman after she had received a blow on the head. Prout
observed sugar in the urine of dyspectics and aged persons,
and Dr. Goolden inVhildren during dentition. Thus, then,
there are numerous circumstances, physiological and patho-
logical, which, directly or indirectly, concur in the formation
of sugar in the economy. Can we now, with M. Mialhe,
explain the presence of the sugar in the urine, by the
greater or less alkalinity of the blood, which in the latter
case cannot transform the glucose the glucose then becom-

220 Existence of Fibrinous Clot in the Heart [March,

ing a foreign matter in the body, and bo discharged by the
kidi Or, with M. Bouchardat, shall we explain the

glycosuria by supposing the presence of some peculiar prin-
ciple, which has an action on starch like that of diastasis ?
Then, again, we have the explanation, resulting from dis-
covery of the glycogenic function of the liver byM. Bernard,
viz: that the function of this organ is impeded, and the
sugar thrown into the general circulation. When, however,
we consider, that in every body there are products which
are returned by the lymphatics into the general circulation;
that the transformation of starch goes on normally in the
intestines ; and that it is accomplished even in the mouth
under the influence of the salivary diastasis ; and if, more-
over, we recollect that glycosuria accompanies dentition,
dyspepsia, certain cerebral disturbances, that it may be
caused by irritation of the brain at the origin of the eighth
pair of nerves; that it exists in pregnant and parturient
women and nurses are we not naturally brought to the
conclusion, that diabetes is a neurosis troubling the har-
mony of the assimilating functions?" U Union Med.

On the Existence of a Fibrinous Clot in the Heart in some cases
of Croup. Letter from Mr. Henry Smith.

[From the Medical Times and Gazette.]

Sir Some of your readers will perhaps recollect that a
controversy took place, some two or three years ago, between
Dr. Richardson and myself, on a question connected with
the pathological appearances which were found in certain
cases of croup in which tracheotomy had been performed.
Dr. Richardson asserted that in some of these cases attended
with peculiar symptoms, the cause of death was to be found
in the existence of a fibrinous clot in the heart which was
formed several hours prior to dissolution. He also stated
that there was a wide divergence between the morbid -signs
in those cases where death was being brought about by
obstruction to the breathing alone, and in those where the
fatal event was ensuing from the presence of a clot in the
heart.

Although at that time I had had a large experience in
cases of tracheotomy for croup and I am sorry to Si
very fatal experience I was by no means convinced that
Dr. Richardson was correct in his views, although his
statements and reasoning made a deep impression upon my
mind.

up. 221

Atthe meeting of the London Medical Societj lay

ling, Mr. Price brought forward a here he had

performed the operation foi croup, and where the patient
died. Dr. Richardson put the question to Mr. Price as to
whether the heart had been examined after death, and then
reiterated his views regarding the pres< ace of fibrinous
Epilum. In ferrea to tl snce of

opinion which had existed between him and myself on this
[iiestion, and requested me Soci-

ety the results of m\ . tion since the period alluded to.

The President of the Society did not think fit to allow
o address any remarks m ; and.

therefore, I wish to state in your columns whal I should
have been glad to have stated to the Society, that further
inquiry on tins matter, and observation both on the living
the dead, have convinced me that Dr. Richards*

J considered them incorrect, and opposed them as well

of justice towards 1 1

tleman, I am glad to state my present conviction, that there

- of croup in which the symptoms are more

atate of the heart than to a

struction in the windpipe. These symptoms con

eat dyspnoea, pallid face and lips, cold extremities, and

very feeble puis* nee and lividity of the

. with blueness of the lips, accompanied with extreme

dyspnoea, mark the insuperable obstruction in the trachea.

In the former cases [ am now disposed to agree with Dr.

Richardson, that tracheotomy will not save life, as there is

every probability that a coagulum has formed in the heart.

1st in the latter experience teaches that an artificial

i in the windpipe may save life.

It is not the mere reflection on Dr. Richardson's views

brought about an alteration in my mind respecting

this point; but a careful examination, both on the living

and the dead, has led me to believe that that gentleman is

in a measure, at least, correct; and in order to he hrief, I

will just mention the details of one of the last eases of croup,

where 1 was able to make a post-mortem examination:

I was called to a child, aged 6, who was suffering severely
from croup, and had been i-H three days. The breathing
was most laborious, the ehild making violent efforts to get
air. and not moving the chest at all; the face was. however,
very pale, and the lips were not blue. The pulse was ex-
tremely rapid and small. My opinion was sought regarding

222 (Xotinth Heart in cases of Croup. [March,

tracheotomy; T did not think it a favorable case. The

operation was not done; and the child died in an hour.

I opened the body with the express view of ascertaining
whether there was a clot in the heart; for the child pre-
sented just those Bymptoms expressed by Dr. Richardson.
Surely enough, on opening the heart, there was seen ex-
tending between the right auricle and ventricle a firm"
deposit, and there was another fibrinous clot at the1 com*
mencement of the aorta. The lungs were healthy, but the
Larynx was lined with a thick deposit, which very much
narrowed the cavity: a thinner membrane lined the trachea.
Now, it struck me at once, that had tracheotomy been per-
formed in this case, the existence of the coagulum in the
heart would have prevented recovery had the obstruction
m the windpipe been overcome; and I am now of opinion
that some of the cases previously operated upon by myself,
and presenting just the same symptoms as existed here,
were instances where a fibrinous clot would have been found
in the heart had it been looked for.

In another instance, where I was recently called to per-
form tracheotomy, the symptoms had come on within only
a few hours. The child, aged 5, was lying in bed perfectly
insensible, breathing with extreme labor: notwithstanding
this, the pulse was pretty good, and the extremities not cold.
I refused to perform the operation, and the child died in an
hour and a half. On examination there was not any eoag-
ulum in the heart whatever: but the lumps were excessively
congested, and the upper part of the larynx and trachea
were lined with an organised cast.

Without venturing to go so far as Dr. Richardson has
gone, I cannot help thinking that his views regarding the
existence of a fibrinous clot in the heart in certain cases of
croup demand serious attention; and, as I once strongly
opposed them. I am now happy to admit that I am, in a
measure at least, converted to his side.

I am, &c., Henry Smith.

Caroline-street, Bedford-s<piare.

The Actual Cautery in Cancw. M. Sedillot, of Stras-
hourg, strongly recommends the use of the actual cautery in
the removing of epithelial cancers: removing as early as pos-
sible (under the chloroform) the healthy parts immediately

surrounding the cancer.

I860.] Needles in the Stomach.

Needles in the Stomach. Treatment by M. Boi ohi r.

A Little girl, whose case attracted notice from its singu-
larity, applied at Mr. Bouchut's consultation, for the exti
tion from the abdominal walls of a needle she had swallowed
three months before.

Many instances of the kind are to be met with in scien-
tific records. In the Dictionnaire rf<

read of ehlorotie patients who. impelled by an unaccountable
fancy, swallowed as many as L500 pins, and died in
of atrophy, their muscles bristling with these foreign bodies
like so man;, pin-cushions. Needles sometimes penetrate
into the skin by the same mechanism, by which an ear oi
rye creeps upward through a sleeve in which it has b<
inserted. This is chiefly observed in cases of hysteria and
chlorosis, in which the integument has more or less lost its
power of sensation, and is unconscious of the penetration of
the foreign body. In the Little girl who suggests the present
remarks, the needle had been inadvertently swallowed, and
the interesting feature of the case was the occurrence of
diarrhoea while Vac needle remained in ber system, and its
continuance, even subsequently to the removal of the im-
plement, the f the intestinal relaxation being obscured
by the occurrence and perseverance of the symptom. It is
not unimportant liere to inquire what connection, if any.
existed between the presence of the needle and the produc-
tion of diarrhoea.

We have stated that the diarrhoea had followed almost
immediately upon the introduction of the needle into the
digestive organs, that it assumed a chronic form, and that
the child had lost flesh. Mr. Bouchut was consulted as
: as a minute inflammatory tumor appeared upon the
abdominal wall, and a small incision allowed him to discern
the foreign body, which he seized with a common forceps
and easily removed. The wound healed rapidly, but the
diarrhoea nevertheless persisted. This circumstance of course
suggested the idea that the intestinal relaxation was not
accidental, and might perhaps be connected with tubercu-
losis; as, however, the patient did not cough, as no mesen-
teric tubercles were discernible, the idea was abandoned,
and in the supposition that the looseness of the bowels was
due to a local cause only, it became necessary to inquire
whether it was catarrhal or organic. A common catarrhal
disease is not usually of so long- duration, but the secretion,
as may be observed in fluxes of all description, irritates the
parts it comes in contact with, and gradually brings on

224 Colica Pktonum. [March,

organic disease, thus giving rise I minable chronic

inflammations. In Mr. Bouchut's opinion, this explanation
applied to the symptoms of the case under consideration.
Championniere' s Journal,

Colica Pictonum. Treatment at La Charite. By M. Trousseau.

A young man admitted into the ward with symptoms of
painte'rs colic was cured in live days by the following
treatment:

1st day. A decoction of cassia was prescribed, prepared
as follows : bruise together legumes and seed of cassia 2 oz.,
boil in 40 oz. of water for a quarter of an hour, strain, and
add one ounce ot sulphate of magnesia, 8 grains of tartar-
emetic, and one ounce of syrup of buckthorn. In the
evening one grain of extract of belladonna was exhibited.

2d day. The painter's aperient enema was administered
prepared with an infusion of 2 dr. of senna leaflets in 16 oz.
of boiling water, to which was added one drachm of pow-
dered jalap, one ounce of the electuary diaphsenix and of
syrup of buckthorn. In the evening the patient took 2 gr.
of extract of belladonna, In the course of the night the
bowels were relieved once.

3d day. A considerable amendment was observed. The
following mixture was prescribed :

I}. Fol. sennse, IS

Rhei contus, . . . . If 5

Boil for a quarter of an hour in aqua?, 5

Strain, add :
Syrupi rhamni, . . . 10 5

Sodas sulphatis, . . . . 4 5

In the course of the evening the anodyne painter's enema
with ol. juglandis 6 J oz., and vini gallici 10 oz. was admin-
istered. Also, a pill of 2 gr. of extract of belladonna.

From this hour the bowels acted freely, and the bella-
donna was continued alone. We should not omit to say
that, in this case, Faraday's electricity was applied from the
beginning, and had much diminished the pain, without,
however, modifying in any principal way the disease.
Champ. Journal.

Formula in Mmtagra. As a local application, M. Richard
employs the following solution, frequently applied, with good
effect: Sulph. of zinc, 16; sulph. of copper, 5; water, 500;
and laurel-water, 15 parts. Presse Med. Beige, No. 25.

I860.] Urethritis and Vaginitis,

Urethritis and Vaginitis. Solutions <>f Chloride of Zinc.

The Gazette des Hopitaux published, some months
the results of a series of experiments instituted by Profi
Legouest, of the Hospital Val-de-Grace, on the value of
chloride of zinc injections in the treatment of urethritis.

The use of chloride ofzince had been tried in 50 patients
belonging to this physician's wards; of these Ci in-<i

thritis 21 were simple, 1 1 acute, IT chronic. All thesi
patients had injected, once every morning, a solution of
chloride of zinc at 1-1000 for simple and acute urethritis,
and at 1-500 for chronic and obstinate cases. Each patient
had retained the liquid injected a space of time varying
from three to five minutes. These experiments proved:
that injections o\' chloride of zinc of the above mentioned
strength, are not in general painful; that they rarely indue
accidents; that they rapidly modify the discharge; that in th<
greater part of cases of acute urethritis they assuage inflam-
mation and pain; finally, that they succeed less perfectly in
Minple and benignant discharges than in acute or chronic
urethritis.

In this last category especially, injections of chloride oi
zinc yielded Mr. Legouest really remarkable results.

We waited, before we noticed Mr. Legouest's remarks,
for further confirmative facts, when the Bulletin de Th
peutiqut informed us through one of its correspondents, Dr.
Gaudriot, that this physician had recommended the medi-
cation alluded to twenty-five years since. Mr. Gaudriot
has done better than moot a question of priority; he proves
that solutions of chloride of zinc are not beneficial in ure-
thral blennorrhagia only, but that they are likewise very
efficacious in vaginitis. The following are Dr. Gaudriot V
formulas for both these diseases:

SOLUTION FOR INJECTIONS.

1$. Liq. zinci chloridi, . . . .24 to 36 min.

Aq. destillatee, 3

Shake and filter.
Two or three injections to be performed daily. The
syringe to be used should be provided with a bulbous ex-
tremity, and a very small quantity of fluid should be
employed, the disease in its incipient stage occupying the
fossa navicularis.

FOR A VAGINAL SUPPOSITORY.

R. Liq. zinci chloridi, .... 5 min.
Morphise sulphatis, .... J gr.

226 AcuU Chorea treated vrith Arsenic. [MarAj

Thicken to a proper consistency with 2 dr. of the following :
\{. Mucilaginis acaciee, . . . . 6 pi
cchari pulvei .... 5 u

Amvli 3 "

Mix with care and mould a hollow suppository not m<
than one line in thickness. One suppository is inserted
every day, and suhsequently every alternate cl

I f Acute Chorea treated successfully with Arsi

Dr. EtoNZiBB Joly. (Bulletin General de Therapeu-
tique, October ;L5th, 1&

Dr. Ronzier Joly was induced to try the effect of arsenic
in chorea, from seeing an article recommending that treat-
ment by M. Aran. The case was that of a hoy, twelve years
old, who was bitten by a dog, and who was suffering also
under acute rheumatism. The latter disease yielded to
ordinary remedies, but when he was convalescenl be began
to stammer and to perform irregular movements with his
body. The arms were continually in motion, and the legs
were almost as actively employed. The movements of the
heart were regular, but frequent; the pulse 90, and com-
pressible. So'on afterwards the patient was seized with an
attack of true epilepsy, which lasted for a quarter of an hour.
Dr. Joly then prescribed a mixture consisting of araenious
acid and water, the doses to he taken in increasing quanti-
ties, heginning with 2j milligrammes of arsenious acid on
the first day, 3| milligrammes on the second day. and 5
milligrammes on the third day. At this period a litth
provement v erved in the agitated moven f the

patient. On the fifth day the dose of arsenic was raised to
6 milligrammes, and on the eighth to 8 milligramn
which \] was again diminished, and continued at the

rate of 4 millh day. On the twenty-sixth day

from the commencement of this treatment, the boy articu-
lated words, swallowed liquids with facility, and put out his
jie naturally; the irregular movements had completely
disappeared, and the gait was Less vacillating, notwith-
standing the extreme weakness of the lower limbs. The
boy's mother perceived at this time that Borne fovous crusts

on' the head were diminishing in size and extent. The

arsenious acid was continued in the dose of 3 milligrammes
a day for some time after the disappearance of the symp-
toms. About three months and a half from the first attack
of chorea, the report Btatesthat all medicines had been sus-

i860.] Treatment of Blennorrhagia. 227

pended for a long period, that there was no farther sign of
chorea, but there were a lew rheumatic pains, and the fevus
had not altogether disappeared.

On the Treatment of Blennorrhagia by Vinum Colchici and
Tincture of Opium, By Dr. Eisenmann, of Wurzburg.
(Bulletin General de Therapeuticme, May 15th, 1859.)

Dr. Eisenmann states that lie once had occasion to pre-
scribe a combination of vinum colchici and tincture of
opium for an officer affected with rheumatic conjunctivitis,
and a few days afterwards he was informed that the medicine
had cured not only the ophthalmia, but also a blennorrhagia,
of which no mention had been previously made. He was
surprised at this result; but he resolved to profit by it, and
to try the same treatment in other cases. He therefore
prescribed the medicine for a girl affected with blennor-
rhagia, and was again surprised that a permanent cure was
effected in a few days. Nothing was ordered externally,
except frequent applications of tepid water. Subsequently,
several cases of blennorrhagia in the male presented them-
selves, and were treated in the same manner. The dose
employed was eighteen to twenty drops, three times a day.
of a mixture consisting of twelve grammes of vinum colchici
with two grammes of tincture of opium; milk was ordered
as the principal article of food, and absolute rest was en-
joined. All the cases of blennorrhagia thus treated were
cured without exception in a few days, especially when the
treatment could he adopted at the commencement of the
affection, and none resisted longer than a week. The ob-
servations of Dr. Eisenmann have been confirmed by those
of M. Collin, of Dresden, avIio treated ten cases of blennor-
rhagia with the greatest success by the mixture of vinum
colchici and laudanum. The patients did not recover so
rapidly as those treated by Dr. Eisenmann ; hut the latter
physician attributes the difference to the provable inferiority
of the drugs employed, and to the fact that the patients did
not consult a medical man at a sufficiently early period.

The Purity of Glycerine may I dropping into

a glass of it a lew drops of nitrate of silver. If, as is often the
case, the glycerine contains any chlorides, there will imme-
diately take place a cheesy precipitate. Bull, Tit r.

228 Normal Hypertrophy of the Heart. [March?

Normal Hypertrophy of the Heart during Pregnancy. In
our number for July Last (p. 276) we gave a brief notice of
the researches of M. Larcher on this subject, and shall now
furnish a fuller account of them.

Mi\ Lurcher has had ample means of investigating thia
subject at the Paris, Maternite, for he has examined 130
pregnant women, the greater number of whom succumbed
to puerperal fever no Lesion having preceded or given rise
to the condition of the hear ed in them. The con-

clusion he comes to is, that the / i ally in << state of

hypertrophy 'on. The walls of the left ventricle

become increased by at 1< m a fourth to a third in

thickness, its texture being also more firm and [ts colour
more bright the right ventricle and the auricles retaining
their normal thickness. These observations, made by M.
Larcher, date back some thirty years, and have been eon-
firmed by subsequent ones, made with great exactitude, by
M. Ducrest, upon 100 other women : but why this paper
has been so long in being published no explanation is given.

Within certain Limits this condition of things may
co-exist with the maintenance of health ; but it none the
less may he taken to express a predisposition to congestions
and hemorrhages. If, as the general rule, the hypertrophy
gradually disappears after parturition, it may be otherwise
in exceptional instances, especially where the recurrence of
pregnancy has been frequent, and with short intervals. Is
this not a cause of the varied lesions of the circulatory
apparatus pamonly met with in women who have

borne many children, either at two premature an epoch, at
too brief intervals, or during an unfavourable condition of
health ? There is every reason, too, to believe that the
bronchitis, which is so common during pregnancy, derives
much of its character of persistency from this condition of
the heart. Again, may we not attribute to this the greater
danger of pneumonia when developed in pregnant women,
and the frequency with which abortion then occurs': The
various forms of hemorrhage met with in pregnancy, as
epistaxis, haemoptysis, metrorrhagia, and apoplexy, are like-
wise predisposed to by this hypertrophy, normal though it
be. Although , pregnancy may, in the majority of c
suspend or render slower the progress of pulmonary eon-
sumption, the progress of this affection becomes accelerated
after delivery, and the still hypertrophied heart increases
the perturbation of the respiratory apparatus. Med. limes
and Gat., Dee. 3, 1859, from Ar hives Generates, tome xiii.

0.] /

I

I'.lll

mini

in '; plan

he |

i >r three

i

f drink.

In tin

it'tv
admin-

B)

\l.
< h

ntlv

; the

apon th< 1" 'in ol

with well
uewhut from tl;

230. Treatm nt of Indol nt Ulcers. [March,

of the face; but in the pigs, which appear to derive their'
convulsive affection from their parents, paroxysms cannot
be induced in this manner; while the form of those occur-
ring spontaneously is not exactly the sane'. The animal is
first seized with trembling, and then falling on its flank it
agitates its Limbs spasmodically. The young pigs thus
affected have proceeded in about an equal number from
epileptic mothers and fathers. Sometimes parents thus ren-
dered epileptic by myelo-traumatism produce little ones,
none of whom exhibit the affection, or while some do, others
do not. M. Brown-Sequard has had under his ohservation
a very large numher of guinea-pigs, and while not denying
the possibility of the tact, he has never seen a single animal
present an analogous convulsive affection, unless it had
previously undergone a lesiou of the medulla, or was the
offspring of a parent who had hcen rendered epileptic in
this manner. Gazette Hebdomadaire, No. 44.

Treatment of Indolent Ulcers hj Vapor of Iodine,
During the Last three years nearly all the eases of indolent
ulcers entered under our care to the U. 8. Marine Hospital,
have been treated by the vapor of iodine. The result is very
satisfactory in nearly all eases: more so, by far, than that
obtained by any other single method. Its advantages are
conceived to he these :

1. Cleanliness and facility of application.

2. Rapidity of cicatrization.

3. Destruction of the odor of the ulcer. Iodine acts as a
disinfectant, like chlorine.

The manner of using it is as follows :

1. Dress the ulcer with simple cerate, spread on lint.

2. Take from one to four grains of iodine, according to
the size and degree of indolence of the ulcer, folded in
several layers of lint, and place it on the ulcer, over the first
layer.

3. Cover this with a piece of oiled silk and tin foil, which
should he large enough to extend beyoud the edges of the
ulcer. . This is to prevent rapid vaporization, and it should
be secured by a roller.

The warmth of the member speedily vaporizes the iodine,
and a sensation of warmth is perceived by the patient on
the ulcerated surface. If applied in too large quantity, or
too directly on the surface, the iodine acts as an escharotic.
Care is therefore required in this respect. N. A. Med.
Chir* lu

0.] Treatment of Gout and Rheumatism. 281

A New Ireatment for Gout and Eheumati
In a report to the Academy of Medicine, M. Bouillaud
describes the treatment proposed by Dr. Lecalve for g*
and rheumatism, two diseases which thai gentleman con-
ceives to be nearly akin, and which should therefore be
sidered jointly .
The syrup and topical application in which Mr. Lecalve's
treatment principally consists are prepared as follows. For
the syrup:

K-. Extr. spirit, aconitse, )

digitalis, . . . >aa. 8 gr.

menth. pip. . . J

Extr. aq. Periscarise, ... 1<> gr.

A.[. destill, q. s.

Ui fiat solutio.
Syrupi gummi acacias, . . . 10 5

For a syrup of which a tea-spoonful should be taken three
nines a day in a glass of gum and water.
For the topical application:

Jy. Tinct hederse, . ^

seillae, . . . . >aa. 2J r5

menth. pip. . . . j

belladonna, ... 2

M.

A compress impregnated with this fluid should be applied
to the seat of pain.

Mr. Bouillaud, in reporting on Mr. Lecalve's communi-
cation, merely indicated, without expressing any approval,
a method of empirical taeatment proposed for diseases,, one
of which at least, rheumatism, is, in the opinion of the
learned professor, essentially of inflammatory nature, and
requires an energetic antiphlogistic treatment, for the pur-
pose of averting cardiac complications.

Norms. Mr. George Browning states [Med. Times and
Gazette, Nov. 19,) that he has lately employed collodion
with marked success as an application for the cure of |aevus.
It is most applicable to mevi situate over bone, exerting
in such cases an ' i pressure much more effectual and
more readily appli i than that produced by means of a disk
of ivory, or other mechanical appliances, with plaster and
bandage. lie says he has never known it to fail when lie
has applied it himself, which he does daily, by means of a
camel's-hair pencil.

232 Cieatrix4ike Streaks. [March,

' icatrix-like Streaks on the Skin of the Abdomen, Bn
and Thighs of Women that arc Pregnant or have Children.
I>y L. Elsbbrg, M. D., of New Xork.

opinion- as to the time of appearance, frequency, and
peculiarities, and medico-legal importance of these
Btreaks, are so unsettled and conflicting, that we gladly hail
the excellent review of the subject by ('cede, of Berlin, one
of the editors of the " Monatsschrift fur Geburtskundi und
JPrauenkrankheiten." We Lave prepared for our readers the
following propositions which he has established: (Mon-
atschr., Sc, Nov.. 1859, p. 323 et seq.)

1. The streaks on the abdomen more or less extensivelj
exist in the great majority of pregnant females. They ap-
pear but verv seldom, however, during the first half of

nancy frequently not until the last month, or the last
but one

2. Soon after delivery they change in appearance, becom-
ing gradually less evident, unless the skin is made tense.
but never entirely disappear.

3. In some cases they do not appear during pregnancy,
and sometimes no trace of them can be found after repeated
pregnancies.

4. Sometimes they appear for the first time at the second
or third pregnancy, or else new streaks are added to the old.

5. They may make their appearance, also, without the
existence of pregnancy in consequence of diseases produ-
cing a rapid and considerable extension of the skin,

dally in dropsy, therefore.)

6. The quite similar streaks on the breasts, and the ante-
rior surface of the thighs, occasionally, also, on other parts
of the body, as the buttocks, calves of the legs, etc., merit

one attention as those on the abdomen.

Mixture for Dispelling inebriety. Several periodicals
have staled that Dr. Beck, of Dantzig, had discovered in a
mineral paste the true antidote of alcoholic inebriety. Mr.
Chevalner, who mentions the circumstance in the Journal tit
Chimie Medicate, remarks that the real specific for intoxica-
tion is the acetate of ammonia, exhibited according to the
torn i ula of Max uy e r :

R. AmmonisB acetatis, - - 2to2gr.
Aq. cum Baccharo, . - 5 ox.
To he taken in one dose.

I860.] Editorial 2ft8

KMTORIAL AND MISCKLI ANKOl S.

To avoid Sutures and Shaving the Head in Wounds or the Scalp.
l$v Henry P. Campbi

Wounds of the Scalp generally heal readily and Beldora gaj e rarely

iring a suture. M its, however, are unwilling to lake the

leave them undressed nor would this course be altogether

prudent, as the inflammation and tumefaction which sometimes follow

these injuries, cause the edges to become everted and give rise to a

troublesome, irritable wound. Often, too, the haemorrhage will not

till the edges are brought together. The usual method of dressing

wounds requires the shaving off of the hair for some, distance

around the wound, in order to apply the adhesive plaster. If the wound

should be a long one, or if there should be many, a very disfiguring

amount of the hair is required to be removed, and long after the wounds

have boon cured, these, often discreditable, patches of baldness remain,

a source of great mortification to the patient. Sutures are inadmissible

from their liability to produce troublesome inflammation. Could they

be safely applied, the plasters and necessary previous shaving would be

avoided.

The following plau of dressing, though not entirely new, has not, in
our opinion, received the attention it deserves :

Having occasion recently to dress the head of an Irish drayman, who
had received an extensive wound of the scalp from the kick of a horse
the wound being irregular and about two inches and a half in length,
with everted edges and bleeding some retentive means seemed neces-
sary to keep the edges in apposition. We were about to shave the scalp
on either side of the wound, in order to make a bare surface for the ap-
plication of the plasters. In handling the matted hair in order to remove
the blood, we found that the edges of the wound were separated or ap-
proximated according as the bordering hairs were drawn from or towards
the median line. From this observation, the measure was adopted of
tying the strands of hair across the line of the ivound, using them
in the manner of sutures to effect ajjp'roximcUion and retention of
the edges.

The plan worked admirably, giving no pain whatever to the patient
A pledget of lint with simple cerate was then placed over the wound as
a compress, and the bandage applied as usual.

The above method is probably familiar to others, but as yet we have
seen no record of it in recent works on Surgery. We regard it as a

234

Editorial

[March,

useful and easy mode of dressing these wounds, and hence this brief
report. Even when an eliptical piece has been removed in the extir-
pation of tumors, this plan will surpercede the necessity of shaving the
scalp.

The only difficulty which presented itself in carrying out this plan was,
that the wet hair was disposed to slip, and for a while, the knot became
loose. This inconvenience can be avoided in many ways, as for instance,
the requisite amount of the proper hairs may be selected from either
side, and these may be folded iu at the ends upon a piece of warm adhe-
sive plaster, the length of the wound, and then wrapped on it in the
form of a roll, after the manner of young ladies " doing up their hair in
papers " or little clamps of split -s> hot may be applied upon the strands
of hair from the opposite sides.

Chloroform Vapor ix Ear- Ache. The use of oil and chloroform
in ear-ache is familiar to many. A recent case treated by Dr. L. D.
Ford, of this city, develops the use of chloroform vapor for this affection
on a method which proved highly satisfactory. The patient, a child, suf-
fered severely, and other remedies failing, Dr. Ford used the following
extemporaneous expedient :

Taking a 2 oz. vial, a small opening was punched through the bottom,
a little cotton-wool soaked with chloroform was then put into the vial.
The mouth of the vial was now applied to the external meatus. The
attendant then placing his lips to the punctured extremity of. the vial,
blew the vapor into the external ear. The relief was instantaneous,
and the patient soon fell asleep, being cured by this single local applica-
tion. We commend the above method as well worthy of trial in cases
of this painful affection of childhood.

Climate and the Consumptive. By Wm. H. Doughty, M. D.
The above valuable communication is completed in our present number.
Dr. Doughty's researches in these important relations have proved of
much interest not only to members of the Medical Profession, but to all
who have had the privilege of perusing the former numbers of his very
full and laborious investigation for who is not interested in the ques-
tion, " How shall we select a Sanatorium fur the Consumptive ?" We
hope still to receive the contributions of our valued correspondent
and here again ask that assistance, in contributions, from other members
of the Profession, which their heretofore liberality, and the wide circula-
tion of this Journal, as a medium of communication, give us the right
to expect.

I860.] Editorial

Dr. N. Bozeman. Wc learn through a private lotter, just as our last
pages arc going to press, that this distinguished gentleman and skillful
operator, has removed from Montgomery to New Orleans. Ee
established a Hospital in New Orleans which will be principally devoted

to the treatment of females, and such as require the various operations
in Obstetric Surgery; and he is prepared to accommodate pati
coining to him from a distance, in a far more comfortable and elegant
manner than they could be at a hotel or private boarding-house. A
Woman's Hospital in the South is certainly a most desirable institu-
tion, ar.d we know of no one more suitable as its head than our friend
Dr. Bozeman.

Formula for Preparation of Strychnine. in the valuable com-
munication published in our January issue, page 5, " Strychnine as a
Remedial Agent, By J. McF. Gaston, M. D.,. of Columbia," there
occurred, we regret to say, an inadvertent omission, which we now
hasten to correct. The error will be found on page 7 of the January
number. It will there be seen that the ingredients of Dr. Green's
formula are given, while the proportions are omitted. The deficiency
is supplied in the formula given below :

SOLUTION OF STRYCHNLE.

IJ. Strychnia grs. xij.

Acidi Acetiei, gtt. Lx.

Alcohol, f: j.

Aqure font., f: xj.

Mix.
The above mixture is to be kept in the office. The dose is from 5 to
10 drops and very rarely as much as 15 drops three times a day.

The American Medical Association. We take pleasure in giving
place to the following :

The American Medical Association will hold its Thirteenth Annual
Meeting at New Haven, on the First Tuesday of June, i860.

The Secretaries of local Societies, Colleges and Hospitals, are re-
quested to forward the names of delegates, as soon as they are appointed.,
to Stephen G. Hubbard, M. D., Secretary,

New Haven, Connecticut.

Injection of Tincture of Aloes in Gleet. M. Gamberini,
of Bologna, states that in some cases in which other injections
have failed, he has derived great advantage from injecting
tincture of aloes 1-t r>arts diluted with 120 parts of water.

236 Miscellaneous. [March,

Persulphate of Iron as a Haemostatic. Monsel, of France,
first proposed the use of this excellent haemostatic, and as
its use is becoming more general, we give our readers Aw
process for its preparation.

"Place in a porcelain capsule 100 grammes of distilled
water, and 10 grammes of sulphuric acid, raise the mixture
to the,boiling point, and then add 50 grammes of protosul-
te of iron. After complete solution Latter, pour,

in small quantities, into the boiling liquid 16 grammes of
nitric acid at 35. When the rapid discharge of orange-
colored vapors has ceased, add. in portions, 50 grammes of
the protosulphate of iron, the solution of which will produce
again reddish flames, and will cause the excess of nitric acid
t i disappear. The volume of the liquid is then raised to
100 grammes, by the aid of distilled water, cooled and
filtered."

Monsel suggests that 100 grammes of this solution be
treated with a few grammes of linseed oil, and that the
mixture he shaken three or four times in twelve hours.
There is thus obtained a perfectly neutral solution, having
no nitrous odor, and susceptible of preservation for a very
long time. The solution is limpid, of a very dark brownish
red, inodorous, and with an extremely astringent, but non-
- ;ic taste. It marks 45 of the pese-sels. When concen-
trated by boiling, it assumes the consistence of honey, and
if, in that condition, it is spread in thin layers on [dates of
glass, and dried at a temperature of about 100 Fahrenheit,
it can be obtained in redish-yellow scales, transparent, like
c of the citrate and tartrate of iron. Jour, de Phar. et
de Chin.

Southern & / the M hoots of Phila-

delphia. We have learned through the newspapers that over
three hundred medical students from the Southern States,
recently left Philadelphia in a body for Richmond, and other
Southern cities.

If this movement is to he regarded as the result of political
causes, it is to be regretted. h\ on the contrary, it was the
result of a returning sense of the mistake the young gentlemen
committed in passing by the schools of their own States,
especially for those of Pennsylvania, we cannot hut commend
their good judgment.

The medical schools of the Southern cities suffer nothing in
comparison with any in this or foreign countries.

Their professors are learned and eloquent ; the facilities for

I860.] M 287

clinical teaching are, in Borne of the large cities, ample. Why,
thou, should they not be Bnpported by Southern Btuaentel
We do not in any wa\ intend to disparage the advan
of Philadelphia as a seat oi medical Learning. Eer chara*
is too well established [nire endorsement or fear de]

elation; but we have i<::ig believed that a more equal di
bution of students among bucIi medical schools of tne country
as possess facilities for clinical instruction, instead ring

five hundred on the seats of a single lecture-room, would be
for the advantage of all concerned, and we hope that I
the medical students of the West will not be behind thoe
the South in their attachment to itutions of their i

particular sections institutions which, if they are ndt already
fully equal to any others, only require the patronage to which
they arc legitimately entitled to render them so. Chicago
Medi

Prepar f Larch Bark in Pulmonary Hemorrhage.

In our number for duly, 1858 (p. 201,) we noticed favourable
results obtained by Drs. Moore, Kennedy, Carmichael, &c,
from the use of the larch hark. Dr. Owen Daly sti
[Medical Times and Gazette, Nov. 12, 1859) that he has used
with equal success this article. He prescribed it first for an
out-patient at the Hull General Infirmary, suffering from
pulmonary h< morrhage, for whom he had, without
slightest benefit, prescribed, all the usual styptics: he
resolved to prescribe the tincture of bark. The patient was
a female, aged 82, a widow in an advanced Btage of consump-
tion. She complained of great difficulty in breathing, of
oppression at her chest, and of a constant cough, attended
witli expectoration of blood. The tincture of larch was
ordered in twenty-drop doses every third hour in a little
water; the relict was Immediate; at the end of a week the
haemoptysis w;i> entirely arrested; and her other symptoms
were so much mitigated that she soon ceased, to attend at.
the infirmary.

The styptic properties of the larch bark had, in this case,
so far exceeded my expectations that I thought it deserving
of a more extended trial, and up to the present time, I have
prescribed it in fifteen cases of pulmonary hemorrhage.
The cases have not been selected some have been
active and severe haemoptysis, others of a passive and more
chronic character. I have also employed it in one very
re case of epistaxi>. and in a ease of chronic cysti-
tis, and with the exception of this latter ease, in ^very
instance with the most satisfactory results.

238 Miscellaneous. [March,

wostwia in Marsh Fevers. M. Burdel thus concludes a
memoir upon this Bubject-; 1. A true diabetes exists in

ah. fevers. 2. Jt is only ephemeral, i.e., being the evi-
dence of the disturbed state of the economy, it appears, per-

. and disappears with the lever. 3. It is the expression of
the special disturbance of the equilibrium prevailing between
the cerebrospinal and sympathetic nerv terns. 4. M.

Claude Bernard's explanation is confirmed by these tacts. 5.
The more violent the paroxysm, and the more intense the
shivering, the greater is the amount of sugar. 6. On the
other hand, the greater the number of paroxysms which have
taken place, and the more these have lost their force when,
in fact, the cachexy has become established, the less is the
quantity of sugar. Union Med., No. 139.

The Influence of Cohabitation in the Transmission of
Phthisis. M. Brouchon concludes an interesting memoir
upon this subject with the following propositions: 1. Pulmo-
nary phthisis may become communicated in the course of time
from individual to individual under the influence of cohabita-
tion, and the consequent intimate relations a proposition
equally supported by reasoning, and by facts. 2. The trans-
mission is usually operated from the older to the younger
subject. 3. In the great majority of cases it takes place from
the man to the woman. 4. It is to be feared in proportion as
the subject exposed to it manifests a pre-disposition to the
disease. 5. The influences which contribute to the result are
identity of hygienic conditions, frequent absorption of morbific
exhalations from the diseased subject, and fecundation by the
latter. Revue Medicale, 1859, tome ii., p. 88.

A Spanish Cure for Nymphomania. A young woman of
high position having terminated a brilliant education at a
convent in Saragossa, was seized, after romance reading, with
nymphomania. M. Ester, the physician, believing that acting
upon the imagination of the patient was the only effectual
mode of cure, had her suddenly and without explanation con-
veyed to the Venereal Hospital. She was there brought into
the presence of a woman covered with syphilitic ulcers, and in
the most deplorable state ; and the sufferings, regrets, and im-
precations she listened to produced so vivid an impression
upon the girl, that she at once returned to chaste ideas. She
has since married, had children, and remained a model ^t'
grace and virtue. Hid., p. 429.

I860.] MisceUam 289

Digitalim i/n Puerperal Fever, By Dr. Sebbe. In one
of the late sessions of the Academic de Medecine of Paris, I >r.
Berre communicated an elaborate treatise <>n the treatment of
child-bed fever, in which he extols the efficacy of digitaline in
this affection. He administered one granule of the prepara-
tion "digitaline," manufactured by Homolle and Quevenne,
every four, five, or Bix hours. He reports' nine cases treated
in this manner, in eight of which the remedy acted very favor-
ably, although the disease had made already considerable
yress iu some of them. The principal effi consists

in diminution of the frequency of the pulse and of respiration,
and a simultaneous amelioration of all the other Bymptoms.
The efficacy of digitaline is, according to his statement, supe-
rior to that of quinine, which has been rec commended,
and produces a similar effect Gazette des Jaopit., 1859, 50.

Tannin Crayons i/n Affections of the Uterus, M. Bec-
rel finds these of great service in affections of the cervix
uteri, being advanta^ institutes for intra-uterine injec-

tions. They are formed of tannin 4, and gum tragaeanth 1
part, mixed up with crumb of bread. They are about one-
sixth of an inch in diameter, and an inch long, and are passed,
by means of a forceps and speculum, through the os uteri into
the cavity of the uterus, in which they are kept by means of
charpie, moistened with a concentrated solution of tannin. The
crayon softens and dissolves ; and at the end of twelve hours
the charpie is withdrawn by means of a thread attached to it.
Anew crayon is introduced every third or fourth day, and
:r a month's treatment the fungosities of the mucous mem-
brane gradually disappear, and hemorrhage ceases. Bulletin
Therap., t. lvii., p. 365.

Application in Tumors of the Breast of a Doubtful Na-
. Benign tumors of the breast so far simulate cancer
sometimes that even experienced surgeons advise their extir-
pation. M. Chahrely has recently published several cases of
this description in the Bordeaux Journal de Ifedecine, in
which a complete cure has been effected by applications of
the following powder continued uninterruptedly during sev-
eral months : Powdered starch, 250 parts ; powdered iodine,
.V to 1 part ; chlorhydate of morphia, -J- a part. Mix. The
powder is to be applied upon a layer of wadding, which is to
be kept in situ by a suspensory bandage. Bulletin de The-
rapeutique^ tome lvii., p. 412.

240 Miscellaneous.

Ala. in Lozenges i/n Affections of the Throat. M. Argenti,
(f Venice, proposes, as a substitute for alum gargles in affec-
tions of the throat, lozenges formed of alum, sugar, and traga-
canth, mixed up with diluted laurel-water, so as to form
lozenges, each containing a suitable dose of alum. The mass
is to be w< i: nlated, and, after division, to be put on a

sheet of paper and dried by a gentle heat. The lozenges keep
well, and form an agreeable medicament, which, by aid of
the saliva, becomes effectually applied to the parts. A phar-
macien of Paris lias for some time past prepared chlorate of
potass in the same manner. Bulletin de Theraj?., tome lvii.,
p. 413.

A New Idea. Dr. Foussagrives, amongst other conclusions
concerning tartar emetic, has arrived at this one : That in large
doses it generally arrests the acute accidents of tuberculous
softening in the lungs, and maintains or brings back the con-
sumption to that condition in which mineral waters and fish
oils are so successfully used. The existence of signs of soften-
ing of the stomach (what is this disease, and what are its
signs?) constitutes the only contra-indication to the rise of the
tartar emetic. Bull. They.

Prof. Cruveilhier's Purgative Mixture. JS^arbonne honey,
30 grammes; syrup of buckthorn, 30 grammes; powdered
senna leaves, 4 grammes; powdered jalap, 4 grammes ; pow-
dered scammony, 1 gramme ; powdered squills, 40 centi-
grammes ; powdered calomel, 40 centigrammes ; powdered
digitalis, 40 centigrammes. Divide the mixture into four
parts, and take the four doses in eight days one every other
day. Used in albuminuria. RejperV Pharm.

Chloride of Sodium as an External Resolvent. M. Ance-
lon affirms that chloride of sodium employed externally,
whether in powder, or incorporated with lard or linseed oil,
forms a most admirable resolvent of indurated lymphatic
glands. Frictions made with a pomade composed of it will
induce an eruption resembling variola, which proves of great
use in pulmonary phthisis and in chronic affections of the ali-
mentary canal. IJ Union Med., No. 132.

In 1813, DeQuincey increased the quantity and frequency
of his doses of opium so much, that he took 320 grs. daily.
Prodigious as this quantity is, it is only half what Coleridge
was in the habit of taking.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(new series.)
Vol. XVI. AUGUSTA. CEOKIilA, APRIL, 1S60. NO. 4

ORIGINAL AND ECLECTIC.

ARTICLE VIII.

Messrs. Editors: In yielding to the solicitations of
partial young friends, by sending you the accompanying
lecture for publication, I do so more from a desire to gratify
them than from any belief in the originality of the remarks
thus hastily extemporised. In order to elucidate the subject, I
have appended translations of such portions of Hahnemann's
works as seemed appropriate.

I am yours, very truly,

L. A. Dugas.
Augusta, 1st March, 1860.

A Clinical Lecture delivered at the Augusta Hospital upon the
subject of Homeopathy. By L. A. .Dugas, M. D., &c.
Written out by request.

Gentlemen : As some of your number have requested
me to give my opinion of Homeopathy, and as I believe it
a matter of importance that you be aided in forming
a correct appreciation of this, as well as of other irregular
systems of practice, I will omit any further remarks upon
the cases we have just seen, and proceed, as briefly as I can,
to gratify the desire expressed.

As the business of the physician is pre-eminently the

search after truth, he should early learn to appropriate it
1G

242 DUGAS. .1 Clinical Lecture [April,

with avidity wherever he may find it, whether in the depths
of ignorance or in the halls of learning, in the vagaries of
the enthusiast, or the logic of the philosopher, in hasty
conclusions or mature observation, lie should not be
deterred from a careful examination of a theory, a system,
or a practice, merely because of its supposed antagonism to
generally received opinion, or because it may be found in
the hands of charlatanism to be made subservient to base
purposes. He should, on the contrary, calmly and dispas-
sionately look into any and every scheme alleged to present
new tacts and consequently new truths in the treatment of
disease. He should never flag in his efforts to discover the
truth, wherever it may lie, and the very difficulties inherent
to the subject of therapeutics should lead him to be extremely
cautious lest he be unconsciously swerved by pre-conceived
notions.

The subject of Homeopathy is, of course, not new to me;
indeed, it is one to which my attention was at one time
specially directed, inasmuch as the doctrines of Hahnemann
were exciting much interest in Europe, and especially in
Paris, during my first sojourn in that city some thirty years
ago. The term Homeopathy is intended to convey in one
word the gist of the doctrine of "SimiUa SimUibus OurtxnJtur"
or that "like cures like." Xow there is nothing new in
the idea that certain morbid conditions may be advan-
tageously treated with remedial agents capable of inducing
a similar state. There is nothing novel I say, however
much /may be opposed to it, in the prescription of a laxa-
tive for the relief of diarrhoea, spirits of turpentine lor
burns, lunar caustic and other irritants for inflammatory
affections. Many physicians occasionally practice upon this
principle. But if you attempt to generalize it, you see at
once that it is out of the question. You have a patient with
the tooth-ache, another with the gout, a third with pleurisy,
and so on. Xow I would ask, what articles do we possess
that can induce either of these affections, or anything like
them ?

The truth of the matter is. however, that although Hah*

I860.] Upon Homeopathy. 248

ueiiianii applied this epithet to hifl system, it docs not indi-
eate the real, the greal peculiarity of his practice. We find
this in the doctrine that tie' potency of a remedy is not, as
has been heretofore supposed, proportionate to the magni-
tude of the dose, but, on the contrary, is increased by its
diminution so that the millionth part of a grain of Peru-
vian Bark is infinitely more potent than an ounce! And
that articles almost inert in large doses, grow so rapidly in
activity, by lessening the quantity^ as to become positively
dangerous when administered in doses so infinitesimal as to
defy calculation !

Again, in establishing the rules by which remedies should
be prepared for Homeopathic usefulness, Hahnemann dwells
at great length upon the vast importance of cleanliness and
the careful avoidance by every means of the perturbating
iniluence of extraneous agents, such as solar light, hear,
gaseous emanations, odors, metallic contact, &c, &c. The
greatest care should be taken to secure correct weights ; to

#"ThBS, gold, silver, platina, charcoal, are inert when taken in their natural
state. The most impressible person may take several grains of gold or silver
leaf, or of charcoal, without appreciable effect. But let one grain of gold be
triturated one hour with one hundred grains of the sugar of milk, and a very
active medicinal agent will be produced. Let one grain of this be now taken and
again triturated with 100 grains of sugar of milk for a second hour, and thug
repeat the operation until one grain of the last preparation shall contain only n
quadrillionth of a grain of gold, and you will have a remedy in which the medi-
cinal properties of the gold will be so highly developed that if a single grain be
kept in a closed vial, and inhaled a few moments by one so deeply affected with
melancholy as to be on the point of committing suicide, it will be sufficient to
effect such a change that in one hour the unhappy man will be entirely relieved
of his evil spirit, (maurais demon.) and be restored to happiness."

* * ..- * * * # * #

'; Medicinal substances are not dead in the ordinary acceptation of this word.
They are, on the contrary, essentially dynamic, and this force can by mere ho-
meopathic friction, be indefinitely increased. This is so true that we should be
careful not to increase in this way the activity of agents too much. One drop
of Droscra, of the thirtieth degree of dilution, each dilution having been shaken
twenty times, will endanger the life of a child to whom it may be given for the
hooping cough, whereas, if each dilution has been shaken only twice, a single
grain of sugar, the size of a poppy seed, if moistened with it, will be sufficient to
secure a prompt and ready cure of the disease.

'"Peruvian bark is one of the most active vegetable agents if used in dis-
eases to which it is adapted, when the patient is violently attacked. I find that
one single drop of the tincture so diluted that it shall contain only a quadrillionth
of a grain, is a dose often too strong, but always sufficient to eitect all that can
be accomplished with the bark in such cases, and that it is very rare that the* dose
will have to be repeated in order to cure the case.?;

Translated from the "Exposition de la Doctrine Medicale Horaeopathique. ou
Organon de I'art de Guerir ; par S- Hahnemann." Paris 1832, p. 337, and p. 3'J.3.

244

Duqas. .1 Clinical Lecture

[April,

use mortars and pestles, as well as spatulas, of a particular
kind ; to have the water distilled in a retort which has never
been used for any other purpose ; to get alcohol, for dilu-
tion, which has been obtained from special substances; to

use none other than the sugar of milk for attenuating pow-
ders, fee, occ*
If you have not yet read Hahnemann's Organon, gentle-

Rules for Preparing Remedies.

The utmost cleanliness and care to avoid the influence of foreign bodies
are necessary in the preparation of homeopathic remedies. This should there-
fore, be done where the temperature is not above that of ordinary dwellings,
where the solar rays cannot reach directly the substances, and where the atmos-
phere is not charged with emanations ; such for example as those of sulphurous
acid, hydrogen, sulphuric acid, carbonic acid, and of odorirfeous medicinal
agents, especially of muse, valerian, camphor, spirit of hartshorn, castoreum,
assafetida, &c, for if the medicinal dilutions receive the smallest quantity of
them, their properties will be changed and become uncertain- For the same
reason it is that homeopathic remedies must not be prepared in vessels that have
ever contained .substances of strong odor, without having been most conscien-
tiously cleansed. After being abundantly washed, such vessels should be sub-
iected to a high degree of heat, for some length of time-" Op. Cit, p. 426.

t; Take one grain (of chalk or charcoal for example) and add to it one-third
of one hundred grains of pulverized sugar of milk in a porcelain mortar : mix
them with a spatula of bone or horn, and rub them together with a certain de-
gree of forcejfor six minutes : the mass should then be forced by the pestle
against the bottom of the mortar for four minutes, so as to make it homoge-
neous, and rubbed again four minutes with an equal degree of force, without
the addition of any other matter. This being done, devote four more minutes to
rubbing it upward and then downward with the pestle, and then place it upon
the second third of the sugar of milk and mix them with the spatula ; rub them
now with uniform force for six minutes, press the mass four minutes, and rub it
again with force six minutes more. After devoting four more minutes to compres-
sion, add the last third of the sugar of milk, which carefully mix with a spatula,
and conclude the operation by forcible friction for six minutes, pressure for four
minutes, and friction again for six minutes.

The powder thus prepared must be kept in a closed vial and labelled 100, in-
dicating that the remedy is of the hundredth potency.

In order to elevate the substance to 10.000, or to the ten thousandth potency,
take one grain of the powder marked 100. put it in a mortar with one-third of
one hundred grains of sugar of milk recently pulverized ; mix with a spatula,
and proceed as above stated, taking care that each third shall be rubbed with
force for six minutes, pressed four minutes, and again rubbed six minutes before
adding the second, and also before the addition of the third portions of sugar
of milk. All this being done, put the powder in a well stopped vial and label it
10,000, indicating that the medicinal substance is diluted to the ten thousandth
degree.

By treating in this way one grain of this new powder, it may be carried to 1,
that is to say to the millionth potency.

Each dilution then requires six compressions of six minutes each, and six rub-
bings of four minutes each, and will therefore consume upwards of an hour.

All remedial agents having been thus carried to the millionth potency iu the
state of powder, are then ready for solution in water or in alcohol. The first
solution cannot be made in pure alcohol, because this will not dissolve sugar of

L860. | Upon Homeopathy. 245

n ion, do so at once. It will amply repay yeu for your trouble.
I read it, a long time ago, most carefully and with as un-
biased a mind as I could bring to the Bearch of truth : and I
must say, that it seemed to me to be the most complete
rhapsody I ever read, save, perhaps, the k> life and narrative
of Thompson," the renowned author of Thompsonianism.
But Thompson was a poor illiterate man, who was deluded
by an imaginary inspiration from Heaven, as many have
been upon other topics. I believe, therefore, that he was
honest in his convictions. Hahnemann, on the contrary,
Was a very learned man, well versed in the history of medi-
cine, and evidently intimately acquainted with human na-
ture. We cannot for a moment suppose that a man of his
extensive acquirements, and a physician, too, of experience,
could believe palpable absurdities in matters purely scien-
tific. And yet they abound in the Organon. It is, as I
have already said, a perfect tissue of rhapsodies, as glaring
as those of Baron Munchausen. Xow, if he could not be-
lieve them he must have had, as well as the author of Mun-
chausen, some motive for inditing them. His knowledge
of human nature taught him that men are more apt to no-
tice and to believe mysteries than the naked truth. Like
many physicians who have passed the age of enthusiastic
and unlimited confidence in the materia medica, in all cases
of illness, he doubtless arrived at the conclusion that man-
kind was suffering verv much from excessive and useless
medication. But if he had at that time proclaimed this be-
lief, he would have been simply ridiculed and soon forgot-

railk. It should, therefore, be made with diluted alcohol, which is prepared of
uniform strength by uniting 100 drops of distilled water and 100 drops of pure
alcohol, by means of ten shakes at arms length, both materials being at the tem-
perature of cellars.

One hundred drops of diluted alcohol thus prepared should be poured upon
one grain of the powder of the millionth potency, the vial stopped, turned gent-
ly until the powder is dissolved, and shaken twice at arms length. The vial
must then be labelled 1001. One drop of this will now be allowed to fall upon
99 or 100 drops of pure alcohol, the vial closed and shaken twice, and we shall
have a remedy to be labelled 10,0001. And by thus repeating these processes,
the potency may be carried to the highest degree, only two shakes being given
at each new dilution.'* Ibid. p. 110, et seq.

' Sugar of milk and alcohol are the best vehicles of dilution, inasmuch sis
neither of them possesses any medicinal properties.'-" p. '

246 t)UGAS\ A Clinical Lecture [April,

ten. Such, however, could not be the fate of a highly
wrought system of mysticism, advocated with the apparent
zeal of an enthusiast and with the ability of a philosopher.
The scheme was well devised, well sustained, and secured
belief by the boldness of its revelations. That there are
some truisms in the Organon, I do not deny. In this the
author displays his tact, for mysticism is always strengthened
by being shown to accord with known truths.

Halmemannism is then, in reality, but a well devised plan
to carry out most effectually the, so called, expectant treat-
ment of disease. It is not, as is supposed by many, de-
signed for the purpose of treating all cases with drops of
nothing ; for Hahnemann insists that none shall practice
his method but thorough-bred physicians* Xow what does
this mean, if not that no one shall practice this system who
is not sunicientlv versed in the knowledge of legitimate
medicine to distinguish between the cases that require no
physic and those that do? This injunction of previous in-
struction is unfortunately too often neglected.

I am afraid that you may think me uncharitable in thus
attributing to Hahnemann the perpetration of so deliberate
a fraud. But there are some who would regard this in the
light of what has been termed a pious fraud the means
being justified by the end. I am not the apologist of such
a doctrine I detest it ! Nothing is valuable in science but
the naked truth, and the French school of medicine has
accomplished more effectually, by a straight forward course,
the reformation aimed at by Hahnemann, than he has been
able to do by the most subtle duplicity. That school was
engaged, at the time Hahnemann inaugurated his new doc-
trine, with the important study of the natural history of
diseases, unmodified by the perturbating influence of reme-
dial agents. Biscay's, were, under the supervision of able
men, allowed to run their course naturally and without in-
terference, and when their natural history was thus estab-
lished, it became an easy matter to determine the relative
\ alue of remedial agents. AVeli, what has been the result of
this study ? It has taught us that a large number of cases of

I860.] Upon Homeopathy, 1M7

illness will terminate favorably without medicine thai sunn.
will prove fatal notwithstanding all the resources of art, and
that others will rarely terminate favorably without the aid of
remedial agents. It is therefore the business of the physi-
eian to discriminate between these cases, and to treat them
accordingly. Hippocrates tells as somewhere, that a phy-
sician must determine, before he prescribes, whether the
case would end favorably if left to itself, and that if
he thinks it will he must let it alone, lest by inter-
fering with the operations of nature he render incurable
that which was not so before. But, von may say, this re-
quires consummate skill. It unquestionably does, and
none but those who possess it have any right to take charge
of the lives of their neighbors, at least without the firm
determination to resort to perturbating means only when
certain of their efficacy, and in all cases to give the patient
what lawyers term "the benefit of doubt," by non-inter-
ference. Dr. Chapman is said to have remarked that " any
fool can give physic, but it takes a good physician to deter-
mine when not to give it."

But, gentlemen, physiology teaches us that the state of
the system is very much under the influence of the mind,
and that in sickness we may accomplish important results
by operating upon the imagination. The hopes engender-
ed by confidence in the ability of the adviser, or in the effi-
cacy of the prescription are often powerful aids in the van-
quishment of disease. As the stamina and recuperative
energies of the system are buoyed up by cheerful hope, they
are correspondingly depressed by apprehension and a want
of confidence. Most persons have great faith in the materia
medica, and believe that there must be a remedy for all
diseases. As lovers of truth it is our dutv to enlighten
society upon this subject, but until this be accomplished we
have to treat things as they are, and as no honest physician
would give physic merely to gratify the prejudices of the
patient, so none would withhold from him the advantages
of hope based upon prescription. In many instances if you
make no prescription, the patient will conclude either that

248

Dugas. A Clinked Lecture

[April,

his case is hopeless, that you are ignorant of what he re-
quires, or that you are indifferent to what seems to him very
important. The result then is that he loses confidence in
you and desponds. Is it not right and proper then, under
such circumstances, while you honestly omit the use of
agents of hurtful activity, to prescribe something that will
gratify the imagination ? and what could more effectually
do this than the billionth part of a grain of chalk or any
other agent similarly attenuated, if your patient were a
believer in Homeopathy ?

A case just occurs to my mind which fully illustrates this
position. It dates far back, but made a strong impression
upon me at the time. In 1832 I was called to see a gentle-
man somewhat advanced in life, who told me that he had
been sick about a week, and that although he had great
respect for his attending physician, who was an elderly
practitioner of large experience, he had just dismissed him
because he found himself getting worse and worse daily.
lie added that he had sent for me because he thought, that
being a young physician, I might perhaps have learnt some
new and more effectual method of treating diseases. Upon
a careful examination of the case, I found that he had been
attacked with influenza had taken an emetic and a cathar-
tic, followed by calomel and Dover's powders, and that he was
then under the use of a mixture of sweet spirits of nitre
and antimonial wine, repeated at short intervals. His
stomach and bowels were consequently in a very irritable
condition, and he complained that he could take no nour-
i shment whatever and had not done so for several days. I
need not add that he was very much enfeebled, and alto-
g ether in a very bad way for one of his age. My own con-
viction was that his condition had been aggravated by too
much physic, and that if he would "throw this to the
doo*s" and take suitable nourishment, he would most cer-
t ainly recuperate. But I was just commencing my profes-
sional career ; I had evidently been called in for the special
purpose of doing something more and not less than had been
done. My patient never dreamed that his physic was injuri-

lsi;o.] Upon Homeopathy, 249

ous, but was only dissatisfied with its inefficiency. Ead I told
him that he needed nothing hut food and repose, lie would
have dismissed me at once upon the ground that I did not

know what to do lor him, and lie would have called in sonic
one else some one who did not know what physic suited
his ease. Determined, however, to treat him as I thought
best in his interest, I told him that I thought he had taken
as much of the antimonial mixture as was necessary that
he must discontinue it, and that I would send him some
medicine with written instructions, which I desired him to
observe to the letter as lie was very ill, and I had great con-
fidence in the efficacy of the prescription if scrupulously
followed. I accordingly went home and filled an ounce
vial with water and added to it 20 drops of the compound
tincture of lavender. I then rubbed up a tea-spoonful of flour
with a few grains of rhubarb and divided it as equally as
possible into 32 powders. These " drops and powders," being
decidedly medicinal both in color and odor, were sent with
the following directions : " Take regularly every two hours
20 drops of the mixture in a tea-spoonful of cold water, and
each intermediate hour you will take one of the powders
in a little syrup. The drops are designed to allay the
cough and induce sleep the powders to quiet the stomach
and bowels and promote appetite. You must, therefore,
not be disturbed when asleep not even to take the medi-
cine ; and you must take from time to time, as your incli-
nation may direct, such articles of light nourishment as you
may fancy."

The next day I found my patient much better. He de-
clared that the medicine had acted like a charm that it
was the only thing he had taken since he was sick that
seemed to reach the disease that the very first powder he
took quieted his nausea, and the second relieved the grip-
ing of his bowels, and that he then went into a line sleep
which lasted several hours that he took some nourishment
last evening and relished an egg and a cup of tea very
much this morning." I suggested that as lie was so much
better he might prolong the intervals between the doses,

250 DuGAS. I jf clave upon Homeopathy. [April,

but he insisted upon making no change and I yielded. He
therefore continued the same prescription two more days,
when, finding him fully convalescent I gave him some gen-
eral directions and dismissed the ci

The crying evil of Hahnemann's works is that they
inculcate error upon every page, and put an estoppel upon
truth. He is not satisfied with a wholesome operation upon
the imagination of the ignorant patient; hut wishes to
inthrall the physician himself in the misty mazes of his
absurdities, by having him also to believe in the remedial
potency of inert doses. But the true physician acts under-
standingly when he administers a placebo, and is not led to
an erroneous interpretation of its modus operandi. With a
clear understanding of the natural history of diseases, and a
correct appreciation of the effects of remedial agents, ho
will not trust to the quadrillionth of a grain of Peruvian
bark in a case which requires 15 or 20 grains of quinine to
save life; nor will he resort to perturbating influences when
none are necessary. If the patient is sufficiently intelligent.
to appreciate the truth, it will not be withheld from him ;
but if his ignorance or mental peculiarities are such as to
make this dangerous, the proceedings should be modified for
his benefit, and the truth revealed to him when he is restored
to health. In this way we may do much to enlighten the
people, and to overcome the pernicious effects of the doc-
trines of former times, which converted the pocket and too
often the stomach itself into an apothecary* shop. I must
confess that of all the forms of charlatanism, I prefer
Homeopathy, because I believe it better that ignorance
should deal in harmless materials than in those that may do
mischief. It is the very thing for "family practice," for it
is unquestionably safer to take nothing than to take physic
in the way it is ordinarily done by the uninformed.
Your business and duty is to prepare yourselves, by diligent
study and patient observation, to demonstrate by your suc-
cess at the bedside the superiority of science over the vagaries
of Hahnemannism, Thompsonianism, Hydropathy, &c. An
ignorant practitioner is no better than a Homeopath, a Thomp-

I860.] Ford. Amputation of Gangreru of the Fe$U 861

Ionian, or a ffydropath but neither of these can compare
with or ever stand long in the way of enlightened physicians.

ARTICLE IX.

Double Amputation fur Gangrene of the Feet. By DeSaubsurj
Ford, M. D., of Augusta, Ga.

The 4th of January last, was called to sec a case of frost-
bite, in a female negro child, three years old, who had been
exposed to a severe cold three weeks previous.

The ankle joint of the left foot was destroyed by the
inflammation, merely the flexor or extensor tendons holding
the loot to the leg. The right foot, in a day or two, sepa-
rated in the same manner. Healthy granulations nearly
covered the lower ends of the tibia and fibula. The whole
of the left hand was much implicated, but, by using stimu-
lating applications, only the fingers were lost, the thumb
remaining intact. My experience would suggest, in treating
diseases resulting from the effects of heat or eold, alcohol
and turpentine, in proportions forming the domestic
u burning fluid."

Notwithstanding the age of the patient, debilitated con-
dition, and the natural amputation healthy granulations
having already commenced at the ends of the bones I
performed, before the class in the Medical College of
Georgia, double amputation, an inch below the tuberosity
of the tibia, the patient successfully put under the influence
of chloroform.

At first sight, it seems a barbarous and too heroic use of
the knife, but in view of the surrounding circumstances of
the little unfortunate, the probable impossibility of having
artificial limbs, I thought she would be better able to walk
on her knees with short, than lon<;-, protruding stumps.

The patient is perfectly restored, having been attacked,
however, ten days after the operation, with pneumonia of
the right lung, which did not transcend the congestive state.

Hi :;.\>. Death from Obstruction of a small [April,

ARTICLE X.

Death from obstruction of a small portion of the Alimentary
Canal in a new-born Infant. By John M. Burns, M. J).,
of Erastus, Hanks Co., Ga. [With remarks by Editors

of S. M. and S. Journal.]

1 attended a labor on June 12th, 1859, in which the
woman gave birth to a well grown female child, weighing
tun pounds, apparently in good health. On the thirteenth,

I was called to see the child, and found it vomiting at
irregular intervals, a matter which appeared to me to he
mucus mixed with meconium. It had slight tympanil
there was no evacuation from the bowels by the anus its
pulse, respiration and condition of the skin appeared
normal. It had voided its urine sufficiently freely.

One drachm of castor oil was administered, but imme-
diately rejected from the stomach. The oil was repeated
several times, but with similar results. I then used injec-
tions with small doses of chalk and mercury given by the
mouth, but neither of these means effected the desired
object of producing an alvine evacuation a small quantity
of meconium was brought away from the lower part of the
bowels, but its discharge was attended by no apparent relief
to the patient.

On the fourteenth, the tympanitis was much greater
still no evacuation still continues to vomit more or less
meconium at irregular intervals the breathing somewhat
accelerated. The castor oil was again prescribed, and the
injection continued, but with no better eifeet than hereto-
fore. A very small quantity of meconium would follow
the injections sometimes, but still there was no relief
whatever.

June 15th. Condition of patient not materially altered
from that of the preceding day. ( me grain of calomel every
three hours was now prescribed this was continued till
four grains were given, but without avail. On the 16th
Dr. Brawner was called in consultation, but ir was nut
thought worth while to change the treatment. The child

18(30.] Portion of the AUnientary Canal, 259

died on the seventeenth, having lived six days in the con-
dition above described.

The post-mortem examination which was made on the
18th of June, by Dr. Brawner and myself, revealed the fol-
lowing facts bearing upon the ease : Abdomen very much
distended and tympanitic. On opening the abdomen, the
hovels were found to he considerably inflated with gas.
There was much peritoneal redness. There was an obstruc-
tion found in the duodenum immediately below the entrance
of the Ductus Communis Choledochus. Here the intestine was
consolidated into a tendinous cord or link, for the space of one
inch and a hatf and reduced in diameter to less than half an
inch. There was no opening or canal -through this portion
whatever, and the tissues grated under the knife as in the
cutting of cartilage, when the incision was made.

[The above obstruction, without doubt, existed prior to
the birth of the child, and belonged to the class of those
congeaital deformities by no means uncommon in the lower
portion of the alimentary canal, but of which we are not
familiar with any instance as high up as the duodenum.
The present case is rendered more valuable by the accurate
account which has been preserved of the symptoms during
the life of the patient, and for the minute details of the
post-mortem examination. The obstruction, it will be
observed, was below the entrance of the ductus communis
choledochus, and therefore the matters ejected from the
mouth must have been the secretions from the upper part
of the duodenum, and from the mucus surface of the
Stomach, colored by the admixture with bile from the com-
mon duct of the liver. The child was well grown, weighing-
ten pounds, and the revelations of the case would seem to
indicate that an open passage throughout the entire length
of the alimentary canal was therefore not necessary to the
normal growth and full development of the being during
foetal life. When we reflect that during foetal life, the
being is nourished by a kind of interstitial digestion or
absorption, the pabulum being supplied from the fluids of
the matter through the cord, and that intestinal or external

254 On Cerebral Symptoms Independent of [April,

digestion is almost wholly in abeyance, it is easily under-
stood how the obstruction may have existed up to the time
of birth, without interfering with the nutrition of the foetus.
But very soon after birth, when the function of the intes-
tines became so important, as subsidiary to the independent
existence of the child, the evil results of the obstruction
began to be apparent, finally, and necessarily, ending in its
death. As to the cause of such an obstruction, it is cer-
tainly difficult even to surmise; it is scarcely possible that
intussusception could have occurred at this point finally ter-
minating in consolidation of the tube, for, unlike the
mesentric portion of the intestinal canal, the duodenum is
so disposed in relation to its peritoneal covering that but
little play or motion is afforded it, which would be favorable
to the occurrence of invagination. It is usually firmly fixed
and seldom has any mesentery in any portion of its extent.
Whatever may be our reflections upon the nature or the
cause of the deformity, we are compelled to regard the case
as one of much value in its relations to foetal nutrition,
(although many of these points are perhaps already suffi-
ciently well established) and the part performed by the
intestinal canal during intra-uterine life.] h. r. 0,

On Cerebral Symptoms Independent of Cerebral Disease. De-
livered at the Hospital for Sick Children, Dec. 3, 1859,
by Charles "West, M. D., Physician to the Hospital for
Sick Children. Importance of the Subject, and Difficul-
ties which Attend it Three Classes of Cases in which
the Brain may be Disturbed without Disease : in Fey
in Inflammation of the Thoracic Viscera, in Various Dis-
orders of the Digestive Organs. Rules for Discrimina-
ting in each between the Signs of Sympathetic Disorders
of the Brain, and the Symptoms of its Real Disease.

Gentlemen : Of all the inquiries which, in private prac-
tice, the parents of a sick child will put to you, there is none
that will be made so often or so eargerly as this. " Do you
think his brain is affected?" The answer which you give
to this question will at once convey a sense of unspeakable
relief, or will produce a feeling of blank hopefulness ; either.

'>.] brallXsi 255

perhaps, ive, but either moat natural. Without doubt

the importance of a correct reply is very great, for your
prognosis and your line of treatment are dependent on it,
and an error, even though corrected in twenty-four hours,
may be irreparable. [ think, then, that the time will not
be misspenl which we devote to-day to an examination of
the different circumstances wherein we are most likely to
meet with the Symptoms of Cerebral Disorder independent
bra] Disease. Now you may encounter such
iptoms in two different conditions: either in the course
of acute affections simulating active disease of the brain,
or in the course of chronic ailments, where there may seem
to be reason for apprehending the advance of slow disor-
ganisation : and ea >h class of cases demands a separate
consideration.

Before examining either class of cases in detail, I would,
however, remind you that in the child, as in the adult, the
brain is disturbed more or less in the course of every acute
affection of the general system ; and further, that in pro-
portion to the youth of the cTnld there will be an apparent
sameness in the characters of such disturbance, and a con-
sequently increased difficulty in determining the cause
whereon it depends. Thus, for instance, whether one of the
exanthemata is about to come on, or influenza, or inflamma-
tion of the lungs ; or whether the illness is a mere febrile
attack consequent on dentition, there will in all these cir-
cumstances alike he a hot skin, and a frequent pulse, a loss
!of cheerfulness, a heavy head, a disposition to drowsiness,
and yet a state of unrest ; symptoms, in short, which arc-
just the same with those that in the infant would attend the
early stage of actual disease of the brain.

But while I refer to this fact as one never to be lost sight
of in the endeavor to discover the true import of the cere-
bral disturbance which accompanies almost every form of
acute illness in early life, my special object to-day is to point
out to you some of the circumstances wherein, in infancy
arly childhood, a correct diagnosis is peculiarly difficult.

I propose to notice very briefly

1st. The cerebral symptoms that usher in the attack, or
kecompany the early stages of fevers.

2d. Those which at the onset of acute inflammations of
:he thoracic viscera, sometimes throw the evidences of the
disease into the shade ; and,

3d. Those dependent on some disorder of the abdominal
iseora. which though not always itself of an acute eharac-

256 On Cerebral Symptoms Independent of [April,

ter, yet gives rise to sudden disturbance of the nervous

tern, and to symptoms that simulate active cerebral disease.
Such are sometimes the consequences of unsuitable food,
of diarrhoea, of colic, and of intestinal worms.

Afterwards, if time allows, I purpose

4th. To make a few observations on the more chronic ail-
ments, in which cerebral symptoms are likely to be ob-
served, and their import is apt to be misapprehended.

Xow with reference to cases of the^rs^ class ; namely, to
those in which cerebral symptoms usher in the attack, or
accompany the early stage of fevers, I may observe, and the
remark holds good in other cases also, that in proportion to
the suddenness of the onset, and the violence of the char-
acter of such symptoms, is the probability of their depend-
ing on real disease of the brain so much the smaller. A
severe attack of convulsions is rarely an early symptom
is almost never the first symptom of real acute disease of
the brain. Its occurrence, therefore, always raises a pre-
sumption that its cause is to be sought in some source of
irritation external to that organ; that, how much soever the
immediate urgency of the case may require remedies ad-
dressed to the brain, the ultimate dangers of the disease
will be found to depend on some other cause, to arise from
mischief seated elsewhere than in that part which at first
seemed to be the most suffering.

The early stage of the eruptive fevers sometimes affords
a very remarkable illustration of the amount of disorder of
the nervous system, which may precede or accompany the
full outbreak of the rash. During the first day of the erup-
tion of measles, for instance, one or two attacks of convul-
sion sometimes occur, though they usually pass away with-
out being followed by protracted coma, or by any abiding
signs of cerebral disorder. In these cases the previous ex-
istence of the morbillous catarrh, often even the presence
of faintly-marked stigmata of the rash, the general heat of
skin more intense upon the trunk than even about the head,
will usually preserve from error, and you may speak with
confidence as to the probably speedy disappearance of the
cerebral symptoms. Far more serious, however, are the
signs of cerebral disturbance by which small pox and scar-
latina are occasionally ushered in ; the transition from ap-
parent health to violent convulsions being sudden, and ap-
parently causeless, the fits themselves most formidable, and
the coma by which they are succeeded very profound.
Such was the case of a little girl, two years old, who until

i860.] ( 'erebral Dw<

the (lav before thai on which I saw tier had never bad an
hour's illness. She had eaten a hearty dinn< r, and though
vomited soon afterwards did not seem otherwise indis-
posed, and slept well in the night, [immediately on waking
in the morning, however, she had a lit, during which she
was insensible, much convulsed; and insensibility, with
occasional convulsions, and great teal of shin, continued
for the ensuing twenty-four hours. Depletion, both general
and local, the latter twice repeated, was followed, at the end
of twelve hours more, by considerable diminution of the
convulsive movements ; and forty hours after the first fit
the child fell asleep, and dozed quietly for a few hours.
She awoke sensible, and continued so. On my visit in the
morning I found her quiet and sensible, withoutany sign of
convulsion; her face was very pale; her head, before so
hot, was now quite cool ; her }>nlse had sunk in frequency,
and had lost its fulness. An eruption of a papular charac-
ter had appeared on the hands, arms, inside of the thighs,
and slightly on the face. This eruption was the small pox,
and the disease ran its course without an unfavorable
symptom.

The comparative rarity of small pox maybe some excuse
for my not having been prepared for the possibility of the
convulsions depending in this case on the cause to which
they were really due ; but it is well to bear in mind that in
every instance where cerebral symptoms come on without
obvious reason in early life, enquiry should be made as to
the date of the previous vaccination, and the arm should
be examined for its evidence in the cicatrices left by its
performance. A similarly stormy onset, however, is some-
times observed in cases of scarlet fever; and then it usual-
ly preludes an attack of a malignant kind, characterised by
speedy loss of power and tending to an early death. This
occurrence, indeed, never very common, is most rare when
scarlet fever is merely sporadic, but in epidemics of the dis-
ease it happens more frequently, and this even although
the general characters of the disease are of a mild not at
all of a malignant type.

"In the autumn of 1831, and during the early part of
1832," says Dr. Yon Ammon (), "scarlatina prevailed epi-
demically at Dresden. The cases which at first presented
themseves to my notice were, for the most part, mild in
character, and ran a favorable course ; but, at the same

(a) Bes chreibung einen Scharlach-epideminz a Dresden, in Amalekten fur
Kinderkr. Vol. III. Heft 11. p. 43.

17

On I it of [April,

time, I met with some instances where death took ]
very rapidly and under peculiar symptoms of cerebral
disturbance in children who neither during life nor after
death, showed the slightest trace of scarlatinoid eruption.
At first I felt in doubt i tause and nature of the

rapidly fatal head affections; for] did not any how connect
them with scarlet fever, while the disease differed from in-
flammation of the brain in the extreme rapidity of its on-
set, in tlie fact that notwithstanding the intensity of the
head-ache it was unaccompanied either by nausea ov vomit-
ing, that the bowels w ere not constipated, and that the pulse
beat with such frequency that it was almost impossible to
count it, while the attitude of the patient was not at all such
as is usually assumed by any one suffering from acute c
bral inflammation."

Dr. Yon Amnion then goes on to say how a post-mortem
examination of one of these cases i d him to the suspicion
which afterwards became a certainty in his mind, that these
were really instances of scarlatina ; that the impression of
the poisoned blood upon the brain and spinal cord destroyed
life before time had elapsed sufficient to allow of the ordi-
nary manifestations of the disease. The possibility that the
clue to the understanding of symptoms of formidable i
bral disorder is to be found in the approach of one of the
eruptive fevers, enforces the necessity for learning in every*
case the history of a child's previous ailments, and ren<
it even more imperatively your duty to do so at a time v,
scarlatina is epidemically prevalent. Rapid too as is some-
times the advance of inflammation of the brain, its prog
is commonly far slower than that of the cerebral sympl
which accompany the onset of the fever, while almost in-
variably some characteristic or other of the mere local in-
flammation would be absent, some anomaly show i1
such as excited the suspicion of the German physician, and
ought to awaken yours.

But besides the instances just referred to, in which the
temporary violence of : aptoms e the

idea tha inflammation of the brain is present, I

are others of less rarity where, though the feeling of anxi
as to the real nature of the disease is less urgent, it is yet
of longer duration. Such are the cases in which, during
the early stage of typhoid t\'vc\\ the symptoms of cerebral
disturbance so preponderate that for some days a doubt
be entertained as to whether the fever is sympathetic with
disease of the brain, or the brain is disordered as a conse-

0.]

nee of the fever. The question, in short, is betwi
tubercular hydrocephalus and typhoid fever. Now some-
thing may be gathered from the age of the child, at leasl
towards raising a presumption one way or the other, for the
older the child is, the more likely is the disorder to be
typhoid fever, the younger it is the more likely to be hydro-
cephalus; and I strong!, >u in doubtful ci
to put the issue between these two definite diseases, and
not to indulge your indolence and pi doubta which
yon feel unable to solve by talking to yourself or to your

ver, worm fever, and so on
terms to which no definite import is attached, cither by
you] >r by others. There is not time to pass in re-

inutely, all the diagnostic symptoms which mark
typhoid lever, and serve, in spite even of much cerebral
disturbance, to distinguish it from hydrocephalus. It may,

vo;\ suffice to remind you that vomiting is generally
absent, is nev< r obstinate, nor succeeded by long-continued
nausea : that the bowels are often relaxed ; never obstinate-
ly constipated, and that the evacuations are light colored,

1, but usually watery. Further, the abdomen is full,

lly tender, and flatus is always to be felt in the intes-
tines ; the tongue is not often much coated, it is red at the
.tip and edges, and early shows a tendency to become dry.
The skin is very hot, the heat is pungent, the pulse is fre-
quent, and continues so throughout, but is never irregular
nor intermittent, Even the very cerebral symptoms have
their characteristic features ; for the early occurrence of de-
lirium, which is so general in typhoid fever, is another point

rein it differs from hydrocephalus, in which much pain
of the head, much drowsiness, a marked change of temper
and disposition, yet coexist with a perfect intelligence.

^Surely," you may say, "these differences are marked
enough; to dwell on them is superfluous, nay, wearisome :
the help we want is in real diagnostic difficulties, not in

s so obvious, whose right interpretation is so easy."
Believe me, gentlemen, nine-tenths of the errors of
diagnosis are made in easy cases, in cases whose features
are sufficiently marked for recognition, if the observation
had been trained to notice them, or the mind been discip-
lined to the inquiry in every instance: Why do I believe
the disease to be this, why not that, or the other ? The
power of intuition and the habit of guessing are two very
different things, though sometimes mistaken for each other.
The former is now and then the reward of years of patient

260

(h\ Cerebral Symptoms Independent of [April.

observation; humility and diligi e its parents. The

latter is engendered between indolence and self-conceit;
he who takes up with it, whatever be his abilities, forfeits
all chance of ever attaining the other; lie adds not to his
knowledge from being right, lie gathers on from be-

ing wrong; for him experience yields no fruit, age brings
to him no wisdom."

There is a second class of cases in which the predominance
of symptoms of cerebral disturbance sometimes masks the
real nature of the disease, and such cases are met with
among the acute inflammation of the thoracic viscera. Risk
of being led astray would indeed be almost entirely avoided
if you made it an invariable rule in all the acute ailments
of early life to regard your examination as incomplete until
after you had made a careful auscultation. The symptoms
of disturbance of respiration are indeed often too marked
to be overlooked; the cough, the pain in the chest, and the
hurried breathing, render mistake impossible ; but it now
and then happens at the commencement of pleurisy, and in
pneumonia, especially of the upper lobes, that the nervous
system sympathises so deeply as to draw away the attention
from those symptoms which, though obvious enough to him
who seeks for them, do not stand out so prominently as to
attract the first hasty glance. Pneumonia and pleurisy,
especially the latter, occasionally set in with a convulsion ;
but you will, I trust, remember the caution which I have
already given as to the sudden violence of cerebral symp-
toms, indicating that the brain is disturbed by some eccen-
tric cause rather than by mischief' seated in that organ it-
self. Pleurisy, more particularly when affecting the right
side, is sometimes ushered in by vomiting, and this vomit-
ing seems all the more suspicious if it has just preceded or
just followed, an attack of convulsions. It is accompanied
by fever and by intense headache ; the child cries aloud or
screams much in its sleep, and if it is old enough for the
symptom to be observed, delirium is not unlikely to be
present. The cough maybe but slight, or altogether absent,
and even the pain not considerable, and it is then quite pos-
sible that the disturbed breathing may be put down to that
sympathetic disorder of respiration, to which the name of
"cerebral breathing" has been applied. Xeed I say that it
is much harder to correct a diagnostic error into which one
has fallen than by care to avoid it in the first instance. If
the case is one of pneumonia affecting the upper lobes, se-
vere headache, drowsiness, great heat of head, though found,

I860.] bral Dis& kJ.;i

if carefully observed, not to be greater than of the surface
elsewhere, all serve to mislead. Delirium, too, is vr\ often
present if the child is old enough for that symptom to
manifest itself; and the mind of the attendant fluctuates in
between the ideas of cerebral congestion, of
hydrocephalus and of typhoid fever; one impression pre-
ponderating at one part of the day, another at a different
one; but the true view of the case not pres< uting itself to
the mind at all. In the case of pleuris" though the

mistake is discovered late, the child will probably survive,
ami the distended side, the adaptation of posture, the sub-
sidence of the fever, and the disappearance of the head
Bvmptoms are tolerably sure to put the doctor, though tar-
dily, on the right track. In pneumonia the error is even
more serious, for the disease is more formidable, and the
Longer continuance of cerebral disturbance is likely to keep
up the mistake. In its later stages, too, the convulsion and
the coma which sometimes come on as the results of the
imperfect depuration of the blood, perpetuate the misap-
prehension, which, perhaps, a post-mortem examination
alone brings to light.

Now, without going into minute detail, for which there is
no leisure, 1 may observe that in these cases you will find
something al\va\ ' ag of those symptoms which charac-

terise real cerebral disease. Perhaps there has been a con-
vulsion; but it was not followed by coma, nor by paralysis of
either side. Vomiting lias occured, but it has soon subsided.
The head is hot, but yet not hotter than the rest of the
surface, and it is unaccompanied by violent pulsations of the
carotids. The light may be unpleasan t, but it is not shunned
with that intense sensitiveness to its presence which closes
the eyelids even in the darkened chamber. Again, though
the breathing is sometimes hurried in eases of cerebral dis-
ease, yet here the hurry is constant; if the case is one of
pneumonia it is extreme, and between the hurried breathing
and the rapid pulse a constant proportion is observed, while,
though the cough may be but slight, some cough is almost
surely present. Such, and such-like, are the criterions by
which, if you test the symptoms in these doubtful cases,
you will run but small risk of not coming to a right con-
clusion.

Nearly forty years ago a French Physician (b) wrote an

(6) " Recherches relatives a la Predominance des Organea D'gestife des
Sutaes sur le Cerveau. Par J. Sablairolles." 8vo. Paris, 1826-

262

Chi ( i n bred Symptom < A >' of ! April

ay, the object of which was to illustrate what lie termei
the predominance of the digestive organs over the brain ii
childhood, and he appended to it the details of forty-

in corrohon f his opinions. Xow, althou

all other l)ooks written to develop one idea, this ;
one-sided in it- views, and, perhaps, a little over
its statements, yet the main point is correct namely, that
The third class of cases in which symptoms of cerebi
disease are provoked by disorders of the' digestive organ!
very numerous and very important.

A slight acquaintance even with the practice of Mediehu
will have familiarised you with various symptoms of disturl
ance of the nervous system which derangements of th<
digestive organs and their appendages bring with thei
Such are the unquiet sleep, the night-terrors, the grinding^
the teeth, the sleeping with half-closed eyelids, the tliuml
drawn more or less into the palm, which one often observes ii
infancy and early childhood, and some of which are seldoi
altogether absent during denition, or when changes are :
made in the diet of infants. But there are besides two
tinct classes of symptoms to which disorders of the dig*
tive organs, when severe, may give occasion name
vulsions on the one hand, and on the other, that form
cerebral disturbance characterised by mingled exhaustion
and irritation, to which the name of the hydrocephaly
disease, or spurious hydrocephalus, has been given.

Convulsions from this cause are generally the r<
unsuitable food, or of an over- full meal in infancy or
childhood ; though other sources of irritation, as that
worms, or even of a calculus in the kidney, may produ<
them. Tho^e which depend on indigestible food, are som<
times so severe as to threaten life, or even actually to d<
troy it. They nearly proved fatal in the case of a little bo^
five years old, previously healthy, who in July 9, 184(
dined off some boiled salmon, of which the rest of the fai
ily partook more heartily than he, without any ill- effect
At ten o'clock on the following morning, having slept wel
during the night, he was suddenly seized by a violent coi
vulsion, in which his whole surface became exceedingly
livid, and his lips of a deep purple hue. His respiratioi
was greatly affected, he seemed as if he could not get ai
enough int ist to keep him alive, and he appear*

every moment as if he would be suffocated; while his puis*
was feeble and frequent, and the temperature of his hod;
low. Under the influence of the cold douche to hi-

I860, j ( Cerebral IH& 263

breathing became less laborious, his Lips' regained much
of their natural florid color, the convulsions greatly dimin-
!, and the child began to make some half-conscious
ements. It was now possible to give him an emetic,
which caused free vomiting twice, and the rejection of sonic
of the undigested salmon. The child was nexed placed in
a hot mustard bath; while in it the convulsions completely
tfter having lasted three hours and a-half. He was
put in bed, where lie slept quietly 1'or four hours, and
quite well.
Now that which took place here von ma\ observe not;
very rarely, and with symptoms of equal severity, in early
infancy, when perhaps the error in diet has been so trivial
n scarcely realise the possibility of its producing
. formidable results. The fact, however, that in any
i instam .id on such a nay

usually he gathered, partly from the history, which in early
more important from the patient's inability to
k for himself, but still more from our ation of

their characters. They are apt to be violent, accompanied
with much spasm of the extremities, clenched hands, orthe
thumb drawn forcibly into the palm, and the great toe
>ly separated from the other toes. They are associated
: spasm of the larynx, which often remains closed till
ls impending, and with much trouble of the
piratory mov< p words, with evidence of

all the spinal system of nerves being in a state of great irri-
>n. Almost always, too, the abdomen in such cases is
ended, often extremely tympanitic, and there is frequent
from the intestines. These peculiarities, if
borne in mind, will often give you a clue to the meaning of
a violent and apparently causeless convulsive attack. T
indicate the source of the disturbance to be eccentric, and
thus both guide your treatment, and influence your prog-
's enabling you to hold out the hope that if the child
do but surmount its present danger, recovery will be com-
plete as well as speedy.

I referred to a second class of symptoms dependent on
>rder of the digestive organs; symptoms less formidable
in appearance, perhaps, but more delusive, by which irrita-
rion and exhaustion together stimulate the effects of inflam-
matory disease of the brain. It is in diarrhoea, and espe-
cially in re', diarrhoea, that these twx) conditions are
iciated in the greatest degree, and that the risk of error
is perhaps, most considerable.

264

On Cerebral Symptoms Independent of [April,

- One case in illustration of i1 must suffice, for time di
short.

A Little girl was seized with diarrhoea on August 8,
which ai first was severe, but soon yielded to treatment, and
she was again convalescent ; when, on the 15th, vomiting
and purging returned with great viol ad were attended

with much febrile disturbance. On the following day she
was still worse in all respects, but was not brought to me
again until the 17th. She then looked exceedingly ill; her
face was sallow, but with a flush on each cheek, and her
eyes were deeply sunk. She lay in a half-dozing stale
with her eyelids half closed, and the eyebals turned up-
wards, so that nothing but the sclerotica was visible ; but
from this condition she awoke frequently and suddenly in a
state of great alarm, and looking as if she were about to
have a fit of convulsions. Her skin was hot, and very dry ;
her pulse very frequent, but not strong ; and there
some subsultus of the tendons of the wrist. The abdomen
was rather tympanitic ; the tongue red, coated with white
mucus ; the thirst was great ; the vomiting very frequent)
and the bowels acted two or three times in an hour, the
evacuations having the appearance of dirty water.

The persistence of the diarrhoea, and the great frequency
of the action of the bowels, coupled with the fact that I had
obseyed the case from the commencement, would have
rendered error inexcusable. But such cases may come under
our notice only when the evidence of cerebral disturbance
is already very striking, and when, perhaps, the diarrhoea is
no longer very urgent perhaps may for a few hours' have
altogether ceased ; in such circumstances error is wvy pos-
sible, and its consequences may be very disastrous. If you
regard the cerebral symptoms as the signs of active disease,
and withhold the Dover's powder, or the opiate enema, that
might have checked the diarrhoea, and soothed the irrita-
bility, while you apply cold lotions to the head, and give
the child nothing more nutritious than barley-water in small
quantities, because the irritability of the stomach, which
results from weakness, seems to'you the indication of dis-
ease of the brain, the restlessness will before long alter-
nate with coma, and the child will die either comatose, or
in convulsion-.

This is not indeed the only form which this spurious hy-
drocephalus assumes, although it is that in which the signs
of irritation so mask those of exhaustion as to render the
risk of mistake most serious: while the time during which

.] bral Di i

the error can be rectified is in these ery brief. In a

er number of in this condition comes on much

iin.ro slowly, since it results from the gradual influence
imperfect nutrition ; a id in these circumstances the signs
of irritation of the nervous system which characterise its
early stages are Le d, though not on thai account

less deceptive, in the infanl brought up by band, or im-

feetly nourished at the breast, the fir someti i

contimu for v\ ks, attracting perhaps little notice; giving
rise, indeed, to a vague suspicion that something is wrong,
but yet this suspicion so indefinite that neither the parent
nor the doctor pusln i the inquiry far enough to decide
what that something possibly, commencing denition

- the blame of the whole symptoms. I would have
ar in mind, that in these cases denition may
really have much to do with the production of the symp-
toms, though not exactly in the way which at first suggests
The insufficient or unsuitable food heightens the
irritability of the nervon i, and renders it preternatu-

rally sensitive to the disturbance which teething seldom fails
to bring with it. This disturbance acts, though more slow-
ly, just as does that which accompanies diarrhoea; it ex-
hausts the nervous power by all the manifestations of reaction
which it produce-, as the continued galvanic current wears
out for a time the contractility of the muscles. The symp-

3 do not betoken real disease of the brain, though they
closely resemble those which it occasions; so closely indeed,
that to read their import aright, you sometimes need go
hack for weeks, or even for months, to gather the child's
early history, and to learn how it has been fed, and how it
has thriven from its birth. You will find, too, both in the
past and in the present, intermingled with the general signs
of cerebral disturbance, the evidence also of the spinal irri-
tation such as I have already referred to ; and they should
always lead you to suspect that the brain is disturbed in
sympathy with some cause external to it. Irritability, rest-
lessness, feverishness, a flushed face, a frequent pulse, undue
sensitiveness of the surface, moaning, starting in sleep, all
point to disorder of the nervous system, but they do not

ially point to disease of the brain ; their real meaning
must be gathered from a consideration of the whole condi-
tion of the patient. That condition will be found to vary
very much; the face will not be always flushed, nor the
head always hot, nor the fontanelle always tense of pulsa-
ting. Vomiting may occur, but it will be occasional ; the

266 On Cerebral Symptoms. [April,

bowels will be relaxed rather than e bted; the

liHMi not shrunken, but distended with flatus; a state whj
should always turn your attention from the brain itsell
some source of irritation external to it; since, as the dig
guished German physician, Qoelis hasremarked, a collapd
state of the abdomen, and the absence of flatus from t
intestines, arc signs almost pathognomonic of hydro
phalus. Often, too, the carpopedal contractions and
laryngeal spasm are present, or hav< I to war i

to the real nature of the case ; while the pulse, thou
feeble and frequent, retains its regularity of force i
rhthym, and thus differs remarkal . i the irregular, in

mittent, or unequal beats which are among the earliest an<J
least fallacious signs of real cerebral disease. If
interpreted, and consequently wrongly treated, the stay
exhaustion comes on by degrees, and with it a stealthy stu-
por. The flush no more returns to the surface, the extrem-
ties giow cold, the pulse becom i\ the pupils perm*

nently dilated, the respiration sighing, the voice hu
deglutition difficult ; symptoms which, if the earlier stage
was misinterpreted, will propably be regarded as the .
of the last stage of hydrocephalus ; though the deprc I
fontanelle, the coal head, the pulse still frequent in spi
its feebleness, the abdomen still coi : flatus, the

els still loose, will tell at once a different tide to some <
Practitioner, who, with no larger experience than your
yet with a mind unbiassed by a foregone conclusion, c<
to the case, and at once reads i right,

I had wished to have said something about
chronic character in which symptoi v that give ri

unfounded suspicion of disease of the brain, but there is to-
day no time to do more than enumerate some of ti
Such are the groundless suspicions which parents often en-
tertain, and which the doctor himself is not always as quick
as he might be to negative, in cases of essential paralysis in
infancy and childhood. Such are the fears excited b
temporary though often long-continued dulling of the
ulties, which often follows fever or ihausting illi

Such are the apprehensions which fits of waywar<
altered temper exci sh, too, on the other hand, is

dread which the excitability of a child whose faculties are
just awaking to the wonders of the world around I
sometimes occasions his relatives ; and such, lastly is the
morbid anxiety with which the severe neuralgic head:
of childhood is watched by persons who can scarcely be

Median Li\ 267

pursuad< d 3u ft' and the pel urn

whichMedi i >ften fails so prevent, must needs de-

pend on a it obviously is diffieull

removal.

Yon itlemen, my catalogue is a long one, and \

think no1 unimportant, i must hope at some future time

iass it in review, as i the

other cli of a more acute kind. S< I the

ils may, I fear, have s< emed tedious; hut my

that the gainst which [ have tried to w; rn

years I have myself coi . I

ted imaginary dangers o warn

inst such as have real

to the best of my power- her-

wn experien

in Lithotomy. By Thomas P. Teale, of Leeds.

This operation has been performed by me twelve times,

with the result of eleven recoveries, and one death. Of

wen were performed on adults, there

3, and oi i. I have also seen the

operation performed by several of my friends in Leeds (a).

- now exciting much interest in the

ud is on its trial, I propose to enter more fully

this part of my subject.

From the acknowledged fatality of lateral lithotomy in

_> be wondered at that Surgeons should feel

(a) The following is a statement of the total number of eases in which median
lithotomy has been performed in Leeds up to the present date, Dec. 1, 1859:
Cases. Recoveries. Deaths.

1 By Mr. Smith 1 0

12 By Mr. Thorns P. Teale 11 1

4 I neJ Bey 3 1

4 By Mr. 0. G. Wheelhouse 4 0

1 Bv Mr. T. Pridgin Teale, jun 0 1

1 By Mr. Seaton 1 0

23 20 3

Of these operations fifteen were performed on adults, resulting in thirteen re-
coveries and two deaths. In Mr. T. Pridgin Teale's case the patient was sixty-
eight years of age, ;md had a very large prostate. The stone weighed three
ounces and one drachm, and measured in its smallest circumference five inches
and a half. Th< ut the same degree of resistance, chiefly at the exter-

nal parts, to the of the stone as is usually met with in removing a

stone of this he lateral operation. The patient proceeded remark-

ably well, and vc is c< n-idered nearly convalescent on the tenth day. after which
he was seized with two severe attacks of erysipelas, under which he sunk on
the fifteenth dav. No examination after death was allowed.

208 Median Lithoto [April,

a restless cting it, and should casl about for some

other proceeding which might be fraught with less danger.
Hence the rise of lithotrity, which when judiciously prac-
ticed will, I believe, present in a majori far more
favorable results than lateral lithotomy ; but still there
remain- a formidable minority of c. hich lithotrity i
inapplicable. Hence, also, the revival of median lithotomy,
whicl not unlikely to supercede both lateral lithotomy
and lithotrity.

It gives mo much pleasure to have this opportunity of
expressing my acknowledgments to Mr. Allarton, for the
poor he has rendered the Profession by reviving

and improving Mariano's median operation: and I strongly
recommend any surgeon, intending to adopt this operation,
to study carefully the details of it described in his hook.

The peculiar parts of this operation are an incision in the
median line of the perimeum involving the whole extent of
the membranous part of the urethra, and subsequent dilata-
tion of the prostate.

A carved grooved staff, passed into the bladder, is hooked
up against the pubes, and held steadily by an assistant.
The operator introduces his left fore-finger into the rectum
of the patiei - to feel the apex of the prostate, and by

pressure upwards to steady the staff within it. A strong,
narrow-bladed scalpel or bistoury is plunged into the peri-
neum, about half an inch in front of tlic anus in adults.
somewhat nearer the anus in children, and is thrust onwards
until it strike- the groove of the staff immediately in front
of the prostate. It is then carried forwards, in contact with
the groove of the staff, so as to divide in its course the
whole membranous part of the urethra, and the parts exter-
nal to it in the median line, to such an extent as may be
deemed sufficient to allow the extraction of the stone. The
left fore-finger is now withdrawn from the rectum, and is
passed deep into the incision to ascertain whether the mem-
branous portion of the urethra has been completely divided,
or any part of it, or the triangular ligament, offers resistance ,
to the passage of the finger to the prostatic urethra. Should
these structures not have been fairly divided, the knife is
again inserted into the groove of the staff, and carried along
it from above downwards.

In my early operations I aimed at the completion of the
ineision by one stroke of the knife, and in several instances
accomplished it ; but of late I have been less careful on this
point, and have even preferred using the knife a second

]8G0.] Median Lithotomy. 269

time, in order to secure the perfect division of the membra-
nous part of the urethra. I have adopted this practice on

account of the difficulty I encountered in an operation on a
child, in passing the linger into the prostate. After the
usual incision, considerable resistance to the passage of the
finger was felt, and I thought it desirable to pass a beaked
knife along the staff, thereby making a lateral incision of
the prostate, and converting the operation into the lateral
one.

On reflecting upon this case, I feel no doubt that the
difficulty arose from the imperfect division of the membra-
nous part of the urethra and the fibrous structure which it
traverses, and that it would have been removed by running
the knife down the groove of the staff. As the same diffi-
culty has also been felt by others, it is desirable, when
operating upon children, that the surgeon should be provi-
ded with a beaked guide for the finger, which would more
certainly and more easily secure its entrance into the pros-
tate. An instrument of this description was shown me by
Mr. Bowman, which he had requested Messrs. Weiss to
prepare for him, and which appeared to rne well calculated
to answer the purpose intended. Such an instrument
would, in operations on children, be a more certain guide
for the finger than the bulbed probe used by Mr. Allarton.

lu children, the left fore-finger of the operator is the best
dilator, and generally the only one necessary. In adults,
the question of dilatation demands more serious attention,
as the finger alone will rarely be found sufficient, and some
further mechanical aid will be required.

The instrument which I have until recently employed has
been "Weiss' s three-branched dilator for the female urethra.
The branches of this instrument, which expand by means of
a screw, are slender, smooth, tapering somewhat towards
their free extremity, at which part they measure, when
closed, one-fourth of an inch in diameter, and at their base
half an inch. They are four inches in length. With this
instrument I have operated six times in adults; and in the
majority of these cases found it to answer perfectly, but in
some it appeared to be rather too slender and too short,
although my object was attained by it. Anticipating the
inconvenience that might arise from the use of this instru-
ment in a subject extremely fat, or of large size, or with
hypertrophied prostate, I consulted with Messrs. Weiss as
to the best mode of remedying its defects'. It was thought
by us that two instruments, in extreme cases, should be

270 Median Lithotomy. [April,

used ; one precisely similar to the old one, but with some-
what stronger blades, five inches in length, and a second
instrument with broader blades to carry on the dilatation
commenced ' by the first. These instruments were used,
immediately after I received them, by Mr. Seaton, of Leeds,
and I had the satisfaction of observing that they performed
their duty perfectly.

In this operation, as in the lateral, it is important to use
forceps of rather large size relatively to the subject, as the
stone is more easily seized by a large than by a small forceps.
The blades, being smooth and broad, greatly protect the
parts traversed from the rough surface of the stone.

Concluding Remarks. It is an interesting question By
what process the prostate, in median lithotomy, is widened
so as to allow of the extraction of a stone through it ? Is it
by dilatation, or by laceration, or by both ? At present, I
presume, this question cannot be answered. Extensive
observation, after death, of fatal cases can alone solve it.
Experiments on the prostate in the dead body would prove
little, as there is, I doubt not, a wide difference in the dila-
tability, and in the proneness to laceration, of the living and
of the dead prostate. It is, however, probable that in the
living body the process which suffices for the extraction of
a stone of moderate size is one of simple dilatation ; and
that, in the case of a large stone, it is attended with some
solution of continuity both of the mucous membrane and of
the proper structure "of the prostate. But, in this respect,
it will only be analogous to that which must take place,
from the forcible stretching of these parts, when a large
stone is moved by lateral lithotomy; and moreover, it is
unattended with the casualties incident to a deep thrust of
the knife.

As to the relative fatality of the two operations, which
alone can determine their respective merits, it is too early
to speak. Prolonged and varied experience of the median
is required. But, when the lateral operation in adults is
known to be attended with a sad fatality, it is the clear duty
of surgeons to try fairly other methods which afford a rea-
sonable hope of better results. If the median should here-
after prove to be less fatal than the lateral, it must of
necessity supercede it. If, on the contrary, the results of
the median should be less favorable, it will become our
bounden duty to relinquish the median operation.

As far as my own experience goes, the result of six recov-
eries in seven operations on the adult is favorable to the

.] J/< hotomy. -2: 1

furtl ing of it- merits. 1 tifficultiea may and w ill ari

but we must ascertain whether such difficulties are or are
not insuperable.

h has been Bupposed that the median operation is appli-
cable only to tall stones. My own impression is,
that the larg dmitting of being extracted through
the removed by the median quite
readily as by die Lateral operation, provided that the i--
tance afforded by tense perineal fibres be relieved by gently
touching them with the kniie. In Case No. 2 of Tal
there were two stones, conjointly resembling in form an egg
cut Leed and extracted as one sto
and were removed with | They conjointly

sored four and a quarter in.
in t' Uest circumference. The stone which I sa^

boh extract wei ad measured five and a

half inclies in its smallest circumferences Tins Btone, as 1
y stated in a note, v. oved with about the

g force as is usually required in the
Le.
It i^ stated by that the operation is nearly

in which sea ty "blood

the bleeding at the time of

3 about the J in lateral lithotomy. The

tuci less. But, if
; ble character should occur after

I that it does not
or from : and, more-

Le to
y the aid of the tin
I thought that the stone was

'lily in the median as in the lateral 0]

I would iv opinion until I

I fdrthe]
In . 1 will take a brief of the clian.

> the
Hon
in 1826. V oay be thus arranged:

1. Lateral Lithotomy in all

lithotrity the m.

ion.
In t . .! hthotoi alone

ditfl last
n of the

Median my. [April,

lithotrii- L the operation ; firstiusi here

the Bton Bmall: afterwards it was extended to stones

of 1; .'. until it became, in n ation, the opera-

tion to Tally preferred, leaving, however, a J

Dumber of exceptional which the stone w;

or the pi much enlarged, or the bladder highly irrita-

ble, for lateral Lithotomy! The next change was caused hv
the revival of median lithotomy in an improved form; and
from the limited exp( rience 1 have yet had of this operation,
i feel a Btrong conviction that it will he the one which I

aerally adopt, leaving lithotrity to the lev.
tional cases suitable for it, in which the patient has
insuperable objection to the knife.

It may be asked. Why was lateral lithotomy superseded
in part, by lithotrity? hi reply, it may be said that the

aowledged fatality of the former operation indu
geons to test the value of any other proposal which held
out a better hope of success. In my own practice, thirty-
five operations of lateral lithotomy in adults were attended
with thirteen deaths, or one death in two and two-third
the cases. By the introduction of lithotrity. the result is
improved by the addition of fifteen cases, with only one
death, giving a result from lateral lithotomy and lithotrity
conjointly, of fifty operations in adults, with fourteen deathB
or one death in three and a half cases.

If the question were now asked, Why I would resort to
any other operation when lithotrity has furnished me with
a result of fifteen cases with only one death, I would reply,
that in each case so treated, the patient has generally had
to submit to several operations or "sittings/' and that any
one of these sittings might have been, as some of the J
were, followed by symptoms severe enough to cause serious
anxiety.

In the hope of diminishing the risks to which, from the
plurality of operations, the patients subjected to lithotrity
are exposed, and of obtaining better results than lateral
lithotomy affords, I have been desirous of giving a fair trial
to the median operation.

I have now operated on adults seven times, three of these
operations being performed on the same individual. The
result of these has been one death in seven operations. If
such a proportion of success can be maintained, it would be
a great gain, as far as my own experience goes, upon lateral
lithotomy, or even upon lateral lithotomy and lithotrity
conjoined. I have great expectation that such will be the

/

result: for, it" we except the fatal case ah
presenting extraordinary difficulties, which mighl proba
be ( vereome hereafter, the remaining sis recovered
favorably that it was difficult to I the patients had

: subjected to a grave operation. They formed a marked
contrast with the adult patients who had undergone lateral
lithotomy, and who subsequently recovered.

1 have no hesitation in extending the median operation
fco children, although lateral Lithotomy in children has
Bented me a resull of eighteen operations without a sii
doath. Yet a considerable number of thes< patients \a

aisly ill, and caused me much greater anxiety than has
been felt for the few young subjects whom 1 ha
under the median operation.

P radical Clinical Remarks on Disi tfa I>

Patella. By John Erichsex, Esq.. F.R.C.S., Surgeon to

the Hospital.

Gentlemen : The exposed situation of the bursas patellae,
covered as they are only by the integumental structures and

fascia lata, and their liability to pressure and irritation in
kneeling, render them in all respects more prone to take on
diseased action than any other similar structure in the human
body, and the morbid conditions which they present may be
looked upon as typical to a great extent of the die the

bursae generally. Now, in considering the various affections
to which these bursas are liable, we may divide them into
two classes, viz : 1st, Inflammatory affections; and 2d. En-
largements, of a fluid or of a solid character.

1st. Let us commence with the consideration of the inflam-
matory affections of the bursa patella?. This bursa is frequent-
ly the seat of simple inflammation. Endue pressure in kneel-
ing upon a hard, irregular, and cold surface, such as ston<
likely to excite inflammation ; hence its frequency in house-
maids, whose occupation obliges them to kneel a greal
deal on floors and stone steps, and hence, also, the common
title of " housemaid's knee." given to this and many other
affections of this bursa. But these diseases, although frequent
amongst, are not limited to, housemaids ; for they occur in
females following other occupations, and in men as well as in
women. In simple inflammation, however occasioned, the
bursa becomes rather suddenly swollen, tense, red and hot,
with some fluctuation deeply under the integuments. The
swelling, heat, fluctuation, and redness, often of a dusky color,
18

274

Diseases of th Bursa PaieUce.

[April.

all situated in front of the patella, point out the nature of the
affection.

The treatmentof this inflammation is simple enough. Leech-
es, followed by evaporating lotions, and keeping the patient at
rest, are the means to he employed. Under this treatment,
the disease will frequently undergo resolution in the course oi
a few days. So many cases, of this simple inflammation of
the bursa patella? occur in the hospital in the course of the
year, that I need not refer to any one particular instan

2d. In many, and perhaps the majority of cases, however,
the inflamed bursa eventually suppurates. Now, suppuration
of the bursa patellars a matter of great consequence, because
the accumulation of pus, being of large size, and tending to
diffuse itself around the knee joint, is liable to be mistaken for
abscess in that articulation. Suppuration of the bursa is, in-
deed, followed by a widely diffused abscess, that speedily gets
"beyond the limit of the anterior part of the knee. This
is owing to the inflamed and suppurating bursa, instead of
bursting externally, giving way under the integuments. If
not, it will point, and the pus discharge itself externally in the
usual manner; but in many cases it gives way subcutaneous-
ly, audits contents diffuse themselves somewhat widely around
the joint.

How are we to distinguish such a collection of pus as this
from suppuration within the knee joint itself? In suppu-
ration of the bursa patella?, the history of the case will show
that the abscess commenced by a superficial swelling and in-
flammation in front of the knee, which, after a time, extended
laterally, enveloping the joint, the fluid gravitating on either
side, but more especially on the outer one, nearly as bar, per-
haps, as the ham-strings. There will have been none of
signs indicative of acute arthritis accompanying the formation
of this large abscess ; no starting of the limb, no laxity or
pain in moving the articulation, no grating of the articular
ends, and little if any constitutional disturbance, which is al-
ways a marked feature of the rapid disorganization of a
large articulation. The movements of flexion and extention
of the joint; up to a certain point, where they are

checked by the mechanical obstacle of the purulent accumu-
lations, lint perhaps the most important diagnostic sign is
the relation of the al the patella. In a suppurating

bursa, the patella is invisible, being covered by the fluctua-
ting swelling; in effusion, whether synovial or purulent, into
the joint, the patella is above, floating upon the fluid.

Having thus made the diagnosis, the treatment of this con-
lition becomes simple enough. A free incision should be

>. i I) 'the Bursa Patella.

made into the anterior part of the bui a to let out the

pus mixed with synovial fluid; and if there beany burrowing
of matter, as there almost invariably is, counter-openings must
be made in proper dependent situations. I may mention the
following case, as illustrating well the points to which J hare
Just adverted :

"Mary T , aged twenty-four, married, was admitted into

this hospital on April L6th, L858. About a fortnight before
her admission, she noticed some degree of swelling on the
front of the knee, but as itdid nol cause a ;. inconvenience,
she took no notice of it until about three days afterwards,
when it began to inflame and to become painful'. Hot fomen-
tations were applied without affording her any relief, and she
continued to get worse up to the time of her admission, when
slio had, at first sight, all the appearance of disease of the
knee-joint. A large abscess covered the front and sides of
the knee, but the patient could move the joint without giving
Herself any great pain, and the fluctuation was more distinct
above the patella than in any other part. A free incision
made into the abscess let out eight ounces of pus. The part
was well poulticed, and on April 24th the woman was so far
recovered as to he able to walk about, and was made an out
patient.

Here, then, is an ordinary case of abscess of the bursa pa-
tella1, gravitating to the sides of the joint, and requiring free
incision and poulticing.

3d. Sometimes, but very rarely, abscess of the bursa patellae,
will go on to disease of the patella itself. Caries of this bone
secondary to suppuration of the bursa is, so far as my experi-
ence goes, exce< dingly rare. I have only seen one case of the
kind that of a woman who was in the hospital under my
care, about three years ago. She wTas admitted into the hos-
pital on the 30th of April, 1S56, and then had several fistu-
lous openings on the fore part of the knee-joint, through
which the probe led down to a rough and carious patella. On
inquiry Ave ascertained that she had had inflammation on the
bursa patellae "housemaid's knee" which had run on to
suppuration. The present condition had resulted from that
suppuration. The joint itself was unaffected, there was no
pain in it, and its movements were perfectly free. I laid open
the sinuses, and finding the anterior surface of the patella soft
and carious, removed with the gouge the diseased bone to
which they led. About two or three weeks after this, the
joint became suddenly swollen, evidently filled with pus, and
the seat of acute pain. In consequence of the severity of
the symptoms, it became necessary to remove the limb above

276 es of the Bursa Patellce. [April,

the knee. After {imputation, it was found that the morbid
action had extended through the patella cartilage, perforating
it by a small aperture, and so giving rise to suppuration with-
in the joint. We have here, then, a case of suppuration of
the bursa patellae, going on to caries of the patella, and second-
arily to disorganization of the knee-joint.

4th. Sloughing of the bursa patella occasionally occurs as
the result of its inflammation and suppuration. A woman
was admitted into the hospital last October, in whom this bursa
had inflamed and suppurated, and not only the bursa, but
also the integuments covering it had sloughed away, leaving a
circular ulcer in front of the knee as large as the palm of the
hand, having a Happy surface and undermined purple edges.
The patella was not exposed. Under ordinary treatment, the
ulcer slowly healed, but no vestige of bursa was left.

We now proceed to the consideration of the second class of
diseases of the bursa patellae those in which there is no in-
flammation, but in which there is enlargement of the bursa,
owingto the accumulation within it of bursal fluid, of this fluid
mixed with solid bodies, or of solid fibroid deposits.

The fifth morbid condition which this bursa may present is a
simple enlargement, dependent on fluid accumulating in its
interior. Continued pressure exercised upon the bursa, as in
kneeling, is the common cause of this affection, (hence its
frequent occurrence amongst housemaids,) and constitutes the
true " housemaid's knee." But it is also common among other
people, whose vocation necessitates long-continued kneeling.
One of the last cases of the affection that we have had in the
hospital was a carpet layer; it was to all intents and purposes
a housemaid's knee, and the tujDor equalled in size an ordinary
orange. A man, aged thirty, was admitted on the 16th of
March last, who, inconsequence of habitually kneeling upon the
left knee in laying down carpets, had a tumor there as iarge as
an orange, indolent, soft and fluctuating to the feel, evidently an
enlarged bursa. It was tapped by means of a trocar, and a
seton passed through the canula, and left in for six or seven
days. Suppuration took place along the seton, the tumour
collapsed and contracted, and the patient left the hospital
cured, on the twelfth day.

"With regard to the pathological nature of the disease, it
would seem to consist in a hypersecretion into the interior of
the bursa, whjch becomes enlarged, thickened and filled with
a clear sero-synovial fluid.

The treatment of these tumours is very simple. In some
cases, the application of tincture of iodine, or the ammonia-
cum and mercury plaster, or blistering, will succeed in indue-

I860.] Di fthe Bursa Patella. -77

ing absorption of the contained fluid, [f these fail, as they
very often do, or if their use is too tedious, a very simple, and
at the Bame time a very safe and successful mode of treat-
ment consists in tapping the tumor with a trocar, and passing
a seton through the canula, either by means of a long straight
needle, or by using an eyed probe, and cutting down upon the
end of it with a scalpel. The seton threads should be lefl in
for a week or ten days at all events until they excite free
suppuration. This treatmeut is, as I jusl said, exceedingly
simple, and perfectly certain in its results. The only poinl to
be attended to is to keep the apertures by which the seton pa
sufficiently patenl to allow of the free escape oi any fluid which
may collect in the interior of the bursa before it is closed.
This is especially to be observed with the lower opening,
which is apt to get Mocked up.

The si\;h affection to which the bursa patella? is liable is
closely allied to the last, and appears to be an advanced de-
gree of it. It consists in a chronic enlargement of the bursa,
the coats of which are much thickened. The contents of the
bursa, so enlarged, consist of a dark fluid, in which float a
number of smooth oval bodies, the size and shape of melon
seed-. I have seen this condition in both the male and the
female. It may be distinguished from simple enlargement of
the bursa by the peculiar crackling sensation which is com-
municated to the hand when the tumor is manipulated. This
arises from the melon-seed floating about rubbing against
each other.

The pathology of this affection is as follows : There is en-
largement of the bursa, and hypersecretion into its interior of
simple synovial fluid, which, however, is dark-colored, owing
ably to admixture of blood which has undergone disinte-
gration. This fluid will be found to contain a large quantity
of cholesterine, broken-up blood-corpuscles, and granules.
The melon-seed bodies are composed of lowly-organized fibroid
matter mixed with cholesterine, and are probably separated
from the Avail of the bursa.

The following case is a good illustration of this form of
disease :

A man, aged forty-eight, was admitted into the hospital
under my care some years ago, with a tumor over the fore

Eart of the patella, which had existed two or three years, and
ad attained the size of an orange. On examining the tumour,
it was found to crackle very distinctly. The treatment adopt-
ed, and which is to be followed in similar cases, consisted in
tapping the tumour with a rather large trocar, and passing a
seton through it. The fluid which escaped was dark colored,

278

of the Bursa I}"f< flee.

[April.

and contained a large quantity of melon-seed bodies. Tlu
patient was cured in a little more than a fortnight.

The seventh and last form of the enlargement of the burs?
patelhv is that in which solid tumours are formed in connec-
tion with the bursa, and of which the following case is a _
illustration :

A female, aged thirty-two, had had nodes on the head and
arms as the result of syphilis. These disappeared, but in
course of a year a small tumour, of the size of a pea, appear-
ed on each patella, and gradually increased to the size of
pigeon's egg. She had not had much kneeling, and had nevei
been a servant. The tumours were the seat of pain, especi-
ally at night; they were hard, indolent, and but slightb
moveable on the patella. This case illustrates well the (
dition termed solidification of the bursa patellae. By many il
is supposed to be the result of the depositon of a fibroid ma-
terial, which gradually takes the place of the fluid of an ordi-
nary " housemaid's knee," and which instead of taking th<
form of melon seed bodies, is deposited in concentric masses,
and thus accumulates in the interior of the cyst. This wi
not the case, however, in the instance just mentioned,
was it in others that I have seen. In these cases I belie v<
there is a true fibroid deposit in the bursa- from the very first
the tumour is never fluid, but hard and solid from the com-
mencement, and continues slowly to augment in size, until
occasions sufficient inconvenience to require removal. In tlu
case under consideration there was a previous syphilitic taint;
the patient complained of pain in the tumour like that whicl
is experienced in nodes, and it is by no means impossible
that there may be a syphilitic origin for these tumours.-
However that may be, in this case, and in others that hav(
fallen under my observation, the tumours have never been
fluid, nor have they originated in pressure, but appear to hav<
been primary deposit of fibroid matter. There is nothing t(
be done with such tumors but to dissect them out, as was don<
in the case of the woman I just referred to. "With the most
ordinary care the joint runs but little risk ; but much trouble
may arise from opening up that layer of deep fascia which, af-
ter surround knee, is fixed to the borders of the patella.
Such an accident is liable to be followed by infiltration am"
deep abscess in the ham, and is to be avoided in keepizti
the scalpel well towards the centre of the patella whei
operating.

These, then, are the affections to which this bursa is liable.
Of the inflammatory affections we have, in the first place,
simple inflammation, which may undergo resolution, or ter-

I860.] Discharges from the Urethra, 279

ruinate in suppuration, and the pus so formed may be limited
to the interior of the bursa, or, a^ is more common, has a ten-
dency to diffuse itself around the joint. Then we may h
sloughing of the bursa itself,and lastly, caries of the patella as
b secondary result. Then, amongst the non-inflammatory af
fections, we have the simple enlargement from the hyp

ipn ; the enlargement attended with the formation of mel
on-seed bodies in the interior of the bursa; and Lastly, tumours
Bolid from the first, and produced by fibroid deposit in the in-
terior of the bursa.
The diseases of the bursa patella' have their analogues m4he
. such as that >ver the tuberosity of the ischium :
Lut the affections of these other bursa* are l>y no means so
frequent, so numerous, or so weft-marked as are those of the
patella bursa. London Lancet.

On Discharges from tfu Urethra not of a Specific Gonorrhoea
C By John Harrison, Esq., F.R.OS.

It was long ago demonstrated that gonorrhoea} matter conies,
not as was previously supposed, from ulcers of the lining mem-
brane of the urethra, but by exudation and secretion, from the
inflamed mucous surface unaffected with any breach of conti-
nuity, except, perhaps we might now add, some degree of abra-
sion from partial exfoliation of its investing epithlium. In some
dices, if I mistake not, the lacuna magna is the source of
puro-mucous discharge, which frequently continues for a long
time, and. so long as it does continue, is a cause of annoyance.
From cases which have come under my notice, I have "been
led to consider this large mucous follicle as the sole source of
the discharge. In oilier cases, again, the discharge has ap-
peared to me to come from the cavity of a small abscess.

In gonorrhoea, abscess every now and then forms by the
side of the fraenum, and most frequentlv bursts externally,
though occasionally into the urethra. In this latter case it is
Bometimes, I believe, the source of a chronic discharge, small
perhaps in quantity, but which may continue after the gonor-
rhoea has entirely ceased. Such cases are by some very like-
ly to be considered of more importance than they really are.
Ajiin, as elsewhere mentioned, I have met with many cases
of purulent discharge confined to the front part of the uthera,
and attended by a pouting, irritable state of the orifice, which
patients have told me has annoyed them for month-, and for
which they have taken internal medicines until the stomach
has been perfectly nauseated. This form of discharge is in
numerous instances kept up by the constant friction of the

280 Dischart thra. [April,

Lips of the ur s, there being an entire 01

partial paraphimosis, the prepua short and the glanda

denuded, by merely shielding the oriiice, the discharge will
frequently cease in eight or ten d

Though the most common form of inflammation of the
mucous membrane of the urethra with puriform discharge is
that which is excited by contact with the viri torrnoea,

and free from any Bypnilitic character, we occasionally meet
with >eginning in the same way as ordinary gonojfrh

and so far runnii .'iar course, but in which, sooner or

la|er, a small ulcer appears on the margin of the lip of the
urethra, which spreads from day to day until it surrounds the
entire oriiice. The ulcer thus formed possesses all the charac-
ters of true syphilitic chancre, and is frequently, and that at
a very early period, followed by secondary sympi

Other forms of inflammation of the mucous membrane of
the urethra with puriform discharge, again, are met with,
which are, as well as the forms just referred to, contracted by
sexual intercourse, though under circumstances where there is
no reason to suspect venereal taint of any kind, the cause
being prolonged venereal excitement, perhaps keeping up
gestion, whereby the ordinary secretion of the mucous mem-
brane of the urethra is rendered botli thicker and more cop:
as in the following case :

A gentleman, aged fifty-five, a frequent " diner out," and
a " champagne drinker ; twice married, the first marriage a
mariage dt conv "ith a lady much older than himself;

the second marriage, after five or six years' widowhood, with,
I may really say, a buxom widow, much younger than himself.
The third or fourth day after marriage, the gentleman suffers
much heat, pain, and irritation in the urethra, with a purulent
discharge. About the tenth day, the lady also experiences
much irritation in the vagina, with puriform discharge. At
the end of a fortnight, both husband and wife are confined to
their bed. suffering from all the symptoms of gonnorrhoea
the husband with inflamed glands in the groin in addition.
By giving up their high living and champagne drinking,
adopting a cooling regimen, with perfect quietude, and ab-
staining from the exciting cause, both ^ot well again in a
fortnight'.

A common can is irritation from contact with what

I call the natural morbid secretions of the female parts, such
as leucorrheea, lochia, &c.

In the female, disch rom the vagina, destitute of any

veneral taint, are common, though capable of exciting in men

i).] Dischar ? from tfo Urethra,

who may h mection with them inflammation of the

urethra, with puritbrm discharge.
What( [. Diday " be of cleanliness,

apparent health, \\ic presumed virtue, the real virl

i virginity of any woman, she may have leucorrhceal i

charge from some cause, often very iunocenl rmetritis, chlor-

deliverj .
aiorrhoja, however contracted
a discharge of some kind, in a

lition to transmit a discharge to a man having

But the forms to which I wish here to dir
tho s wholly unconnected with sexual in-

oximately so. Irritation being once
eet up in the genital organs, from any cause whatsoever and
there are many, w shall se< . which tend to produce it, is
mpanied wi h puro-mucous discharge, whichmay continne
for an indefinite ] The dischar< t, and in

;' harm!' ivided no promiscuous intercourse take

plac d at in a wrong light, as all such dis-

charges arc liable T > be, it may prove a source of annoyance,
uietude and suspicion. reat impor-

tance that the medical attendant should be ready to clear up
explain the matter of such c md thus relieve the

minds of the patients and their friend

The mucous membrane of the urethra, then, is subject to
Linmation, with puritbrm discharge, from various other
sides the venereal poison.
The mechanical irritation of a bougie, or the chemical irri-
tation of a stimulating injection into the urethra, lias been
found to excite inflammation with puritbrm discharge. Thus,
1 have known the injection of soap and water, or laudanum
which had been used to wash out the urethra after a promis-
cuous connection, with a view to prevent gonorrhoea, occa-
. irritation, inflammation, and discharge. Exposure to
cold also acts as an exciting cause. Herpes preputials may
id into the urethra and give rise to ulceration there, with

We sometimes meet with puro-mucous discharge from the vagina in female
children, accompanied by purulent ophthalmia ; the latter, no doubt, having
been excited by matter accidentally conveyed from the vagina to the eye. as hap-
pens in cases of true gonorrheal ophthalmia. This discharge from the vagina
appears sometimes to be occasioned, sympathetically by the irritation of the
rectum by ascarides, or by ascarides which have actually made their way from
the anus to the vagina. Vaginial discharge in young female children is calcula-
ted to cause much alarm at first, but this 'may be quickly allayed by explaining
the nature of the case. The treatment is simple; a dose of .scammony, and the
use of a weak solution of the sulphate of zinc as an injection into the vagina.

282 Discharges from tfu Urethra. [April,

or without discharge, and accompanied by severe pain, espe-
cially on the introducti m of a bougie.

That some discharges from the urethra are of a scrofulous
origin was long ago suggested Dy Mr. John Hunter. Of this
there can be as little doubt as that the affections of the lach-
rymal passages are of that nature. The rheumatic or gouty
diathesis also sometimes manifest itself in urethral discharge.
At any rate, in these diathesis the scrofulous, gouty, and
rheumatic there is a predisposition of the mucous membrane
of the urethra to be more readily affected, by occasioal causes,
with blennorrhoea, just as Ave find to be the case with the con-
junctiva and lachrymal passages of the eye.

In stricture of the urethra and diseases of the prostate we
often meet with puro-mucous discharge. Oases are frequently
met with, in which there is much irritation of the anterior
part of the urethra, attended with glairy discharge, the secre-
tion sometimes muco-puriform, with shreds of lymph in the
urine. Here the disturbance at the orifice of the urethra is
symptomatic of a disordered state of the neck of the bladder
and posterior part of the urethra. In these cases there is a
liability every now and then to attacks of inflammation of the
testicle. As the irritation at the posterior part of the urethra
subsides or improves under appropriate treatment, the irrita-
tion and discharge &c. at the orifice cease. The disordered
state of the posterior part of the urethra being in the vicinity
of the verue montanum and excretory ducts of the t
swelling of the testicle so frequently attending these c
is accounted for by the continuity of the muscous mem-
brane of the urethra with that of the vas deferens. Mr.
Hunter mentions cases in which, fvuwi sympathy wifl
the cutting of a tooth, all the symptoms of a gonorrheal
were produced. This happened several times in one patient
Children, indeed, are subject during dentition to a discharge
from the genitals.

The endless and ever-varing charges o^ the urinary secre-
tion which takes place in certain morbid states of the const3|
tution gout, rheumatism, gravel, chronic dyspepsia, &c.
are conditions which, it must be borne in mind, exert more or
Less influence in producing irritation of the lining membrane
of the urethra. The appearance in the urine of uric acid and
urates, oxalates and ammonia, which takes place in the affec-
tions above mentioned, may be accompanied by much distress
and irritation of the urinary passage.-, with puriform discharge.
In these cases, we are too apt to look at the local disturbance
alone as the disease, whereas they ought rather to be consider-

>. ] i om tin I rretfrra.

ed as\ symptoms iv< of the general disordered

the system.

The gouty form of discharge may be produced bi
Blight excitement, is troublesome and protracted, frequently
led with derangement at the n< <!. of the bladder. If
this form of disci large be treated as gonorrhoea, specifically,
tlie local distress is increased, without any diminution of the
discharge. These cases arc liable to relapt

In certain affections cf the Bpinal eord, the on of

urine is morbidly altered ; whilst, in consequence of | arab
of the bladder, it cannot be evacuated without instrumental

stance. In such cases, there is congestion of the muc
(ttteinbrane of the urethra, with puro-mucous disci

Some of the forms of diabetes arc attended with ur<
discomfort with now and then a puro-mucous discharge. Piles
and habitual costiveness, suppression of discharges elsewhere,
cure of old eruptions, and injuries of the penis, may also give
from the urethra.
Again, certain medicinal substances, it is well known, exert
an irritating action on the urethra, and excite discharg
Terebinthinate medicines, the gum resin guaiacum, etc., have
this effect. Besides these, certain articles of diet, also, it" in-
dulged in freely, now and then occasion much irritation of the
urinary org ms, ardor urinae, &c, attended with more or less
piriform dischargi . resembling gonorrhoea.

For instance : A medical practitioner, thirty-four yei
age. - une twenty-four hours after eating largely of asparagus
young, green asparagn rienced

heat and burning pain along the whole track of the urethra,
h frequent micturition, chbrdee, sympathetic fever
&c. On examination of the parts, the lips of the urethra
served to be much swollen. The urine was high-col-
ored, scanty, and strongly impregnated with the odour of as-
paragine. In thirty-six hours, a moderate puriform discharge
from the urethra set in, having all the appearance of gonor-
rhoea. Under appropriate soothing treatment, all the symp-
mbsided in five '
Those who drink largely of fermented liquors are not un-
frequently troubled with urethral discharge. Bavarian beer
pecially said to produce this effect, cayenne pepper also.
The history of the case, its antecedents and comcomitants,
will suggest its true nature to the practitioner who bears in
d, as every practitioner ought to do, that es from

urethra are not always owing to a specific venerial
sidering the various circumstances, above indicated, under
which simple discharges from the urethra may occur it is ob-

284 Infra-Ocular Haemorrhage, [April,

vious that no one particular mode of treatment can be laid
down.

The removal, rectification, or amelioration of the conditions
by which the discharge may have been excited, or on which
its continuance depends, will frequently be followed by im-
provement or recovery; but it may- be necessary, in addition,
to make use of a weak astringent injection, on the same prin-
ciple that we find it necessary to make use of an astringent
eye-water in cases of puro-mucous inflammation of the con-
junctiva, no matter by what cause, or under what circumstan-
stances the inflammation may have been excited. London
Lancet.

On Infra-Ocular Haemorrhage after Extraction, and other
Operations Requiring a large Incision in the Cornea. By J.

Whittaker Hulke, Esq., F.R-.C.S., Assistant Surgeon
to the Royal London Ophthalmic Hospital, and to King's
College Hospital.

The publication of a case of intra-ocular haemorrhage
after the operation of extraction, by Mr. Hildige, in the
Lancet (Xovember, page 410) induces me to offer some re-
marks upon tliis accident, which, owing to the absence of
recorded dissections, has been until recently but imperfectly
understood. The older surgeons ascribed this haemorrhage
to a rupture of the arteria centralis retina?, or of some of its
large branches, and -more recent authorities have accepted
this theory unquestioned, although it is quite insufficient to
explain the phenomena of the accident, and the order in
which they occur. Several cases have come under my per-
sonal observation, three after extraction, the others after
operations, requiring less extensive corneal incisions. With
two exceptions, the haemorrhage supervened immediately
upon the completion of the operation, which was attended
by loss of victrous humour, though in no instance had this
taken place to any considerable extent. A moment or two
after the loss of some of the vitreous humour a sharp pain
was felt ; then the globe became tense, blood trickled from
between the lids, and soon the rest of the vitreous humor
mingled with blood, and covered. by shreds of retina, was
extruded from the interior of the globe through the corneal
wound. After this a very troublesome oozing of blood
continued in some of the cases for several hours. Suppura-
tion and subsequent shrinking from the regular termination.

To avoid the distress which suppuration of the eye-ball

).]

entails, and the protracted recovery, a patient in the Royal
London Ophthalmic Hospital, to whom this accident hap-
pened in October, ls~>7. was prevailed on by Mr. Bowman
to submit to immediate extirpation of the irreparably dam-
I examined the globe innm diately after its re-
moval, and noted the following appearances, which I com-
municated to the Pathological Society: "The globe was
partially collapsed, but fell hard rather than flaccid. The
paii oi the retina, covered with dotted blood, was
agled in thecorneal wound. The sclorotic and choroid
widely separated by a large clot of blood, by which
latter membrane was pushed inwards towards the
grlobe. The ciliary nerve were imbedded in the outer
surface of the clot The small space which was left in the
centre oi' the globe was traversed from back to front by
a b1< re<j of retina, which connected the entrance <>f

optic nerve with the rest of the retina entangled in the
corneal wound." This dissection proved beyond doubl that

the hemorrhage came from the vessels of the outer surface

the choroid; and although this source had been previ-

y hinted at by others, BVfaras I know, the fact had never
actually demonstrated.
I haw d four other specimen- obtained

equently, prepai f which are in our museum at

rnelds, and theappearai incide in every important

particular with what I had observed in the firsl example.
ther preparations have been alluded to
by Mr. White Cooper in his work on "Wounds and In-
juries of the Eye," and in the Annates d' Oculistique, to which
journal >^^; - <>n this subject have been contributed

drau. The haemorrhage having been
shown I d from vessels in the outer surface of the

id. the natural presumption is that the vasa yorticosa
and their tributaries are the immediate sou;

I hit a different view h advanced by M. Rivaud

Landrau, hich appears t<> me to be based upon an

imperfect k: the anatomy of the pails. Be says,

d by Mr. Hildige, The vitreous humour, in being
proi y detached from the chorio<

and it is in this maimer that the rupture of the minute Ban-

- which wind about (in) the cells of I
hyaloid membn the choiroidea towards

Frm this statement we glean I

hyaloid capsule of
the vi1

286

Epithelial Cancer of the Lips.

[April,

from the choiroid. The first fact is, at best, non-proven until
the evidence upon which it rests is adduced ; and the sec-
ond would imply the absence of the retina, which intervenes
between the two other structures , besides which no bleed-
ing from the inner surface of the choiroid can, as I have al-
ready stated, explain the phenomena of the accident and
their sequence.

The loss of vitreous humour which precedes the flow of
blood externally has been variously considered in relation
to the hemorrhage ; M. R. Landrail considers the escape of
the vitreous humour as the immediate cause of the haemorr-
hage ; Mr. White Cooper, as the effect. I think both views
contain truth, but neither to the exclusion of the other.
The loss of vitreous humour, by depriving the large choir-
odial vessels of their accustomed support, places them in a
favorable condition for rupture, which, however, does not
take place without some predisposing cause, and this lies in
their preternatural dilatation and varicosity, which I have as-
certained in one case by actual measurement. In short, the
explanation of the accident is briefly as follows: The
larger choiroidal veins being pre#sposed to rupture by vari-
cosity and attenuation of their walls, burst when their
wonted support is taken away, when an operation requiring
a large conicle wound is complicated by the loss of some of
the virtreous humour. The blood poured out on the outer
suface of the choiroid rapidly strips this membrane from the
sclerotic, and thrusts it inwards towards the axis of the
globe at the expense of the rest of the vitreous humour,
which is thus mechanically squeezed out, with the retina
covering. In this way the loss of vitreous humour is alter-
nately cause and effect of the haemorrhage. London,
Lancet.

)

Epithelial Cancer of the Lips.

Isolated examples of this form of cancer of the lip are
^ occasionally presented to the notice of the pupils at the
different general hospitals in London, and, when the disease
has not extended too far, it is removed by operation. On
the occasion of a single visit to the Cancer Hospital, we
observed the following cases :

A man, sixty-eight years of age, had the left side of Lis
lower lip affected for a year with a distinct epithelial can-
cerous ulceration, slowly enlarging. It had now almost
entirely healed by the application, 'three times a day, of

I860.] helial Oancer ofth Lips.

equal parts of almond oil and solution of diacetate of Lead
(two drachma of each). This has a Boothing and drying-up
effect, and absorbs the surrounding induration.

Another man, sixty-one years oi age, had been the subject
of cancer of the middle of the Lower Lip for fourteen years.
It had been removed ten years ago, at St. George's Hos-
pital, but recurredsome time afterwards. Prom beingvery
large it had diminished to the size of a shilling, and was
drying up or scabbing over by the simple application of
distilled vinegar and Goulard*s Lotion.

A third example was that of a man, fifty-eighl years of

. wiili the same disease affecting the Left side of the

lower Lip for four years. He had never been operated upon.

and was being treated with apparent advantage by the local

application of spirits of turpentine three times a day.

A man. aged forty-five, had Ids lip and submaxillary

affected. The diseased pari of the lip was excised

by Mr. Stanley, at St. Bartholomew's Hospital, about

iteen months before, the whole duration of his dis<

having been now three years. The lip remained well after

the operation, hut the glands in the submaxillary space of

Bide of the neck began to enlarge and suppurate

i rwards. This is not a favorable ease to treat,

of the disease; hut, under the use

mbrocation of lead, with tonics, the man was greatly

improving.

. Chelsea pensioner, seventy-one, had a cancer

ed from the righl er lip two years i

Hospital, Brompton. The
returned, but I as dwindL d to v, me] r super-

. b by the die soothing lead lotion.

In these five vhich we had the opportunity of thus

ce of the off cre-

i had a healthy appearance,

and the patients felt that th< tingbetter. Without

to the ungli I <f a tobacco pipe.

J ii l .' inherited.

( in the 19th July, < f the Lower lip

n at ( '>n\'- Eo jpital. The !ii>t

Qe epithelial form < f the

righl half of the lip, involving the
mu Hilton by a

V . and tl if the would v. i aghl

ether by needles. The

[A
in a midd man, in whom tl.

pro*
< n ma]
marble, and
pati< I Brnok* >nlv in I

of thi ipe. 1

M.

\\'c'c:ui hardly do jus
brn

ntaine I h of Lnl

annotic
Prof. Joy]

physiologists, viz: "Thatfibri
from !> niizaliK- or

the immediate pabulum of the most highly vita
. reality, an
nutrition,
which ;.. - n in the bli

-in the waste of th<
elimination from tl.
Prof. Joyi to tlu* older theory, until :

held by all physiologists, which
important element i nutrition, I

u by tl
i

" Fibrin ;- .Evident ndiJ

cations of h ind in the fluid drawn from la

anima] in full dig i I their verj the

intestine; but il the

transformati

ugh it
ven< in ; and a further

> the art<
tion. v. affirm, I

I860.] Physiological position of Fibrin. 289

where materials are needed for the nutrition of tissue; and we
may ask if fibrin be an excrementitious product, why should
it appear in th chyk directly after its absorption? We can-
not account for its p] bere by the waste of tissue, nor
can we reasonably suppose the occurrence of a "retrograde
metamorphosis" a destructive change in the products of
digestion as soon as they arc absorbed.

2d. "Fibrin is normally found only in the nutritive fhdds
of the economy the blood, chyle and lymph. It is not a
constituent of any excretion^ as are all those constituents of
the blood which are admitted to be excrementitious such
as carbonic acid, urea, uric acid, creatine, etc.

3d. "Fibrin is nature's agent for the arrest of hemorrhage.
When vessels are divided, the coagulation of the blood is
the means by which their occlusion is mainly effected, and
the now permanently arrested. If the blood contained no
fibrin, and were therefore not coagulable, hemorrhage, even
from the lightest wound, could never be arrested by the
efibrts of nature. But for the same protective property
every separation of a gangrenous part would be attended
with bleeding. Effusion of fibrin is also the means by which
suppuration is circumscribed, and prevented from assuming
that diffuse character which is sometimes so destructive.
In these several particulars, fibrin performs offices which
are singularly conservative. Can we say as much for any of
these products of wear and tear which constitute the true
offal of the system ? It has been aptly remarked that the
organism bears an increase of fibrin better than o diminution.
"Witness the comparative gravity of sthenic inflammation
and the severer grades of typhoid fever. Not so with any
organic compound of the excrementitious class. The accu-
mulation of these in the blood is the signal of urgent peril.

4th. "Is it mere fancy that sees in the spontaneous coagu-
n of fibrin, and the definite position which its particles
usually assume in solidifying, the indication of a special
tendency to organization ? And is it unwarrantable to
argue therefrom the possession of a certain degree of vitality?
All attempts to ascribe this coagulation to the operation of
mere chemical or physical influences have failed. It is a
change which fibrin always undergoes of its own accord,
when not kept in contact with living parts, whatever

be the external condition in other respects. Whenever, in
the course of the circulation, the plasma of the blood is
effused from the capillaries in .the midst of the tissues for
their nutrition, the fibrin being now at rest, is free to pass
19

Thn at ned Abortion. [April,

into the solid slate, and enter into combination with the
tissue or tissues of which it is the appropriate food. AVe
have no just ground for affirming that fibrin is the only
immediate tissue-forming ingredient of the blood; that
albumen, for example, which abounds there, must |
through the form of fibrin before combining with any living
structure. The probabilities are all against such an exclu-
sive view. But that fibrin is a specially and eminently organ*,
izable or histogenetic material, this, I am convinced, is a truth
which cannot be successfully controverted." Va. Med. Jour.

A Case of threatened' Abortion apparently caused by Malarwu
By M. 0. Davidson, M. D., Van Buren, Arkansas.
I attended a negro woman during the months of Feb-
ruary, March and April last, who was threatened with
abortion every two or three weeks. I first saw her on the
10th of February, at which time she was laboring under
severe uterine contractions. From the character of the
pains, the rigidity and non-effaeement of the os uteri, I was
convinced she had not arrived at the full term of her uteri tie
gestation; and from the state of her physical strength I did
not think it advisable to employ any remedy that would
tend, to debilitate the system. I therefore administered fifty
drops of laudanum, and in two hours gave twenty di
more. Under its influence she soon fell asleep, and had no
more pains until the next evening, when they came on
about the same time as the day before. I stopped them
with the same medicine, but not until I had administered
eighty drops. Her bowels not having been moved for three
days, the next morning I gave her a full dose of calomel,
followed in three hours by oleum ricini, which prodi
several alvine evacuations. The pains returned in the eve-
ning, but were stopped by forty drops of laudanum.
Knowing the patient to have been the subject of intermit-
tent fever the summer and fall previous, it occurred to me
that perhaps malaria was the cause of the uterine disorder.
I therefore administered between fifteen and twenty grains
of quinine the next day. She had no return of the pains
for about three weeks, at the end of which time they came
on again. I stopped them with laudanum, but they returned
daily until I gave quinine. They continued to return at
intervals of two or three weeks, until the 1st of April, when
she was delivered of a fine child, at full term.

I several times withheld the quinine for a day or two,
when the pains would invariably return; but when it was
administered regularly it never failed to keep them in check-

I860.] / /" Common Carotid. _ii> I

Jjigatim of tin Gov I rotid for Hcemorrhagi from

T ;. Under the care of l>r. St lnlei .

We are glad to be able to furnish further particulars in
the history of the case of Ligature of the Carotid, the \'^v
mer particulars of which will be found in ourpagea for
>ber29, p. 429.

The rase up to the morning following the operation \-
ful 1 \ recorded, though it is in one particular erroneous.
The hemorrhage from the tonsil al the time of tin- puncture
was very slight, and the greal losses came on some time
after at repeated intervals. The following details of the
operation will also not be oul of place. An incision, an
inch and a half in length, was made over the direction of
the artery. The descendens noni nerve, where it lies on
(he carotid sheath, was seen, and turned aside. The artery
was secured by a ligature of Glasgow twine, about three-
quarters of an inch below the bifurcation.

Since the operation the man had no untoward symptoms;
the hemorrhage did not recur; the ligature fell on the
fourteenth da}'. On November 18, the following note of
his. case was made by Mr. Rogers, House-Surgeon, (to
whose kindness we are indebted for the particulars of tne
i: "The patient is going on quite well, and for the last
few days has left his bed. December 2. The man I

lily improved ; the wound is nearly healed; no pulsa-
tion can yel be fell in the facial or temporal arteries of the
affected side, lie is so nearly well, that he is anxious to
;go out; but Mr. Stanley thinks it advisable that he should
remain a little longer. There does not appear to have been
any cerebral symptom of any kind, except a little sleepless-
ness one night, which is referred to excitement from his-
anxiety, etc."

Cases in which bleeding after the puncture of an abscess-
in the tonsil is so profuse as to require further surgical
interference are very rare. Excepting the one given above,
and a second about to be recorded, we scarcely recollect a
single instance of such in the whole of the London Hospitals
during the last five years. It singularly happens that the
two cases occurred within a day or two of each other. In
botli the bleeding was profuse and occasioned serious
anxiety as to the life of the patient. Med. Times Gazette-

m~+

Neevus Cared by Oreasote. Dr. Buzalsky reports in the
Med. Z< it. the entire removal of a neevus on a child's temple*
by pencilling twice a day with ereasote.

Hypodermic Treatment. [April,

On the Mode of Employing the Hypodermic Ireatment. Ev
Charles Eunter, late House-Surgeon to St. Gcor.
Hospital.

The Syringe Its Employment; the Tissue, and the Part
of the Body to Inject. the Quantity of Fluid; D
Cautions. Greater Effect on Women than Men. Medici-
aal Administration by the Tongue and Rectum. In co
oucnce of the polite letter from ww Medicus," in this journal,
and numerous others which I have received relative to the
employment of the hypodermic treatment; I feel called
upon to make the following observations ; and firstly, with
regard to

The Syringe for Injection. The little instrument I use is
made by Messrs. Whicker and Blaise ; it is of the same
make (but a little larger as regards the barrel) as their ori-
nal caustic syringe. The barrel is of glass, with silver fit-
tings, and contains a piston which works by a screw-rod, each
half-turn of which expels half-a-minim, as a fine drop from
the end of the pipe.

Two pipes belong to each syringe, the one larger and
stronger than the other ; the smaller pipe will be found the
best for general use ; it screws on and oft* the barrel at
pleasure, and is made of silver, with a hardened gold point.
This point is sharp like a needle, and perforated on one
side by an oblique opening, through which the drops of the
narcotic otic or other solution are expelled.

No incision is required with lancet or other instrument,
when this syringe is used, for the point of the pipe 1
. sharp and tine, is readily passed, with proper pre
tion, beneath the skin ; no blood is shed, and the operation
is no more than the prick of a needle.

The Emt . Having charged tl.

e with the narcotic fluid, hold it in the right hand at the
junction of the barrel with the pipe, and with the left hand
take up, between the finger and the Thumb, a fold of the
-kin ol' the patient, so as to make tense the part beyond
your thumb, then the right hand being gently steadied, but
not heavily pressed on the patient, let the point ol* the
ivringe, which is held at a right angle to the skin, t<
tlie part which is tense, and with a <jukk but stead t
'. be passed through it: the point being well ih
, the direction of the pipe n > that it i

I860.] Hypodermic Treatment

run along in the ellular tissue beneath; all thi

the work of a monienl ; the pre-arranged number of dr
are thou introduced by bo many turns of the
pipe is then withdrawn, a finger making slight pressure ai
near as possible on the punctured spot, the o pi eel being both
teady the skin, and prevent any drop of liquid escaping;
and lastly, a narrow strip of plaster, cut beforehand and
warmed, is placed on the spot.

The Btrip of plaster is generally a precautionary mea
but it becomes a necessity when the quantity injected ii
large, say twenty minims; but it is always useful to pre-
vent the spot from being chafed. A broad piece of plaster
rse than none at all ; it pre* the "little Lump,*

which is caused for a few minutes by the pres< the

injected fluid beneath tin and not at all, perhaps, on

unctured spot, and so it does more to press the fluid
out than to keep it in (I have soon a first injection in a case
lelirium tremens fail for this very reason); but a narrow

'"/.
$e directions may appear unnecessary, but the 0]
tion may fail, as just shown, for want of attention to these
little points. If the introduction of the syringe be attemp-
ed. the skin of the patient being loose, or the syringe held
at the further end, and consequently unsteadily, the patient
by these means he put to a great deal of pain, and the
pipe of the syringe may be bent or broken from the sock
but when it is introduced with a quick, steady movement,
the skin being tense, the patient docs frequently not even
v when the point is introduced.

'ect. The tissue injected is the cellularor

lar tissue body ; it may not matter much whether

cellulo-adipose, the panniculus adiposus, or the retic-

ular tissue beneath it (not containing fat) be injected, but

latter is to be preferred : it is the looser of the two. fluid

injected into it meets with no obstruction, and cannot easi-

m it, but if injected into the skin itself, as some

think it is, or the conjoined cellulo-adi] ue, it is apt

pain, it enters loss readily, and is more apt to es-

: nor docs it seem to act quite so rapidly as when in-

ed into the loose cellular tissue from which most proba-

hly absorption is the more rapid.

*In the majority of cases, the plan above described is best, especially with
thin people ; it however, the patient is very fat, it is better to perforate vertical-
iiortion of skin and subjacent fat. pinched up, and so made tense between
the finder and thumb.

294 Hypodermic Treatment. [April,

The Part of the Body to Inject. When the object is to
quiet the brain, or to produce a general effect, it is material
whether the fluid be injected into the cellular tissue of the
body or of an extremity ? No ; the non-necessity of local-
isation is the basis of the plan of treatment, and is the
reason of its applicability in cerebro-spinal affections and
general diseases. I need only refer to the various cases de-
tailed in corroboration of this. The site which I, however,
most commonly inject, is the inner pen l of th arm. The skin
Is here thin, easily made tense, and easily perforated ; the
cellular tissue beneath is loose and readily receives the fluid;
there are perhaps more veins here than in some other}-,
but they are easily avoided.

The Quantity of Fluid to inject. It is well to have the
fluid of that strength that three or four turns of the piston
shall be an ordinary injecting dose. Two or three turns
<can be made in a moment of time, and it is no small relief
or surprise to the patient, who has been expecting, perhaps
dreading, an operation, to find all over in less than, half a
ute.

The Dose. Too much caution cannot be employed with
regard to the amount of the narcotic injected. Two half
turns, if your solution is strong, may double the dose, and
the life of the patient, for want of due care, be placed
in jeopardy; I would, therefore, urge attention to t
points :

1. Be certain of the exact strength of the fluid employed,
and the exact value of each turn of the piston.

2. Concerning first injections, never use more than half
the ordinary, stomachic dose for males, nor more than a
third for females.

3. Should a second injection be necessary, let it not be
used too soon; nor in a full dose when the patient is parti-
ally under the influence of the narcotic.

These points are of practical importance; a certain degrei
of narcotism lias to be reached for benefit to accrue, and by
the injection it can be reached in many cases by a very
.small quantity of the narcotic, because of the rapidity with
which the effect is produced, what we have to avoid is too
areat&n effect ; what we try to produce is a certain tfu-t\x\X\\
as smatta quantity as possible. This leads me to remark that
men bear narcotics much better than wo\

I was not aware to what extent this was the case until I
had employed this treatment some little while : but I now
think it may be looked on as a rule that men in general

I860.] Hypodern ic Treatment l,.,."

will bear with no ill effects, bul be benefitted byj injected

is of narcotics, which doses would very Btrongly, il' not
seriously, affect women ; in fact, this treatment is a test of th

I amount of a narcotic necessary to produce ;. desired
effect, when taken by direct means into tic general circula-
tion. For instance, you introduce beneath tii'' -kin the
one-eighth of a grain of morphia, the effect which follows

ie whole effect of the whole one-eighth; bul von can-
Dot be certain that the effect which follows the administra-
tion of one eighth of a grain, (irstly^by the Bkin ; secondly,
by the stomach ; or, thirdly, by the rectum, is the effect of
the whole one-eighth; but it is the who! I of the

quantity absorhed.

As by this method we get the w) > of the known

quantity introduced, which we are not sure i f g tting by the
other modes, we have now a method as acurate as that of
venous injection (without it- dangers) for testing the pre<
effect of little-know.n medicines on animals, and the exact

g and effects of well-known medicines on man, of see-
ing the difference which the sex requires in the dose, andof

rtaining the minimum amount required to produce a
desired effect.

It is impossible to say -'what amount is to he injected,"
without knowing the particulars of the i . well as the
sex and age: but taking the^acetate of morphia for an ex-
ample, I think that first injections for adult females, should
vary from the one-eighth to a quarter or one-third of a
grain: for adult males, from the one-sixth to half or three
quarters of a grain.

First injections should he small rather than large, and are
good indicators of the amount necessary, should repetition
he required. It is true that I have seen used and employed
myself, much larger quantities than those I have mentioned,
for first injections; but the case have been exceptional, and
under close observation.

In the preceding papers on this subject, I have shown the
advantages of this mode of treatment over the endermic,
enepidermic, and stomachic methods, which requiring longer
to act are less certain, and apt to fail completely. Before,
however, bringing this paper to a close. I would allude to
two other modes of medicinal administration, viz., by the
tongue and by the rectum.

1, Medicines administered by the Tongue. Dr. Wardrop
has shown* that there is a remarkable difference in point of

*Ranking's Half-yearly Abstract, Vol. xxii. p. 30-J.

2(. ;

Hypod* run'" Treat

[ApriJL

time when medicines are absorbed from the stomach or from
the mouth, absorption being mosl rapid from the latter, an<^
the effect is more regular and more equable. Nor is it dif-
ficult to svc why ' >ed from the moul
is taken directly into the general circulation. Imt when at
sorbed from the stomach, it lias en rout to pass through tin
portal system ; absorbed from the tongue, the effect is more
regular, because the medicine is more certainly absorbed
en ma

There is, then, much similarity between the hypodermic
and the lingual modes. Rapidity of absorption is the greal
point in the modus operandi of each ; and with regard to tin
effect, they both have the advantages of rapidity, greatei
efficacy, regularity, and equability. Can the one methoc
then, replace the other? Are they applicable for the same
cases and ro is? No ; they both have their advanti

ges. Dr. "Wardrop's plan isl test for the administration o]
tasteless medicines, for cajomel, et hoc genus oinne, but it can-
not be used for those medicines which are nausea;
bitter not, in fact, for narcotics generally, not for ca.
delirium, patients refusing medicine, etc., which are the
cases where the other plan is most desirable.

2. Medicine* administered by the Bectum. This mode 01
medicinal administration is of great value, and useful
means both for local and general treatment; there can b(
no doubt that this method has advantages which the stom-
achic has not, viz., of greater rapidity of action and greatei
effect, but the effect is uncertain ; this uncertainty of actioi
is not dependent on the mode of introduction, especially
the medicine be used in the liquid form, and employment
be made of the graduated syringe, invented by Mr. Spencej
Wells, to regulate the exact amount introduced ; but is dm
to the want of regularity of complete ah . which can-

not be done away with. The rectal method is the more
advantageous where the object is to administer the smallei
doses of narcotics for affections of the intestinal canal, th(
rectum, and the parts adjacent supplied by the great sym-
pathetic, but n ially for the speedy introduction of
stimuli, and of nutriment in urgentcases; for liquids intrc
duced by this plan have the advantrge of being convcyec
simultaneously into both the portal and systemic circulation
the hypodermic, on the other hand, isjjthe more applicable
for those cases where the part requiring the narcotic is su]
plied by the systematic circulation, and is under the influ-
ence of the cerebro-spinal nervous system.

186 Paint in Seven Bu

]]'

In the Chicago toTedical Journal for December, is r report
re burn, successfully treated with white paint,
that occurred in our practice aboul two yean The

patient was a girl aged aboul eleven years, and was burned
from her clothes taking fire while she was alone. *- '1 he whole
hack, from the hips to the shoulders, a surface thirteen inches
wide and fifteen long, was completely charred. Tin baci
both arms, from the elbows to the shoulders, was also burned
in the same manner."
We did nol attend the case until after the fifth day. 'Inking
ge of the case, we " removed the dressings, and, on cutting
through the charred flesh, we found the texture destroyed to
the depth of at least half an inch. White paint was applied
r the whole extent of the burned surface, and quinine and
opium, with brandy, was administered internally." The bed
was covered with oil silk, and the suppurative discharge be-
e fully established on the ninth day. The discharges were
emely profuse, exhausting, and long continued. The lead
-ing was covered mainly throughout, with some little
:asionally in the form of application. Dry tannin
was also sj inkled upon the surfaces occasionally. Recovery
t complete until after about fourteen months.
Judging from this case, we should think the danger of lead-
ing from absorption had been overrated.
In that report, we made one practical remark that we con-

important, and shall take the liberty to quote it here.
"The friend- were directed not to wash the sore at all. Through
the repeated importunities of neighbors, an attempt was made

?e soap and water, in cleansing the sore, at one time in
our absence, perhaps about three months after the receipt of
the injury. The pain it occasioned was extreme, and the

s inflamed considerably, and did not recover their former

for several days. Strange as it may seem, healthy pus
is the best possible protection to healthy granulations, and the

security against their unhealthiness. When new dressings

applied, the sores were quickly and very gently wiped
with dry lint only."

An explanation in regard to this case is required. We here
that fourteen months were required to effect a cure, and

in the paper referred to it is stated that the sores were healed
e end of the tenth month. The above referred to report

was written last March, at which time we supposed the cure
complete. We were, however, subsequently called to the
, and a cure was not effected until four months later.

298 - Dyspepsia cured with Stryeh [April,

A Case of Dyspepsia Cured with Strychnia. By 0. C. Gibbs,
M. D., of Frewsburg, X. Y.

There are but few diseases more annoying to the ph\
cian than dyspepsia. The results of medication are often
quite unsatisfactory to the physician, and doubly so to the

hypochondraic patient. The cause of the dh sase is often to
be found in the sufferer's habits of life or mode of living,
whie' a the case, he is either unwilling or has

not the fortitude to change. If out-door exercise or manual
labor is advised, instead of following the judicious pre-
scriptions, he wonders at the obtuseness of intellect that
cannot better understand his case, and changes physicians.
Medicines he will have, however unwisely selected or un-
adapted use.

In our experience, we have found it a matter of necessity
to so regulate the functions and mitigate the symptom
to awaken the energy and ambition of the patient before
proper rules of * important for the physical and

mental welfare of the patient, can be enforced. Hence, all
that concerns the therapeucia of this affection are matters
of interest, and any fact, however isolate in character or
limited in range, is by no means unworthy {of record. It
is in view of this last fact that we report the following
case :

In May, 1859, we were called to see Mr. K , aged

about 40 years, He had been ailing for about two years ;
was now considerably emaciated ; his skin dry and sallow :
his tongue furred, and bowels costive, lie was greatly dis-
couraged, irritable in temper, melancholy, and desponding;
his appetite was capricious; his sleep disturbed, irregular
and unrefreshing. lie had been under treatment most of
the time since his illness commenced. Regular, homoeopaths,
eclectics, and all the traveling physicians that had peram-
bulated the country in the time, had all had an opportunity
to try their skill upon him. lie seemed the worse for their
attentions, and succeeding months only added to the amount
and complication of his sufferings. For the last six mouths
he had been in the habit of taking physic every other day.
lie had great faith in the purgative process, and supposed
he could not live long without cathartics. That greatly
abused organ, the liver, was supposed to be the disturber
of his p -ace, and the cause of all his sufferings. The
Rcg<iJu.r beseiged it with calomel and blue pill until the gen-
eral health suffered, hut the disease refused to capitulate.
The llonm opath tried to coax the offender from his strong

1 1 wed with Strychnia, 299

bold with sugared mercurialis, hut all to no purpose. The
fired his big guns, loaded with leptandrin and po-
dophyllum peltatum with no*better effect Now the hi J

supposed to be in fault, and the great purgative puri-
fiers were put in requisition.

We informed the patient we would undertake hia case
only on condition that he would follow our direction^ to the

r, and take, during the time, no other medicim s. To
this he consented. We ordered nitro-muriatic acid, in four
drop doses in cinnamon water, three times a day, and Prof.
Mettauer's aperient solution, in teaspoonful doses, thi
times a day : the dose of the last article to he lj I or

diminished, as necessary to s< cure simply on.- alvine evacu-

i daily. This treatment was continued for ten days
with slight improvement. We now ordered the following:

Iv. Quiniae sulph. gr. xx.

Bismuth, subnit. 5jss. M.

Divide into twelve powders, and take one three times a
day.

r>\ Sp. amnion, arom.

It. cardam. co. aa, f. 5 ij. M.

A teaspoonful three times a day.

This treatment was continued for two weeks, with im-
provement of >f the distressing symptoms in the gas-
trie region. The bowels were obstinately costive, and would
not move once a week, unless in response to active ca-
thartics.

Thinking nowT that the fault of the system consisted in a
defect of nervous energy supplied to the organs of diges-
tion and assimilation, we ordered strychnia, in one sixteenth
of a grain dose, three times a day: the mixture of ammo-
nia and tincture of cardamoms to be continued. At the
end or" a week the patient said he felt better than he had
done in a year, and was satisfied the last prescription was
exactly what he needed (we had not informed him of its
nature.) The bowels were regular, and the mind cheerful
and hopeful. AVe have several times observed this mental
change under the administration of strychnia. The treat-
ment was continued about four weeks longer, when the pa-
tient was discharged, cured. He is now in good health and
flesh, and i> daily employed in active farm labor.

Similar, in one or two points, to the above case is another
which we have now under treatment. The patient is a fe-
male, aged 47 years, and has been troubled with costive-

300 Nervous Diseases of Syphilitic Origin. [April

for twelve years. She is quite thin, and looks like on<
addicted to the use of opium, but is free from that habil
She has been taking strychnia" for two weeks, and to-da]
informs us that sh< has derived more benefit from this pre-
scription than from anything else she has ever taken. Elel
bowels.are now quite regular, though she has not taken air
laxative medicine since she commenced the use of the
chnia.

We have several times previously derived the happiest
effects from strychnine in certain forms of costiveness.

That this article of medicine will always act as favorable
as in the case reported, is not to be expected. But, if it
will act curatively in one case in ten, or will mitigate, with
any regularity, any of the distressing symptoms, it will
prove a valuable addition to our long list of remedies in
such cases. "We think it is certainly worthy of further
trials. Medical and Surgical Reporter.

Contributions to the History of Nervous Diseases of Syphilitic
Origin. By Dr. G-jor.

The description of these diseases is based upon the accu-
rate observation of thirty cases. Fourteen of the patients
were less than thirty-live years of age, eleven were from
thirty-five to forty years, and only one individual was more
than forty-live years old.

In the great majority of the cases, the invasion of the
disease was preceded by distinct prodromic symptoms; they
consisted of pain in the lumbar region or in the extremities,
or of an obstinate headache, with nocturnal exacerbati

Most frequently the characteristic signs were of a para-
lytic nature ; the symptoms which accompanied the com-
mencement of the paralysis were in genera! notveiwser;
and rather fugacious: fifteen times attacks in the form of
apoplexy occurred, but were of but little intensity ; live
times only these attacks gave rise to a complete loss of con-
sciousness, and consecutively to weight in the head; twice
the loss of consciousness was associated with convulsi<
in two cases the apoplectiform attack occurred twice. Of

o iifteee there were only four in which the ]

lysis supervened suddenly, and without the health having
been seriously impaired ; in the eleven other cases it de-
veloped itself imperceptibly.

In half of the eases hemiplegia was noticed ; eighttir
paraplegia ; twice, facial hemiplegia; in three cases, paralysis

1 sr.n. | Di Syphilitic Origin.

confined to one extremity; in two, a general weakness of
the movements of the four extremities ; in nine anesthesia;
ami in two cases, hyperesthesia. The paralysis of the ex-
tremities was accompanied, in several cases, by paralysis of
the sphincters, and in four cases by amblyopia, with dilata-
tion of the pupil.

The interval which separated the fired symptoms of con-
stitutional syphilis from the paralytic attacks, v,
obvious in two patients : severa] months to a year, in eleven ;
one to live years, in eight patients. In the resl oft!
the appearance of paralytic Bymptoms was retarded still
longer.

It seemed that the patients who had suffered from several
relapses of the symptoms oi' constitutional Byphilis v
not any more exposed to the nervous diseases than those in
whom these symptoms had been observed only once; the
number of eases of the first category is, in fact, only ten in
, the statistics of Dr. Gjor; hi' observes, however, that the
number of his cases is not sufficient to deduce from them
jectionable conclusions.
The treatment of the nervous diseases of syphilitic origin
has not given, up to the present time, very satisfactory re-
sults. Of the thirty patients of Dr. Gjor, only live were
cured; in twelve a more or less decided amelioration was
obtained; in six cases, no change took place, and seven
3 the disease had a fatal termination.
I >r. Gjor employed particularly the iodide of potassium,
and often combined with it strychnia, or the preparations of
: a; this remedy has afrordid him the most advantageous
and prompt results. Mercury was employed in five cat
was not successful in a single one. Dr. Gjor tried,
lilization several times: in one case only it produced a
id cure, in the six other cases it was not followed by any
rovement: in all syphilized patients the state of the
ral health was, however, much improved.
The three autopsies reported by Dr. Gjor prove, at least,
that nervous diseases of syphilitic origin are not alwi
owing, as was formerly supposed, to exostoses situated in
the cavity of the cranium or of the spine ; in one case Dr.
Gjor found softening of the brain; in the two others no le-
sion of the nervous centres could he detected. Schm
Jarbucher, 1859, CL., p. 028; from the JVorck Magazin, XL,
p. 794.

302 Permanent Exutories in [April,

Permanent Exutories in Chronic Phlegmasia.
By M. RURKOWSKI.

Lesions which result from chronic inflammation, when
exempt from all diathesic influence, are generally, even
after a very long period, susceptible of resolution. Sucl
fortunate terminations have frequently been due to the ex-
utories. It is especially in diseases of the articulations
that the greate'sl number of successful cases have been ob-
served. Of 58 cases of Pott's disease and white swellings,
the exutories were the sole means employed in 22; thej>
were used in conjunction with other means in 12, and in 24
they were resorted to after other measures had failed. A
no less positive amount of success has attended their use
in chronic myelitis and the consequent paralysis 44 in-
stances of recovery from such paralysis, with or without
vertebral disease, being on record. Of 20 cases of amau-
rosis, 7 were treated exclusively by exutories, and 13 after
the failure of all other means ; permanent success resulting
in the whole. So with 30 cases of various desciptions oi
opthalmia, the great bulk of which had previously been
treated without success. Besides these, may he mentioned
old cases of pleuritic and peritoneal effusion.

EXUTORIES IX TUBERCULISATION.

The author reports 10 instances of pulmonary eonsump-
tion treated with success with exutories. These individuals
were all the issue of healthy parents, with no antecedent
phthisis in their families, There were no concomitant or
anterior abdominal affections, signs of scrofula, or disease
of the bones or joints. But all the patients had cavities at
the upper part of the lung, accompanied by the usual cor-
tege of symptoms.

KXUTORIES IN NEUROSES.

Their beneficial effect has been observed in the various
forms of these, whether relating to modifications of sensi-
bility, motility, or impressionability, or to aberrations of
the perceptions, of the intellectual powers, or of the moral
and affective faculties.

Seeing, then, how useful this means may often prove,
how comes it that it has fallen into discredit ? By reason
of the abuse which arose from its indiscriminate employ-
ment, whether suitable indications were present or not.
Among the conditions which should oppose the use of per-

I860.] ( hronic Phlegma

manent exutories as a means of treating chronic disease,

are the follow ing:

1. DBBP-S] vi ED \i.i I i; \"i I' mm I it RE.

For example, the atrophy or melting down of an organ,
which has already given rise to symptoms of resorpation or
colliquation. In subjects placed even in the mosl favorable
conditions, if the organs have undergone deep seated altera-
tions, if the general reaction is continuous, giving rise to
disturbance ol some important funetion, ana especially [f
nutrition be already deeply impaired, not only have exuto-
ries no longer any chance of success, hut they in.
hasten the fatal termination.

II. DEGENERATIONS.

Without speaking .here of primary heteromorphies, for
which no one would think of employing exutories, we al-
lude to those insidious transformations of simply indurated
or hypertrophied tissues, which arc brought about cither by
the sole effect ol' chronicity, or under the influence of some
liathesic or hereditary condition.

III. TUBERCULIZATION.

Although exutories may exert a beneficial action in cases
of isolated tubercles, limited to a circumscribed portion of
an organ, they offer no chance of success in general tuber-
culization that is, when the diseased process has been set
up in several organs at once, or even in several parts of the
same organ. It is from their having been too frequently
employed in cases of this nature, that their credit has be-
come compromised to the extent of causing their utility to
be doubted in cases in which they are really indicated.

IV. HEREDITARY INFLUENCE.

This exerts great pathogenic influence in chronic disease.
Next to tubercular affections, it is in the neuroses especial-
ly that it plays so immense a part. In the examples of epi-
lepsy and insanity, in which exutories have proved useful,
Ihe patients have been exempt from this fatal influence.
Unfortunately these are the rarest cases ; the immense ma-
jority are subjected to hereditary influence, and exutories
will fail to exert any salutary effect upon them.

In "Wurtemhurg, according to a recent decree of the
government, homeopaths dare not dispense their medicines
The licensed druggist, and only he, prepares and com-
pounds the imponderables of Hahnemann.

304 A Revolution in Ana [April,

A E i m An

The Paris medical papers are full of the now
pr during anaesthesia introduced byM. Azam, of Bordeaux

It would appear that, about eighteen months ago, M.
nn, had under his care an hysterical young lady, who
subject to cataleptic attacks. Upon this patient very
extraordinary phenomena were noticed, coming to the
ofBazin, proffessor at the Faculty of Sciences of Bordeaux,
this gentleman advised M. Azam to consult a work publish^
ed in England in 1842, by Mr. Braid, in which the meainj
of producing catalepsy and artificial ansethesia were detail-
ed. M. Azam, procured this book, of which Dr. Carpenter
is in Dr. Todd-'- Cyclopaedia, under
the head of " Sleep," and began a series of experiments

patient and about thirty other pers . lie
found tl * of Mr. Braid's statements were cor]

and that catalepsy and anaesthesia could actually be obi
cd in the following' manner:

The patient, either sitting up or lying down, is put in a
convenient position. The operator th ither

before or behind him, places hi nee oft

few inches, but a y nearer than the point which al-

lows of distinct vision, some bright object, upon which the
patient should steadily and continually fix his eyes.
bright object should be so placed that the eyes, in loakh
it, must be forcibly directed upwards, the contraction of the
superior recti being carried to its maximum In

this position, thelevatores palpebrarum andrectiare stiv
contracted, and convergent strabismus takes place. A
tins attitude, which is certainly fatiguing, has been kept up
for two or three minutes, the pupils are noticed to c
and soon afterw; lids quiver rapidly,

then fall, and the patient is asleep. Two symptoms ah
always present, are then ob ; they are, however, in

less marked and i 1. cata-

lepsy 3cribed in bo ks ; 2

lasts from t\ fifteen minutes, eitl te or in-

complete, but which allows of pinching pri
ling, without any feeling being aroused in
Lout any in the cataleptic state

This ansesthi rally f<

site condition namely, very remarkable hyper ia, in

which the sen-es. the feeling of heat, and muscular activity
reach an unusua '.ability. At any menu

the experiment the symptoms may sudd L, by

I860.] .1 Revolution m Anxsthcfies. 805

rubbing the eyelids, and directing upon them a stream of
cold air. When the patient recover their senses, theyre-
member nothing of what has taken place.

Several experiments have been instituted in Paris by
Messrs. Follin, Broca, and others; M. Velpeau seems bo
convinced, that he has presented a Bhort paper on the sub-
ject, by M. Broca, to the Academy of Sciences at the meet-
ing of the 5th in-!.

The GazetU Hebdomadaire, of the 9th of December, men-
tions the following case: A woman, aged twenty-four,
rather nervous and timid, had, in consequence of a burn, a
large abscess by the vergeof the anus, and was told that
she would be narcotized before it was opened. A bright
brass tube (a telescope made by Bruece)was placed five in-
ches in front of the nose. The patient was obliged to
squint considerably in order to look steadily at the object,
the pupils contracting very strongly. The pulse, which be-
fore the experiment was quick, became now weaker, but
immediately afterwards weaker and slower. After a couple
pf minutes the pupils began to dilate, and the left arm
being artificially lifted up vertically above the head, remain-
ed motionless in that attitude. Towards the fourth minute
the answers became slower and almost painful, but perfect-
ly sensible, and the respiration slightly irregular. At the
end of live minutes, M. Follin pricked the skin of the left
arm. which was still held up a right angle with the trunk,
hut the patient did not move. Boon afterwards a puncture
was made which drew a little blood, hut no feeling- was
evinced. The right arm was now placed in the same atti-
tude as the left, and the region where the al was situ-
ated brought into view. The patient yielded willingly, sav-
ing, very quietly, that she was doubtless going to be hurt.

Finally, about seven minutes after the beginning of the
riment, M. Follin laid the abscess largely open, and
freed a great quantity of foetid pus. A faint cry, which
lasted less than a second, was the only sign of reaction
which the patient gave. Xo movement of the muscles of
the face or the limbs was observed ; and the arms remained
in the same cataleptic state which they had previously as-
sumed. Two minutes later, the attitude was still the same;
the eyes wide open and a little vascular; the face motion-
: the pulse as it was before the experiment began :
the breathing quite free ; and the patient insensible. The
left heel was now raised, and it remained unsupported
in the air, whilst the cataleptic state of the arms persisted.
20

30G

Ju tics.

[April,

M. Brocaat this period removed the bright object which had
hith< rto been the patient's i

i yelids, ai ited upon them a current

old air. e a few movements, and

e had felt anything ; upon which she answered
she did not know. Both arms and the leg remained, how*
ever, in the artificial position in which they had been put.
At this stage the left arm wj d pricked, and ;i

tion thereby excited.

Eighteen minutes after the beginning of the experiment,
and twelve after the operation, another friction on the eve-
lids and another current of cold air were \\<cd ; whereupon
the patient awoke suddenly, the cataleptic lirnhs all falling
together. The patient then rubbed her eyes, came to her
senses, remembered nothing that had 'passed, and was sur-
prised that the operation was over. Her state was some-
what analogous to that of patients who wake from anaesthe-
sia induced by ordinary means; though the waking was
certainly more sudden, and without agitation or talking.
The anaesthesia, which had thus been artificially interrupted,
had lasted from twelve to fifteen minutes.

Two attempts of the same kind have been made by M.
M. Azam and Follin, in the same hospital, upon a girl a
eighteen, who was affected with a slight wound of the foot;
but the results have not been so satisfactory astlieywere ii
the last case. Two other experiments which were under-
taken by M. Azam on the 8th instant were more successful.
In a young woman, catalepsy began in a minute and a half,
and in twro or three minutes both catalepsy and ansesthesii
were complete. With another woman, suffering froi
chorea, anaethesia was well established in less than two min-
utes. A third experiment was tried in the presence of M.
Trousseau, upon a girl who has been for some time in tin
hospital for epileptic vertigo. In a minute and a half, h}
means of a pair of scissors held ten inches from the i
she was cataleptic and asleep; and whenawakened, she com-
plained of severe lumbago and much fatigue ; altogether
she remained in a state of hebetude and stupormuch longei
than happens after recovery from epileptic attacks.

Very thin perforated elastic tubes are extensively used ii
ivi Lai d and France instead of tents of lint, sponge, etc.
They keep the orifice in an abscess open, and effect ii
complete drainage. They are readily introduced, and pre
duce no irritation.

0.] i s P< rforatic

Markoe on Subcutaneous /' i of Bone in Ununited

Fracti

We extract, says the Chicago Medical Journal, the fol-
lowing notice of drilling from a recenl lecture of Dr. Tims.
M. Markoe, one of the surgeons of the New 5Tork Hospital,
for the purpose of showing the result of the employment of
the method and the opinions entertained of ii in thai estab-
lishment, and also as showing a change of opinion in regard
to the question of priority ol its use.

' We differ only in some minor points with Dr. Markoe in
regard to the value of the method, but as we hope ere long
to publish another essay on the subject, we shall not enlarge
upon the Bubject here.

1. Drilling the broken extremities, in such a manner as to
wound, as tar as ma\ he, the opposed surfaces, and thereby
to reproduce in a certain degree, the condition of recent
fracture. As we now perform it, it was first suggested by
Dr. Brainard, of Chicago. The operation consists in making,
first, a minute puncture through the skin, near the seat of
fracture, and then introducing such a drill as this I show
you, which is nothing more, in fact, than a long carpenter's
drill, and with it boring, in various directions, wounding as-
far as possible the sui faces of the fragments, as often as may
seem necessary, to excite some action in their boii}- tissue.
This operation may he repeated every eight or ten days
according to the effects produced, or until union is found to
he commencing, the parts being kept in the meantime in
good apposition and at rest. The principle of this operation
is. by the wounding of the broken extremities of the bone
to excite, by that means, anew, the disposition in the parts
to throw out reparative material. It is supposed that when
in any case of fracture, the reparative nisus has failed of its
effect, the disposition to repair ceases, in a great decree
and even if the obstructing cause be removed, the parts will
remain quiescent, until the reparative effort is, in some way
again aroused. This is in fact the principle upon which are
founded all the surgical procedures, which have gained any
repute, in the management of these cases. This operation
by drilling is a simple, easy application of this principle
and its subcutaneous character, while it docs not impair its
efficiency, renders it less liable to produce evil consequences.
In its present form, it is too recent to be precisely appre-

308

Pn> innonia.

[April,

ciated as to its result, but it lias been sufficiently tried to
show, tint in a certain number of cases, it will suffice for a
cure. We have employed it in a number of cases, in this
hospital, and in some of them, with a yery satisfactory suc-
[t has the great merit of being comparatively safe,
and in a certain class of cases, not the worst, is a very
valuable surgical resource.

Pneumonia.

In the Chicago Medical Journal for December, Dr.
Heavenridge has a lengthy paper on pneumonia. We quote
one passage in regard to treatment. "In uncomplicated
cases of pneumonia, little else will be found necessary than
to premise a full bleeding. Should the patient be plethoric,
clear the bowels with an active cathartic, and then admin-
ister quinine and opium in such quantities as to insure their
quietmg and sudorific effects ; controlling, at the same time,
the arterial circulation by means of veratrum-viride or
digitalis. Should the inflammation be found obstinate in
yielding, a blister will be useful in the latter part of the
treatment."

The quinine and opium treatment of pneumonia seems to
be gradually growing in favor. This treatment, with some
variations, we have advocated for some time past, as is well
known to our readers. For five years we have not found it
necessary even to "premise a full bleeding." We have
frequently seen a skin become moist and cough loose, that
had resisted blood-letting and antimony, very soon after
changing the treatment to quinine and Dover's powders ;
and seen a pulse come down from 140 to 90 per minute,
under the same change. For report of cases, we beg leave
to refer to a former paper of ours, in the Lancet and Obser-
ver for October, 1858, and the Buffalo Medical Journal for
November of the same vear.

Another "Black Doctor." The following is a part of the
public advertisement of a negro doctor:

i\ Edwards is naturally a Doctor having a gift from
the Lord. My mother was her mother's seventh daughter,
and I am her seventh son; my father was a seventh son,
and I an; his seventh son; I was born with seven cauls, and
J am a seven months' child, and walked in seven months
after I was born, and have shed my teeth seven times."

I sco.] Editorial 809

EDITORIAL AND MISCELLANEOUS.

Medical College op Georgia Annual Commencement The

commencement exeroises of this institution were held at .Masonic Hall
in this city on Friday evening, the second of March. An address to
the graduates was delivered by Prof. R. M. -Johnson, of the University
of Georgia, and a valedictory by Dr. J. M. Turner, a member of the
Graduating class. The occasion was one of unusual into rest, and the
large hall of the Masonic building was crowded to overflowing, many
going away finding it impossible to obtain scats. The award and dis-
tribution of the prizes added much to the interest of the occasion. The
first prize, for the best original thesis, a beautiful gold medal of the value
of fifty dollars, was awarded, by the committee, to Dr. William S.
Cannon, of Barnwell, South Carolina. The second prize, another gold
medal, of value twenty-five dollars, was received by Dr. J. M. Anderson,
of Georgia ; and the elegant surgical pocket-case, generously offered by
Dr. J j. A. Dugas, Professor of Surgery, for the best Clinical Report?
was borne away by Dr. D. 13. Putnam, of Georgia.

The Dean's Report Bhows a better average of preparation in the
examinations ; and the general style and composition of the inaugural
essays, show a marked average improvement also on previous years. The
large class in attendance, the number of its graduates, and the other
evidences of advancement, will gratify the many friends of this institu-
tion, and strengthen confidence in its long continued prosperity and
influence throughout the South.

dean's report.

To the President and Board of Trustees of the Medical College

of Georgia :

Gentlemen In conformity to the regulations, I present the Annual
Report of the Faculty. The course of Lectures which has just termi-
nated, has been marked by no incident to which it is necessary to refer.
The class has been uniformly attentive and orderly, not only whilst
within the precincts of the College, but their deportment elsewhere has
been satisfactory to the community. The examinations of .he candidates
for graduation have developed a degree of proficiency above the ordi-
nary average, and it is with great satisfaction that the Faculty present

310

Editorial.

[April,

the following list of names of those upon whom they recommend you to
confer the decree of doctor of medicine :

A Bolsenbake, 8. C.

J. M. Turner, Georgia.

J. M, Simmons,

T. N. White, Alabama.

J. K. Lawhon,

E. D. Rhodes, Georgia.

R.G.Pope,

E. J. Tarver,

G. M. Witt,

C. G. Stovall, Ala.

W. S. Cannon, o. C.

L. W. Savage, Ala.

E. A. Davis, Georgia.

W. H. Daniel, "

W.J.Barnes, "

C. S. Russell, S. C.
W. M. Worrell, Ga.
A. S. Johnson, Fla.

D. S. Holt, Georgia.
J. H. Brightwell, '

T. F. Fleming,

D. B. Putnam,

V. B. Burton, Ala.
J. A. Scott, Georgia.
Edward Hatcher, "
M. B. Merriwither, Ga.
W. II. Jarrell, " .

E. Sjteedly, South Carolina.
N. H. Henderson, "

S. M. Cross, Alabama.
S. Cox, Georgia.

J. M. Anderson, Ga.

F. 1). Coleman, S. C.
J. C. Whitehead, Ga.

G. M. Minis, S. C.

M. A. Marshall, Georgia.

I. C. Vaughn,

J. W. Duffy,

Moses Q u inn, "

J. Y. Utter,

W. H. Pugesley, "

T. II. Wilkinson, "

J. L. Flai]< "

M. F. Crumley, "

W. W. Smith,

W. W. Jamieson, Ala.

J. L. D. Prreyinan, Georgia.

T. B. Akridge,

C. M. Quinn, "

F. D. Cumming, "

J. M. Wright, Mississippi.

M. W. Hodges, Georgia.

S. H. Gates,

F. L. Jarrett, Alabama.

E. W. Treadwell,

T. G. Butler, Georgia.

Thos. Gibson,

J. G. Knight,

H. M. Cumming, "

W. M. DAntignac, Jr., Ga.

A. J. Lamb, Georgia.

W. T. Grant, "

They also recommend that the honorary degree of 31. D. be conferred
upon Dr. J. R. Dickinson, of Alabama, and Dr. J. F. Knott, of Georgia.

All of which is respectfully submitted.

Marclr2, I860. I. P. Garvin, Dean.

In accordance with the resolution of the Board, the degree was con-
ferred on the above gentlemen by the H nezer Starnes, President
of the College.

The address of Professor Johnson and the valedictory of Dr.

I860.] Editorial. 811

Turner, w ', appropriate to tJ and

applied for, for publica-
tion, wo will not attempt t i give any summary of i!

Private [nstructiohb in Chemistry, kc. Our friend and col-
li i, Dr. Joseph Jones, Professor of Chemistry in the Medical College
9 to give a course of instructions with lectures and
experimental demonstrations in tl important branch of medic;. 1

science, during the present summer. We know of to more impr
.way of spending the interval between the courses of lectures than in
devoting the time to a tfa attainment of these important and most

difficult departments. Students Cuming to Augusta to remain during
this course, will have the advantage of witnessing many important surgi-
cal operations, and of seeing milch which will be of great value to them
in the general practice of medicine.

The Georgia Medical Association. The annual meeting of the
State Medical Association will take -place at Rome, on the second Wed-

:y (11th) in April, instant. The last meeting was a highly inter-
esting one, on account of the number and importance of the Reports

nted, most of which have been published in the pages of this
journal, and we hope the approaching one will not foil short of its prede-

r in interest and scientific utility. The annual address will be
delivered by H. W. DeSaussure Ford, M. D., of this city. Several
important committees have been appointed, reports from which will be
looked for with much interest by the profession. The committee to
revise the Constitution of the Society will have important suggestions to
make, which should be heard and voted upon by as large a number of
the members of the Association as can be collected together at a single
meeting. TVe would urge a large attendance by the physicians through-
out the State, and from the happy experience of many of these re-unions,
we can confidently promise them " a good time," both professionally and
socially. Go to Rome, and take our word for it, you will be received
with open arms and a cordial welcome by that classic people.

Binding of the Fifteenth Volume. Our readers all know full
well how we dread annihilation, and we earnestly ask that our twelve
members, viz : the numbers from January to December, be gathered
together and bound in one body corporate, and we promise a handsome
and most useful volume as the result. In the several numbers of this

312 Editorial. [April,

journal, it has been our pleasure and our pride to lay up as many of the
treasures of the gea could contain the work is intended

to be useful, not only fur present reading and instruction, but a
of reference for the future. How greatly, then, will its value be en-
hanced by having the work neatly and durably bound, for there is
scarcely a subject which can interest the practitioner, which will not be
found collected in the body of the volume, and carefully indexed at the
end of it.

Our own volume we have now before us, and feel that its value is
doubled by having it in convenient book-form. Doubtless many of our
subscribers have for years preserved their Journals, and to those who
are in access to this place, we would say that they should send them all,
with their fifteenth volume, to the Book- Bindery of the CJtroniele -
Sentinel office, where we can assure them, from our own experience,
the work will be promptly, neatly and cheaply executed.

A Practical Treatise on the Diagnosis, Pathology and Treatment
of Diseases of the Heart. By Austin Flint, M. D., Professor of
Clinical Medicine, in the New Orleans School of Medicine, etc., etc.,
pp. 473 : Blanchard & Lea, Philadelphia. For sale by Messrs. T.
Richards k, Son, Augusta.

A monograph on the Diseases of the Heart was certainly a desidera-
tum in the medical libraries of this countiy. Since the appearance of
Dr. Hopes' valuable treatise, published nearly twenty years ago, very
important additions have been made, to our knowledge, on these inter-
esting subjects, which, scattered through the journals, and held only in
the perishable and precarious record of pamphlet literature, would soon
rapidly pass again out of the general knowledge of the Profession. No
single work embodied them all noue but an extended and comprehen-
sive monograph could. Dr. Flint has undertaken this laborious task,
and most ably has he performed it. Among the contributors to the
science of this department, no one has been more prominent, for years
past, than Dr. Austin Flint. A simple collection and arrangement of
his own valuable papers, would have been doing excellent service to his
profession, but he has done far more than this; in the work before us.
we find a systematic treatise embodying all that is valuable in the past.
and bringing the indoctrination of the book fully up to the present hour
of our most advanced knowledge.

" In the preparation of this volume my aim has been," to use the
author's own words, " to meet the wants of the Medical Student and
Practitioner, by the production of a work devoted exclusively to diseases

;o.] EdUa

of the heart, and treating ooneiselj but comprehensively of
with reference i" their diagnosis, pathology and treatment." With this
object in view, he livides the work into ten chapters, treating bis aub-
3 under the following heads rospectivelj : Chapter 1. Enlargement
of the Heart. Chapter II. Lesions, exclusive of enlargement, affi
the walls of the Heart. Chapter III. Lesions affecting the ralves and
orifices ofthe Heart. Chapter IV. Physical signs, diagnosis and treat
ment of Valvular Lesions. ( haptcr V . Congenital displacements, defects
and malpositions ofthe Heart, Chapter VI. Certain affections incidental
to organic diseases of the Heart. Chapter VII. [nflammatorj affections
vi' the Heart Pericarditis. Chapter VIII. (Inflammatory affections of
the Heart Endocarditis Myocarditis. Chapter IX. Functional disor-
der of the Heart; ami lastly, Chapter X. Diseases of the Anita Tho-
racic Aneurisms.

In the above summary, our readers will, at a glance, take in much of
the value of this work, but justice can only be rendered to the laborious
and distinguished author by purchasing and carefully reading the book.
No organ in the body requires a more careful study and the exercise
of more caution in arriving at conclusions, in relation to its manifestations,
than the heart If our author has Failed anywhere in his most excellent
and comprehensive treatise, to do full justice to all subjects, it is in
regard to the extensive nervous or reflex relations which the heart
rs to e\cry organ in the entire body. Receiving its innervation from
the two great sources of nervous force, viz : 1st, from the cerebrospinal,
through the pnoumogastic nerve, and secondly, from the ganglionic sys-
tem, through branches given off by certain sympathetic ganglia in its
vicinity, and also within it< muscular substance, the heart is brought in
the most intimate relations with, and has the most available connections
with, all the functions, both of relative and organic life. It must neces-
sarily have imposed upon it such a constant and imperative conformity
to bo vast a number of varying influences, that when we endeavor to
ite the various sources of its movements, the task becomes one of
much difficulty, and unless great caution is exercised, we are apt to
attribute symptoms to a different source from that whence they truly
originate. The blood acting as its irritant, its own inherent muscular
irritability, the presence of ganglia within its own substance, and its evi-
dent supply of both cerebro-spinal and ganglionic nervous influei
render its study m v and difficult, Yet, notwithstanding all

bscurity and complexity, it is plainly manifest that no organ in the
is more extensively correlated in regard to the influences which
i it and modify its action, than the heart is; the emotions of the

/ [Api

mind,

add 'i

0 . S j

i it.*
< hi

!! .

-

of jir

I

in th<
id this

!t.

1800.] Editorial 815

The Microscopist's Companion ; A Popular Manual of Practical
Jlicroscop?/ ; Designed for ll in Microscopic Inves-

tigations, Schools, Seminaries, Colleges, etc., etc., By John
King, M. D. pp. 308. Illustrated with 114 wood cuts. Rickey
Mallory & Co. Cincinnati, 1839.

Nearly twenty years ogo, when in our early pupilage we began to find
interest in, and were attracted by the description of microscopic objects,
casting about for some book of instructions to guide us in the manage-
ment of our very imperfect instrument, nothing could we find but the
single work of Mandl, in the French language, at all accessible to the
American student.

Since then, what a change has taken place in the progress and litera-
ture of this department, and how completely altered is the aspect of all
the branches of science upon which microscopy has been brought to bear.
Natural History, Physiology, Pathology and Anatomy, indeed, every
branch, however remotely or directly related to medicine, has been made
to illustrate the wonder-working, illuminating power of concentrated and
refracted rays through the medium of the microscopic lens. Since then,
too, thousands have engaged in the study, and many hundreds have re-
corded and published their observations, and now the science of micro-
scopy may be said to have a more abundant and profound literature than
any other department of human knowledge. Indeed, all the other
departments, as they exist at the present day, more or less depend upon
the services of this choice and most useful of all the handmaids of science.
The books of the other departments arc, in the main, so far as relates to
ail new discoveries, but Micrographia of the hidden secrets of a world
till recently, beyond our ken. Ever widening in its researches, the
naked eve is no longer trusted ; as the Astronomer peers with the tele-
scope, into the wide ethereal expanse above him, bringing out world after
world and system after system, so the scientific man of the present day
peers into the illimitable space furnished by a single drop of water, and
from it brings out individual after individual, species after species, class
after class, until an entire universe heretofore unrevealed and even
unsuspected, looms up before him, convincing him ever, that God is
great even in the minutest, as in the most stupendous, of his works.

If we attempt eveu to recount the names of some of those who have
engaged in this creat work, we would find this alone no inconsiderable
task ; we find here the names of all countries, and certainly of all portions
of the alphabet Agfissiz, Audouin and Addison ; Bailey, Beale, Bell,
Bennet, Burnet and Brocklesby ; Carpenter, Catlow and Coultas ; Du-
jardin, Dutrochet, D'Orbigney, Dana and Doane ; Ehrenberg, Edwards,

316 Editorial [April,

Escliricht, Eickhorn and Erdl ; Focke, Frey and Frooip ; Grant, Gresse,
Goadby, Goring, Girard, Gulliver, Griffith, Gerber and Gliechen ; Has-
sel, Heale, Henfrey, Hogg, Hooker, Hoffmann and Huxley ; Joly, John-
son, R. Jones, C. H. Jones and Jacobson; Kolliker, Kosse, Kirkland,
Krohn and Kutzing ; Leeuenhoek, Lenchart, Lowen, Leue, Leidy and
Latour. And so we might continue to enumerate at least as far as Unger,
Yolkmann, Weigmann and Zenker, but the list becomes tiresome, and
the labor will scarcely remunerate.

The work before us is a very useful elementary resume of what is
necessary for the practical working of the microscope. It does not pre-
tend to be original, claiming only to be useful and practical. Instructions
are given as to the choice and prices of microscopes, and a minute
description of the various parts of the instrument, and also as to the
selection of test objects and the collection of specimens. A most valuable
feature of the work is the glossary at the end of it, which seems to have
been carefully brought fully up to the latest addition of microscopic
nomenclature ; and on this account, if for no other reason, the book will
be found most useful in the hands of the young microscopist.

The typographic and lignographic execution of the book is very good,
and the entire work may be said to do credit both to author and publisher.

Improved Needles for Vesico-Vagtnal Fistula. We have re-
ceived specimens of an improved needle for this operation, from our
friend, Dr. Robert A. Kinlock, Surgeon to Roper Hospital. The eye of
the needle is so devised that the wire sutures can be applied directly,
without the previous use of silk threads. A groove, extending from the
eye to the head or back pait of the needle, accommodates the wire and
permits the whole to pass smoothly through the tissues. We have not,
as yet, tried these needles practically, but in a few days expect to do so
on a case now in Jackson Street Hospital.

" Unaccountable Antipathies. The following are a few of
the more striking manifestations of the unaccountable feeling
of antipathy to certain objects, to which so many persons are
subject, and with instances of which in a modified form,
perhaps most people are acquainted with :

" Erasmus, though a native of Rotterdam, had such an aver-
sion to fish, that the smell of it threw him into a fever.

" Ambrose Pare mentions a gentleman who never could see
an eel without fainting.

"There is an account of another gentleman, who would fall
into convulsions at the sight of a carp.

L860.] Miscellaneous, 817

M A lady, a native of France, always fainted on Beeing

boiled Lobsters. Other persons from the same country expe-
rienced the same Inconvenience from the smell of roses,
though they were particularly partial to the smell of jonquils
or tube-ro

"Joseph Scaliger and Peter Abono never could drink milk.

"Cardan was particularly disgusted at the sighl of eggs.

"Uladislaus, King of Poland, could not hear to see apples.

" If an apple was shown to Chesne, secretary to Francis, lie
bled at the nose.

! . entleman in the court of the emperor Ferdinand,
would bleed at the nose on hearing the mewing of a cat, how-
ever great the distance might be from him.

" Henry III. of Trance could never sit in a room witli a cat.

The Duke oi' Schomberg had the same aversion.

" M. de Lancre gives an account of a very sensible man,
who was so terrified at seeing a hedgehog, that for two years
he imagined his bowels were gnawed by such an animal.

f. Yangheim, a great huntsman in Hanover, would faint,
'.' he had sufficient time, would run away at the sight of a
roasted pig.

"John Rol, a gentleman in Alcantara, would swoon on
hearing the word tana (w>,.h pronounced, although Ids cloak
was woollen.

The philosophical Boyle could not conquer a Btrong aver-

d to the Bound of water running through a pipe.

" La Mothe la Yayer could not endure the sound of musical
instruments, though he experienced a lively pleasure when-
p it thundered.

The author i f the Turkish Spy tells us that lie would rather

[inter a Lion in the deserts of Arabia, provided he had but

a Bword in hi- hand, than feel a spider crawljng on him in the

dark. He < that there is no reason t<> be given for

- secret dislikes. He humorously attributes them to the

transmigration of the soul, and as regarded

himself, he supposed he had been a fly, before ho came into

tnd that having been frequently persecuted with

Bpid :il retained the dread of hi.- old enemy."

M. Bean, an hospital physician of Paris, has found I
workmen who handle Lead do not suffer from phthisis, and
that the proa this disease ha- been Btopped by symp-

Lead poi

318 MisceUaneouSi [April,

Dying Words of Noted Men and Women. '-While you
in health and' Btrength labor to do good, and to avoid,
evil, if yon ever wish to escape the distress that oppn
me." -S''V John Hawkin

"Be good, be virtuous, my lord. You must come to
this.'' Lord Littleton.

"See in what peace a Christian can die." Addison.

" So you will keep peace within, which will he a comfort
in the day of trouble." William Pant's Fat

" I have lived, long enough." Locke.

"It is a sharp medicine, but a sure remedy for all w
So the h< right, it is no matter which way the h

lies." Sir Walter Raleigh.

"Be of good cheer and play the man, Master Ridley. A\"e
shal] tiii- day light such a candle in England, as I hope by
God's grace, shall never he put out." Latimer.

"I am grateful to divine mercy for having left me suffi-
cient recollection to feel how consoling prayer is to the
dying." M. de La Harpe.

"Had I served my God as diligently as I have served the
king, lie would not have forsaken me in my gray hairs."
Cardinal Wolsey.

" God bestows talents on our youth. Do see that they
use them right." Meldncthon.

"Give Dayroles a chair." Lord Chesterfield.

" God preserve the Emperor." Haydn.

"The artery ceases to beat." Holler.

Nux. Vomica as a Febrifuge* M. Angels Pogliani has
tried nux vomica in thirty-seven cases of fever, which should
be divided in the following manner: One case of quartan,
two of quotidian, two of double tertian, thirty-two of simple
tertian.

The use of the medicine was always preceded by a saline
or oily purgation and acid drinks. The dose was from >ix
to nine grains of nux vomica, divided into eight papers, one
taken every two hours during the apeynxia. If the fever
returned, another dose of nux vomica was administered, or
the half only of the first prescription in one or two times.
Under the influence of this medicine twenty cases yielded
to the first dose, eleven required two, four required three,
and two were absolutely rebellious to the medicine. It is
necessary to add that with the last two subjects quinine waa
equally inefficacious, an effed which M. Pogliani attributes
to a strongly marked state of gastric inflammation. Jour.
de Qhxm. Med. and The Druggist.

1800.] Mxscell 819

Preparati i. The process of cafibin most i

insists in treating ground coffee with boiling water, and
adding to the infusion a salt of lead, for the purpose of pre-
cipitating the tannin. The precipitate is washed with boiling
r, and the filtered liquid treated with sulphuretted hy-
drogen, to remove the excess of load. The liquid, deprived
of the sulphide ofle*ad, is concentrated by a moderate 1.
and crystals of caffein obtained.

To pr bis substance, M. Vogel indicates a m

mow simple ami less costly; it consists in treating the coffee
with benzole; we isolate by this means the caftein and an
oily substance. The benzole is separated by distillation ;
the residue is put in boiling water, which dissolves all the
caffein, which can be crystallized by the concentration qf
the liquid. Jour, de Phar. et de Chemu and Druggist.

milk and Longevity. It has often been stated, that
the majority of centenarians here, attributed their long life
to the free use of buttermilk; and the Philadelphia pap<
in noticing the arrival from Ireland, in that city, of Mrs.
McKenna, an old lady, who lias nearly completed her cen-
tury, very gravely added, that "her existence hi pro-
-d by buttermilk." To this, the venerable old lady
replied, in a spirited card, in which she says:

"Sonic of the papers, in Bpeaking of my life, refer to the
old saying, of using buttermilk; in answer to which, I have
merely to say that I have never used any kind of milk,
tpt in t< v, &c. I am now nearly one hundred

years of age, and, for the last half century, have resided in
Calledown, a beautiful village, in the county of Tyrone, in
the north of Ireland. Temperate habits, and my usual
walk, of about two miles to church, I think, had a great
tendency Towards lengthening my existence in this world."
Hoiiu Press* St. Louis.

The North American Medico- Chirurgical Beview. With
the January issue of the Review the name of Dr. S. W.
Gross, Lecturer on Surgical Anatomy and Operative Sur-
gery, appears. Dr. Gross has been for some time doing
editorial duty, and his announcement on the title page is a
proper acknowledgment of his position.

The government of Bavaria has prohibited the wrapping

of tobacco and snuff in lead or tinned lead foil, on account
of the danger of metallic poisoning to those who continually
use these articles.

JOSEPH JONES' Laboratory

For Practical Instruction iii Medical Physics, Chemistry

and Pharmacy, Toxicology, Microscopy, Experimental

Physiology and Comparative Anatomy.

MEDICAL COLLEGE OF GEORGIA, AUGUSTA.

PHYSICS. EXPERIMENTAL AND ANALYTICAL CHEMISTRY.

The Student will he furnished with the Apparatus and Chemical Re-agents,
and will be instructed in the modes of Experiment and Analysis, and will be
exercised in those Experiments and Analyses, which are necessary for the
thorough and practical knowledge of Medical Physics and Chemistry. The
Therapeutic application of Heat, Light and Electricity will receive special
attention.

PHARMACY.

The necessary Apparatus and Chemical Re-agents wi I be furnished, and the
Student will be exercised in the abstraction and preparation of the Alkaloids;
and in the preparation of Inorganic Medicines, and in the demonstration of the
Chemical relations of Remedial Agents.

TOXICOLOGY.

The Actions of Poisons and Medicines will be illustrated by Experiments upon
Animals; and the Student will be furnished with the necessary apparatus and
tests, for the analysis of poisons and the demonstration of ti.e Chemical relations
and modes of action of remedial agents.

PHYSIOLOGICAL k PATHOLOGICAL CHEMISTRY

Special Instruction will be given in Physiological and Pathological Chemistry.
The Student will be furnished with the necessary apparatus, and with the solids
and fluids of man and animals; and special instruction >m!1 be given upon the
Chemical Constitution, physiological and pathological relations, and methods of
analysis of the Blood and Urine.

MICROSCOPY.

The Student will be furnished with a Microscope, and instructed in the ap-
pearance, and mode of examination of healthy and diseased structures secre-
tions and excretions. The microscopic examination of the Blood and Urine, will
receive special attention.

COMPARATIVE ANATOMY.

The Student will have free access to the Private Collection of Dr- Joseph
Jones, which numbers more than Fifteen Hundred Anatomical Preparations, and
Minute Injections, illustrating the structure and development of the Animal
Kingdom; and will be carefully instructed in the arl of Minute Injection.

LECTURES.

One Hundred Lectures will be delivered, during the course of the year, on
Physics. Inorganic, Vegetable. Animal. Physiological and Pathological Chem-
istry. Pharmacy, Toxicology and Comparative Anatomy.

HOSPITAL.

The Students will have free access to the Augusta City Hospital, and will
have an opportunity of studying disease, and will be instructed in the methods
of conducting Clinical and Pathological investigations.

TERMS.

Laboratory bee, for one year $100 00

Laboratory Fee, for one month 20 00

Fee for One Hundred Lectures 30 00

For further information, apply a1 the Medical College of Georgia, corner of
Washington and Telfair-sts.. or at ihe residence of Dr. Jones, No. 90 Green-st.

JOSEPH JONES, M. D.,

Professor Medical Chemistry and Pharmacy in the Medical College of Georgia.
Augusta, Ga-, April, i860.

SOUTHERN

MEDICAL AM) SURGICAL JOURNAL

IM'W -I RIKS. I

U XVI. AUGUSTA, GEORGIA, MAY, 1S0. NO.

ORIGINAL AND ECLECTIC.

ARTICLE XI.

Caffeim as an Antidote in the Poisonous Narcotism of
Opium. By Henry Fraser Campbell, M. IX, Professor

of Anatomy in the Medical College of Georgia.

It is the design of the present brief communication, to call
the attention of the profession to an important, and we think,
most valuable application of Caffeine, as illustrated in a case
<>f extreme narcotism from the effects of Opium.

Our knowledge of the vegetable alkaloids, and indeed, of
the whole subject of Organic Chemistry, is of comparatively
but recent date. In the year 1817, Terturner, a German
Apothecary, having announced the existence of Morphia, the
spirit of investigation was immediately aroused, and the study
of every class of organic bodies has become the favorite occu-
pation of the chemist, and has yielded him a treasure of the
most valuable results. This process of investigation is still
ardently pursued, and, every day, some new organic compound
is being added to the already lengthened list

"The alkaloids as a class," says Br. Parrish, "are the m
powerful of organic principles, displaying their effects espe-
cially on the nervous system, which they so forcibly impress
as to constitute, many of them, virulent poisons: a few, how-
ever, seem nearly destitute of active properties. They all
contain nitrogen, and by destructive distillation, or by treating
with alkalies, evolve ammonia; they evince their alkalinity
21

322 Campbell. Caffeine as an Antidote in the [May,

by restoring the color of reddened litmus, and though not
always crystalline or even solid, they combine with acids to
form definite salts which are crystalline ; they also, like the
alkalies proper, form double salts with bichloride of platinum.*'

Most of the alkaloids are said to be but sparingly soluble in
water, but they dissolve readily in alcohol, especially with
heat. Ether, the essential oils, and chloroform, dissolve most
of them, and almost all of them are soluble in benzine. " They
are all precipitated from solution, whether alone or combined
with salts, by tannic acid, which is hence, when taken imme-
diately, one of the best chemical antidotes for them ; they are
precipitated by alkalies.''""

These principles exist in many plants, but not in a free
stale, being generally combined with some peculiar vegetable
acid. " All really poisonous plants are believed to contain an
alkaloid or neutral characteristic principle, except, perhaps,
those few acrid poisons which owe their activity to resins."f
To the presence of this neutral principle many of our most
valuable remedial agents, especially in the vegetable king-
dom, owe all their activity, and by it the phenomena they
evoke from the animal economy is characterized.

"Whatever may be the peculiar property of the crude vege-
table, whether potent for good or for evil, that property is
ever found to exist in a higher degree of intensity in its alka-
loid representative ; hence, of late years, since these princi-
ples are becoming better known to the Medical Profession,
many of them have entirely displaced as remedial agents,
their more bulky sources on account of their far greater
potency and unmixed action. Tims quinia and its salts have en-
tirely replaced, as an antiperiodic, the weaker and more bulky
Peruvian bark, while the salts of morphia are rapidly supply-
ing the place of all the other preparations of opium, and, except
for the intensity of their action, strychnine and atropine
would long ago have driven all the other preparations of nux
vomica and of belladonna, out of the catalogue of remedial
agent-.

*See Introduction to Practical Pharmac.v, bv Edward Parrish. Philad. 1859
JIbid. *!

18G0.] "Poisonous Narcotism of Opium. 323

For a long period if has been well known to the profession,
and even in domestic life, thai coffee, Cqffea Arabica,^
Besfeed virtues as a stimulant of a most valuable, and at the
same time, of a peculiar kind. In the London Medical Times
& Gazette, of June, L855, Dr. Julius Lehman has shown that
coffee is powerful as a stimulant in increasing the nervous
energy, and that it also retards the metamorphosis of the tis-
sues. It is further considered that one of the physiological
effeote of coffee is to Lessen the elimination of urea. Prominent
among the alleged effects of coffee is its antisoporific power,
or that of inducing wakefulness when taken in large quanti-
ties, or by persons unaccustomed to its use. "With this effect.
ry one is familiar who has ever indulged in this common
beverage.

The therapeutic applications of coffee in the form of infu-
sion or decoction, have been various and long known to the
Profession. It has been highly recommended as a remedy in
Cholera Infantum-' ; it is said to quiet nausea in many cases of
irritable stomach, a fact which we have ourself verified ; its
use is prophylactic as well as curative in intermittent fever
it has long been a valued remedy with some asthmatics is
said to be one of the best agents for overcoming the effects of
alcoholic liquors has been, from time immemorial, the favor-
ite beverage of opium-eaters, and is frequently administered
to counteract the effects of this and other narcotic poisons.
The use of coffee for this purpose was common some forty
years ago in this country, and several of the theses of .the
University of Pennsylvania, on the subject, were printed.
Very strong decoctions, without sugar or milk, were recom-
mended for this purpose. All opium-eaters are said to be great
coffee drinkers. Beaujour, in his work on Greece, gives an
account of an opium-eater who drank i: more than sixty cups
of coffee a day, and smoked as many pipes. All this was de-
signed to counteract the pernicious action of the opium. "f

In the Edinburgh Medical 6c Surgical Journal for January,
1842, a case of poisoning is reported, caused by one and a

*Dr. Pickford. London Medical Gazette, Nov. 24, 1848.

fSeo Materia Medica and Therapeutics, by T. D. Mitchell, If. P., he.

324 Campbell. Caf eine as un Antidote in the [May,

quarter grain of sulphate of morphia, equal to seven and a

hall' grains of opium. The cure was effected by gill doses of

Dg decoction of coffee frequently administered. Were ir

nece^ary. we could easily adduce many more witi f the

therapeutic application of coffee, but the above is sufficient to
show that it has been long known as a powerful agent in many
diseases, and further, that it has been fully recognized as a val-
uable means of counteracting the effects of opium. We have
ears been in the habit of giving strong doses of the decoc-
tion of coffee in cases of over-doses of opium, and have seldom
treated a case without applying it after other and more effi-
cient remedies, as the stomach-pump, emetics, &c., have
emptied the stomach to re-animate the patient and to over-
come drowsiness.

As we have just said, whatever may be the peculiar medi-
cal or physiological action of any vegetable medicinal agent,
its alkaloid representative has been generally found to exer-
cise that influence in a far more efficient manner than the
crude source from which it was obtained. This is thought to
be eminently the case, with regard to Caffeine, the alkaloid
active-principle of coffee.

There are several vegetable alkaloids which are said to be
identical with Caffeine, both in their chemical constitution and
in their effects on the animal economy. Theme obtained from
Tea, and Guaranin, from the Guarana Paullina SorbiHs*
are each said to possess virtues which, in no respect, vary in
their effects from that of Caffeine.

u Caffeine is procured by exhausting bruised coffee by two
successive portions of hoiJiruj water, uniting the infusions ; ad-
ding acetate of lead to precipitate the principles which accom-
pany the caffein ; filtering and decomposing the excess of ace-
tate of lead in a filtered liquor, by sulphuretted hydrogen ;
concentrating by evaporation and neutralizing with ammonia.
The Caffein is deposited in crystals, upon cooling, and may be

According to Von Martias, an extract is prepared in Brazil from Paullina
Sorbilis. -which is known there under the name of * Guarana/' which is em-
ployed successfully in chlorosis, tedious convalescence, paralysis, the colliqua-
tive diarrhoea of Phthisis, and in hemicrania.

See Dunglison's Xew Pvemedies. p. 573-

18(30.] /' - Narcotism of Opium* 325

purified by re-dissolving in water, treating with animal char-
coal and evaporating."* It presents itself in the Form of long,
silky needles; is Poeible, volatile and soluble in water, alcohol
and ether.

Phobus is inclined to doubt "whether caffeine is of the im-
portance that has been assigned to it ; but Von Falck, from
much observation, ascribes to it a highly powerful and even
poisonous action. Experiments 06 the lower animals have
been made with caffeine by Beveral physiologists ; Albersof
Bonn, produced tetanic phenomena by ita administration to a
frog, and the same symptoms Mere induced by inserting a
Bolution i>\' the citrate of caffeine under the skin of the thigh
of another frog." Mulder gave a grain of caffeine to a rabbit :
the animal ate but little the next day, and aborted the day
after. Lehman gave it in doses of from two to ten grains,
and reports^ that, " it caused violent excitement of the vascu-
lar and nervous systems, palpitations of the heart, extraordi-
nary frequency, irregularity, and often, intermission of the
pulse ; oppression of the chest, pains in the head, confusion of
the senses, tinnitus aurium, scintillations before the eyes, sleep-
lessness, erections and delirium ; and, in all cases, there was
an increase in the amount of urea secreted." It is extolled by
Hannon and Eulenberg in the various forms of Hemicrania,
and has been frequently used for the same purpose, by the prac-
titioners both of England and of this country. Of the a2>plica-
tion of caffeine as an antidote in the poisonous narcotism of
opium, we have as yet seen no published account, and hence
we have deemed the subject of sufficient importance to call
the attention of the profession to the details of the following
case : }

Extr< me Narcotism of Opi wr< 'promptly relieved by Artifi
Respiration and the administration of Caffeine^
by Injection.

Monday, Oct. 10th, 1S59, 8 o'clock, P. M. We are called in
haste to Mr. F. II. T., aged 24 years, who, it was said, had taken

^Dispensatory of the United States, 10th ed., p. 1318.
t Physiological Chemistry.

'32G Campbell. Caffeine as an Antidote in the [May,

laudanum, and was in imminent danger from the effects of the
drug. We found the patient in the clerk's office of one of the
hotels of this city. He was lying on a sofa with his head sup-
ported in the lap of a friend. His respiration was very slow,
though not counted at the time pulse full, but of nearly nor-
mal frequency he was completely insensible tongue and
lips purple, and muscular system greatly relaxed. It was
positively known that he had taken, in a fit of temporary de-
pression, over one ounce and a, half of laudanum, nearly an
hour before the time of the present visit

The condition of the patient was so alarming that we began
the treatment by the pouring of cold water on the head till the
stomach-pump could be applied for on attempting to intro-
duce the tube into the oesophagus, respiration appeared to
cease altogether the entire muscular system was so com-
pletely relaxed that the tongue hung out of his month, and
was pushed about by the end of the stomach-tube, in certain
positions, folding back into the fauces, and apparently ob-
structing respiration. The attempt to use emetics was of course
out of the question. The continued use of ice-water upon the
head, and the occasional resort to artificial respiration, in a
short time improved his condition a little a very little and
we were willing to introduce the stomach-tube. This was
effectually applied; large quantities of tepid water being re-
peatedly introduced into the stomach and again pnmped out.
Laudanum was detected both by its odor and color in the fluid
first discharged from the stomach. At the end of an hour, his
condition becoming apparently more urgent than before the
use of the stomach-pump, he was taken from the clerk's office
to a room on the second floor of the hotel, where he was un-
dressed and placed in bed, and the application of ice-water to
the head was resumed.

12 o'clock, midnight. The condition of the patient was now
decidedly worse than it had been at any previous time ; the
surface was cold, and purplish from imperfect aeration of the
blood, the muscular system, if possible, more relaxed than
ever, the respiration, fearfully slow, when counted, by the
watch, was found to be hut four to the minute. The intervals

I860.] Poisonous Narcotism of Opium.

between the inspirations were now irregular, and each I
we had to resort to shaking and slapping the patient to pro-
voke the automatic action of the respiratory muscles, and to
raising him up suddenly to the sitting posture, for the same
object. The tongue had to be constantly pressed forward with
the lingers to prevent its falling hack and obstructing the
opening of the glottis. The imperfect and irregular action of
the heart became now more alarming than ever. It was found
that, in the reclining position, this symptom of the case was
more alarming than when the patient was placed in the Bitl
posture. Several times the intervals between the beats of the
pulse led US to fear that the patient had expired, but on ele-
vating him, the action of the heart became more regular. He
was now kept in the elevated position, and not allowed to
recline except for a moment at a time, for fear that lie would
die immediately. Ceaseless efforts were now necessary on the
part of his attendants to provoke the respiratory movements.
Surrounded by his friends, several of whom were remarkably
self-possessed and indefatigable, not a moment was allowed to
pass without some effort, as by shaking, compressing the chest,
occ, to excite inspirations. Xo time was now to be lost but
our best efforts at exciting respiration began now to fail to
have any effect, and it was evident that artificial respiration
was now, the only possible hope tor the patient. This measure,
under the circumstances, was a natural suggestion, but for
reasons sufficiently apparent, it seemed impossible to carry it
out in the present case ; most of the ordinary means of effect-
ing artificial respiration seemed to us impracticable, on ac-
count of the delay involved in their performance, and Dr.
Marshall Hall's "Ready Method" involved the horizontal
position, in which situation, it was clear to the minds of all
present, the patient would die immediately.

Artificial Respiration in the Sitting Posture.
1 o'clock. Under these circumstances, we devised a method
of artificial respiration which was well adapted to the condi-
tion of the patient indeed, the only one possible and which
we do not recollect to have seen reported any where in the
writings of any one on this subject.

828 Campbell. ( uffeine as an Antidote in the [May,

The patient was supported in the sitting posture, by an
assistant kneeling on the bod at his back and holding his head
erect between bis hands; two other assistants standing on each

side of the patient now took charge of an arm each, holding
the limb firmly at the elbow and upper part of the forearm ;
the tongue Mas now pressed down by the handle of a spoon,
or the fingers introduced into the mouth : thi assistants hath
ing charge of the arms, were now di/rected to elevate these
limbs simuUaneouslg, carrying them above the head at an angle
of about forty-fine degrees^ and dragging upon them so as to
slightly lift the patient, the arms were then depressed and
brought down close against the vide* of the Thorax so as to
compress the chest.

The effect of theseknovements was the following: At each
attempt at lifting the body by the arms in this way, forcible
traction outward* was made on the walls of the chest, through
the pectorales major and minor muscles, the serrati and parte
of the two latissimi dorsi muscles giving rise to expansion of
the walls of the thorax ; the air was thus caused to enter for-
cibly into the lungs, and thus inspiration was completed.
The arms were then brought steadily down, and pressed
against the sides of the thorax and abdomen compressing
them and expelling the air forcibly from the lungs and effect-
ing expiration.*

Under the nse of the artificial respiration, the appearance
of the patient was much improved. The color was restore* I
to the face, the lips became redder, and the countenance more
natural, though the relaxation of the muscular system was by
no means lessened ; if the head was left unsupported for an
instant, it fell forward as suddenly and forcibly as that of a
dead man. The artificial movements were continued for more
than an hour, and though the color of the patient was im-
proved and the heart's action became normal, still when they
were omitted, there was found no improvement in the natural
respiration, these being still, but four times in a minut
before artificial respiration was applied.

*A more extended description of this method of artificial respiration will be
given hereafter.

I860.] Poisonous Narcotism of Opium* 829

We now felt the necessity of adopting some means of intro
during a stimulant or anti-narcotic agenl into the system.
Strdng Coffe< naturally presented itself to our mind, but the
only preparation we could obtain at that time, was a rather
weak infusion left from the supper at the hotel. It was clearly
Impossible for the patient to swallow anything, and we did
not think it advisable to ran the risk of introducing the
stomach-tube in his present condition; we therefore called for
a Byrinare, hut the weakness of the coflfee caused us to hesitate;
aboul using it. when, fortunately, the idea of Caffeine occurred
'to us, and we sent immediately for that preparation. The
artificial respiration was then energetically resumed, in order
to prepare the patient tor being placed in the liorizontal posi-
tion. A -mall quantity of the Caffeine JTas rubbed upon the
tongue and to the inner surface of each cheek. The patient
was then laid upon his side, and an injection of the coffee with
(< large quantity {afterwards ascertained to he twenty (/rains)
of the Caff eine dissolved in it. was administered by the rectum,
with a common syringe. The patient was then immediately
raised again to the sitting posture, and the artificial respira-
tion resumed;

in less than half an hour, we perceived that occasionally,
between the artificial movements, the patient would effect a
natural inspiration these became more frequent, and soon
to about eight in the minute. He was then laid down
and the artificial respiration omitted. The assistants, however,
were directed still to remain on the bed and to retain their
hold on his arms, that they might resume their efforts at any
moment. An hour had not elapsed from the administration
of the injection, when the patient, to the astonishment of all
prteent, forcibly jt rkeA his left arm from the assistant! (which
was the first action of the voluntary muscles he had performed)
and immediately began to twist himself in bed, and told those
about him, angrily, "to let him alone I"

From this time, he did not again sink into the comatose
state, and the relaxation of the muscular system did not re-
turn. The respiration became more and more natural, but he

330 Campbell. Caffeine as an Antidote in the [May,

remained drowsy, and efforts were continued occasionally to
prevent his remaining too long asleep.

The condition of the patient during the remainder of the
night, (from %1 o'clock till daylight) was very peculiar; his
- were heavy, lie seemed greatly inclined to sleep, and oc-
casionally would snore a little, but yet he appeared quite
cognizant of even thing going on around him, and of all the
remarks made by his attendants ; he had great repugnance to
being held or touched. During the earlier part of the nar-
cotism, one of his friends, a young man, tried the expedient of
tickling him on the ribs and lower part of the abdomen, with
the hope of arousing him ; then, the tickling had no effect
whatever, but now, it seemed to produce the most painful an-
noyance, and vexed him beyond all control. The measure
was advised, nevertheless, to keep him from falling asleep.
He would lay apparently asleep, but before the hand could
reach the surface, he seemed to be aware of the intention, and
would select the offender from the whole crowd of his atten-
dants, and aim the most angry blows at him with great accu-
racy ; and, finally, on one occasion, before he could be
restrained, he jumped out of bed and followed him to the
head of the steps, threatening to shoot him if he thus annoyed
him again."""

We left him at daylight. His drowsiness at that time was
not very marked.

11th. We called at the hotel at 10 o'clock, A. M., to see
Mr. T., and were informed that he had " gone home to his
own residence, nearly a mile distant, at the lower part of the
city."

12 o'clock, M. We were called in haste to see our patient.
Found him in a most excited condition ; he seemed somewhat

We have been thus minute in the description of these latter manifestations,
because this peculiar sensibility and irritability appeared to us to be the result
ot the Caffeine, and we think it important to relate every thing which evidenced
its influence on the nervous system, when administered in such a large dose-
The irritability was not the ordinary itching of the skin following opium : (he
had that too) but an intolerance of ail impressions made on the surface, accom-
panied with a singular imtchji'lncss of the mind, (considering his tendency io
sleep) on certain subjects. He never, for a moment, seemed to forget thai he
was in danger of beimr tickled, and on no occasion did he mistake any other
necessary handling of his person for an attempt to annoy him. There was a
clearness of the mind in this respect, which was truly remarkable.

I860.] Poisonous Narcotism of Opium, 881

alarmed, his face was flushed, his eyes presenting an unusual
brightness; he complained of head-ache, great restlessness,
and the surface was covered with a profuse perspiration; the
pulse was full, quick and frequent, lie stated that he had
had an alarming attack of a nervous character, which lie
referred to irregularity and palpitation in the action of the
heart.* This had subsided, however, after taking a stimulant,
and his condition was such as just described. Prescribed the
application of cold water to the head, and that he remain
quiet at home till his excitement had subsided. lie rapidly
recovered and was well in a few days.

If in Caffeine, so powerful an alkaloid possessing, in a con-
centrated form, all the antisoporific virtues of Coffee we
have thus found an antidote for the narcotic effects of opium,
and one which can be applied even in the most extreme states,
by injection, we must feel that an important extension of its
application as a therapeutic agent, has been made, and that
many lives may be saved hereafter, by its use. Reasoning
from the result of a single case, it is true, however remarkable
that ease may be, i-. we are aware, always more or less unre-
liable; but with the most jealous interpretation of the phe-
nomena, as we observed them, we have been forced to the
belief that the means used here, acted most powerfully, in
producing the favorable result. Indeed, we have never wit-
nessed sequences after the administration of a medicinal agent,
which impressed us more fully with the conviction of cause
and effect. ^\Te would, however, take occasion, in closing, to
urge the repetition of the administration of Caffeine in cases
i>\:' Opium-Coma, to a >ufficient number of the many which
are daily occurring under the eyes of the Profession, in order
to prove or disprove the validity of our confidence in the
remedv.

*We would here state that we would not advise the administration of the Gaf
feine in such large quantity, viz : xx grains, as we used in the above case. Did
the occasion occur again, we should use repeated doses of v or x grains, till the
desired effect was produced.

332 Carroll. Jackson Street Hospital Reports. [May,

ARTICLE XII.

Jackson Street Hospital Reports. By Robert 0. Carroll,
.\f. I)., of Augusta, Ga., Resident Physician.

Messrs. Editors With your permission, I design re-
porting, from the note book of Jackson Street Hospital,
the details of such cases as may he deemed most interesting
to the Profession. These notes I have carefully kept during
the progress of the eases, and from time to time I will fur-
nish them to the pages of the Southern Medical and Surgical
Journal, for the perusal of your readers.

Respectfully yours, R. C. Carroll.

Augusta, April 17th, 1860.

CASES OF MENSTRUAL DERANGEMENT IX NEGRO WOMEN.

The frequent occurrence of menstrual diseases among
negroes, is a subject of deep interest to the Southern prac-
titioner of medicine. The exposure to which negro women
are liable, their proverbial carelessness of themselves, their
reckless disregard of the precepts of their medical attend-
ants, and their disposition, in some localities, to treat them-
selves or to submit ignorant and improper medication, in
all affections involving their sexual organs, render them
more liable than white patients, to prolonged cases of
menstrual disease, and present difficulties to be overcome
in their treatment, which every practitioner of much expe-
rience will not hesitate to acknowledge. The following
cases having been submitted to treatment under circum-
stances in which we rarely have the opportunity of obser-
ving and recording from day to day the details of practice
in negro patients, viz: in a Hospital Tinder the eye of the
physician. I hope the following report will be found more
accurate and fuller than those made under the ordinary
conditions of plantation or private practice.

1st. Report of a Case of Hysterical Convulsion* of long stand-
ing, traded with Tonics and Cautery to Os lincae.

April 25///, 1859. Entered Jackson Street Hospital,

*These cases were treated under the daily superintendence of Drs. H. F- and
R. Campbell.

I860.] Jackson Hospital Reports.

Mary, a mulatto woman aged aboul 24 years, property of
Mr.'.i. B., of Edgefield District, S. CL This case was
kindly senl to the Drs. Campbell by Dr. Elberl Bland, of
Edgefield village. The history of the case, as given at the
time, was the following: From the age of fourteen, Mary's
catamenia had been irregular, both as to time and quantity.
She had had but one child, when aboul L8 years of age, which
only survived three days. For some eighl or nine years
past, she had been aftected occasionally with hysterical
Bymptoms, which were ao1 Bevere, and manifested them-
selves at first, by a lethargic and obtuse state of the nervous
system, more particularly about the time of the menstrual
period; but latterly, those symptoms had become more fre-
quent in their occurrence, and more serious in their charac-
ter, being attended frequently, by decided convulsive move-
ments, followed by stupor of more or less duration. Ac-
cording to the statement of those accompanying her, these
symptoms had recently become of daily occurrence gen-
erally about daylight in the morning. lias not been able
to do work of any consequence for many months.

Examination of (he Case. The present condition of the
case is the following : She is pale, somewhat emaciated and
anaemic, tongue and lips white and bloodless presents a
listless and melancholy expression of countenance. Has
diarrhoea, the discharges being large, thin and watery
frequency of about every one or two hours. Spine more
or less tender on pressure throughout the entire length, more
particularly in lumbar region. There is also tenderness on
pressure over the region of the womb, extending up as high
as the umbilicus.

By digital examination per vaginam, the os tinea? is
tender to the touch, causing her to shrink from the pressure
of the linger. Leucorrhcea exists, but is by no mean-
abundant. On viewing the womb and interior of vagina,
through the speculum, the os tinea? is found to be quite
tumid and of the most florid color the tumefaction has
very much contracted the canal of the neck of the womb.
The walls of the vagina are apparently healthy, but covered

334 Carroll. Jackson Street Hospital Rejoorts. [May,

in certain places with a thick whitish leucorrhceal discharge,
a small quantity of which seems to ooze from the mouth of
the womb.

The Drs. Campbell wishing to ascertain the truth of the
statements made by the patient, in regard to her " convul-
sions," and also their particular character, directed that
another woman should remain in the room with her, who
had directions to call me at the coming on of these attacks.
On the second morning after her arrival at the Hospital, I
was called by the attendant at daylight, to witness Mary's
condition. I found her lying in a state of apparent uncon-
sciousness and lethargy, somewhat straightened backward,
her lips compressed, and her eyes tightly closed. She was
aroused with much difficulty, and her behavior during the
attack, and after being aroused, was such as to convince all
present that any suspicion of deception on her part, was
entirely unfounded. The attack, though not a true convul-
sion, was certainly genuine of its kind. It appeared to be
what may be called Hysterical Catalepsy. She continued
to have these attacks frequently for about three weeks after
her arrival.

TREATMENT.

April 25th. Ej. of Prepared Chalk, - - 5\j-
Sugar, - -

Gum Arabic, aa, - - gss.
Tincture of Catechu, - - j.

" of Opium, - - gss.
Camphor Water, - - gyj.
Mix and write ;
Dose, 1 dessert-spoonful every two or three hours, till
dejections are arrested.

April 26th. Patient expresses herself as feeling better
to-day diarrhoea somewhat checked. [The mixture was
continued till four ounces were taken, when the bowels
resumed their normal action.]

April 30th. Prescribed the following : Ej. of Muriated
Tincture of Iron xx drops, 3 times a day, in J tumbler-full
of sweetened water. Diet of the most nourishing kind.

I860.] Jc ' - n Street Hospital Hep

Beef and beef soup a1 dinner, bread and molasses al other
meals.

May 5th. The tincture of iron has been continued to the
presenl time. Complains of pain in the loins and aching in
the thighs and knees, which she attributes to tjie coming on
of her " monthly sickness." Prescribed laudanum \\ (hop-,
and directed hot mush poultice to lower pari of abdomen
to relieve pain and to procure rest*

May 6th. Menstrua] discharge lias made its appearance
in small quantity. Prescribed ammoniacal tincture of
guaiacum; dose, 1 teaspoonful :'> times a day. [This pre-
scription was continued to the 12th, having the effect, as
appeared to me, of relieving greatly the pain, and also of
keeping up the discharge in fuller quantity. The discharge
ceasing on the 12th, the Dewees's guaiacum mixture was
discontinued. The entire amount discharged, however,
was but small, and the menstruation could by no means be
regarded as normal.

13$. Muriated Tincture of Iron resumed in similar
doses as before.

23rd. Vaginal examination with speculum, reveals the
neck of the uterus much conjestcd and florid. The os tinca^
also presented an inflamed and patulous appearance, in-
tensely reddened within. Application of the solid nitrate
of silver was made by Dr. IT. F. Campbell freely to the
neck of the womb, and the pencil pushed through the mouth
of the womb into the canal of the neck. The patient ex-
perienced little or no pain, but was directed to remain in
bed for the rest of the day.

25th. Prescribed compound mixture of iron, (Griffith's
myrrh mixture), close, 1 table-spoonful 3 times a day.

28th. The patient expresses herself as being better in
every respect, than she has been for a number of years past.
She is increasing in flesh, and has regained her strength ;
is lively and cheerful. Her whole appearance very greatly
improved. Has had no appearance of convulsions or other
nervous symptom for nearly a week.

336

Carroll. Jackson Street Hospital Reports. [May,

June 5th The patient has continued the iron mixture to
this date. The Catamenia again made its appearance on

the 3rd, unattended by pain or other unpleasant symptom.
She says that she does not remember any period when she
has heen so entirely free from pain in her sickness the
discharge coming away so perfectly natural and so freely.

StJt. Mary having completed her menstrual period in the
above normal manner, and having had no recurrence what-
ever of her nervous symptoms her owner being in the city,
wxc deemed it safe to avail ourselves of the opportunity of
sending her home, and she was discharged from the Hos-
pital to-day, her owner being requested to keep her from
exposure to the sun for a while, till her convalescence be
fully confirmed.

March 29th, 1860. More than nine months after the dis-
charge of the above patient, Mr. J. E. being again in the city,
reports that Mary remained about the house and yard for
three weeks after her return home, in order to carry out the
directions given at the time of her leaving. At the end of
that time, she requested to be allowed to go into the field
with the other hands, and has continued at work and veil
ever since, not having had the slightest return of any of her
old symptoms.

Xo case could have been more satisfactory, either in its
response to remedial measures and in its final result, than
this one, the notes of which I have above reported. The
case may be considered of particular interest on account of
the long duration of the disease of the womb, and the
variety of alarming symptoms attending it. That a de-
ranged condition, as inflammation and engorgement, of the
neck of the womb is competent to arrest the regularity of
the menstrual flow, and change the normal quality of the dis-
charge, no one familiar with these cases will pretend, at
the present day, to deny. Anaemia chlorosis and the many
evidences of blood-derangement and general loss of stamina
which attend upon imperfect or obstructed menstruation
have too often, in my humble opinion, engaged the attention

1800.] ei Itospital Rep

of the practitioner, in cases where the local affe<

wonii). and in mo8l instances the neck of the womb,

been the offending ease, and very often, the

verj - of the entire catalogue of Bymptoms,

whether they refer, on the one hand, to the nervous

as manifested by lethar. smodic tremors, convulsi

ic phenomena; or on the other, by altered
Becretio] red nutrition and general debility.

are often treated for months together, with Ferrugin
tonics, the so-called emmengagues, and every variety
dication, without the slightest benefit; wh
did the practitioner take the trouble to make a specular
examination of the neck of the womb, he would there find
Buch an amount of unmistakable local disease as would lead
him. without hesitation, to the use of local remedies. It is
seldom of any use to attempt to correct the condition of the
blood, from which the menstrual elimination is made, until
the eliminating organ the womb itself is put in condition
to perform properly its functions.

I do not pretend to say that tonic and other specific treat-
ment is not advantageous for in most cases they are
highly beneficial, and can seldom be dispensed with, even
where cauterization is the principal treatment, but where
there is much local engorgement in the neck of the womb,
we know of no plan of treatment offering any rational hope
of relief, which can be compared to frequent applications of
nitrate of silver directly to the womb through the speculum.

I find three or four more cases of menstrual derangement

on the books of Jackson Street Hospital, which present

many points of interest ; especially one of Chlorosis, and

another attended with violent hysteric convulsions at

the menstrual period. The present report has, however,

occupied more space than I intended, and their further

.records will be deferred to a future number of the Journal.

(To be continued.)

99

338 Gardner. Cranial Deficiency [May,

ARTICLE XIII.

Cranial Deficiency in a Foetus at full Term. Reported by R.
P>. Gardner, M. D., of Barnesville, Ga. With remarks
by Editors of S. M. & S. Jour.

It may not be uninteresting to some of your readers, to
report a singular case of fetal peculiarity, which came under
my observation at the time of delivery, at the full term of
utero-gestation. On the evening of the 17th ult, I was
called to Mrs. , in labor, about two miles from the vil-
lage in which I reside. Early after my arrival, and after
the necessary preparations were made, I proceeded to make
the usual digital examination, whereupon I found consid-
erable dilatation of the os uteri, with a corresponding
amount of protrusion of the membranes, and expulsive
pains of moderate force rapidly recurring, but experienced
great difficulty, in consequence of the unnatural feeling of
the part presenting, in determining the precise presentation.
The labor, however, advanced rapidly, and soon the mem-
branes were ruptured, discharging their fluid contents and
revealing to my finger a very remarkable condition of that
portion of the head which constituted the more prominently
presenting part. The moment the child was born it gave a
jerk or two and immediately expired; and at the same
time, upon examination, I ascertained that the circulation
in the cord had also entirely ceased. I hastened to sever
the connection between mother and child, turning the latter
over to a negro woman and addressing myself to the wants
of the former. After waiting upon the uterine contractions
about an hour, I removed the placenta manually, and thus
completed the delivery.

The child being dressed, I now obtained permission to
examine it instrumentally. I found the cranial bones, all
above a line drawn circumferentially from the upper margin
of the orbits to the occipital protuberance, entirely wanting,
with here and there rough prominences upon the edges of
the projecting bones beneath. A delicate expanse of der-
moid tissue was found stretching across the intervening

18G0.] In a Foetus at full Term.

chasm, with something resembling a thin coagulum of blood
partially organized and of some permanency, and about five
or six inches in circumference, closing its renin- and ap-
pearing to have had some previous connection with a dis-
eased brain. An incision through this collapsed covering
revealed nothing but the irregular upper surface of the
cranial base beneath.

It' you ran give any information in regard to the true
nature of the condition of things detailed above, I would
be pleased for yon to add some remarks to that effect. It
seems exceedingly remarkable to me that the fetus, under
the existence of so important a deficiency in the cerebral
portion of the nervous system, should have survived until
its full time arrived as I was assured, and had other rea-
sons to believe, was the case for it to assume an indepen-
dent existence, ('an it be possible that its connection with,
and dependence upon its mother, could have maintained its
life until the period of its birth?

Remarks. By Henry F. Campbell.

On a careful reading of the above report, we arc com-
pelled, taking all things into consideration, to recognize a
case of Anencephalous monstrosity. The object found be-
neath the skin "resembling a thin coagulum of blood, par-
tially organized," was probably indeed, an accumulation of
blood effused from the small vessels of the scalp during the
progress of the labor this, coagulated in the tissues of the
scalp or among the membranes within, constituted a kind of
thrombus easily accounted for, and attributable, rationally
enough, to the pressure attendant on labor.

The occurrence of anencephalous monsters is sufficiently
rare to render the record and description of each a matter
of much interest to the profession. Since the work of
Geoffroy St. Hilaire, and other writers of about the same
period, the subject has been studied with much energy, and
each case has been subjected to diligent investigation, and
the result has yielded much light, both on the subject of
development and on the respective importance of several

340 Gardner. Cranial Deficiency [May,

parts of the organism to the growth, nutrition and well-
being of the Fcetus. The nervous system especially, has
been studied in these relations by several of the best physiolo-
gists of a more recent date. The result of these observations
has been to confirm the view, previously gaining ground,
that the cerebro-spinal nervous s}*stem or the nervous sys-
tem of relation, is not necessary to nutrition during intra-
uterine life, and that its non-existence is not incompatible
with the normal progress of pregnancy, nor in the least, with
the fullest development of the Fcetus these Fcetusses be-
coming developed and passing to full term exactly in the
same manner as when the entire nervous system is
present.

Two remarkable cases reported, the one by Mr. Lawrence,
and the other by the late Dr. Marshall Hall, of London,
now occur to our mind which will hilly substantiate the
above assertion, and will also throw some light on Dr.
Gardner's case herein presented.

Mr. Lawrence's case was that of a Fcetus at full term,
and well developed, in which the brain was entirely absent ;
but Dr. Marshall Hall's case was still more wonderful, and
of a value, in establishing certain facts in relation to the
nervous system, which can scarcely be too highly estimated.
The fcetus was born at full term, well nourished, perfectly
developedj but devoid of every trace of either brain or spinal
marrow ; presenting an absence of the entire cerebro-spinal
nervous centres.

Dr. George Davy,* in a paper on the Ganglionic System,
read before the Medical Society of London, the object of
which was to prove the entire independency of the organic
nervous system, brought forward a variety of facts, some of
which were of startling pertinency in corroboration of his
views. "After some preliminary remarks, intended to
show the unsatisfactory and contradictory opinions ex-
pressed by some of our most popular writers on physiology,
viz: Wagner, Todd and Bowman, Carpenter and others, con-

*See London Lancet, June 25th, isr>3.

I860.] i Foetus at full Ti 84]

earning the Ganglionic System, be affirmed, on the author-
ity of many good names, that the ganglia of the sympathetic
nerve are those parts first formed in the foetus, and that
this same fact obtains equally, it was premised, through the
whole kingdom. The early organism of birds was referred
to in confirmation of that opinion, which assigns to the
solar ganglion and its dependencies, an existence anterior to
any other part of the animal fabric." He then referred to
the two cast's we have just adduced, viz: the Ancncephalous
and Amyelencephalous monsters of Dr. Lawrence and Dr.
"Marshall Hall. He argued that, if in the latter instance,
the functions of secretion, absorption and nutrition were
duly and sufficiently executed without any aid from a
cerebrospinal system, then was this latter, in no instance,
either requisite or necessary in any way, to the integrity of
such functions in the animal economy. " The ganglionic
system," said lie, "is perfect at birth, and its functions are
also perfect ; this is- completely organized, while the brain
is nothing more than a mere pulpy mass, without any kind
of function or use to the individual in possession of the
same ; the one is in active and increasing operation, the
other is but a blank, doing nothing, useless ; the ganglionic
system executes its function instinctively, whereas the brain,
if not the spinal cord, requires time and experience and
direction, ere it perform its functions, either for good or for
evil."

The monstrosity reported by Dr. Marshall Hall, organ-
ically considered, may be compared to some of the lower
classes of animal life, the Medusarise ; these perform their
functions, it is thought, entirely instinctively, and they are
solely of a preservative character. Secretion, absorption
and nutrition are the physiological ends of their existence,
and it ma}- therefore be inferred that these animals possess
only a ganglionic or organic nervous system. The nervous
systems, then, of the Amyelencephalous monster, and of
the Zoophyte are " precisely similar, and their animal func-
tions on a par."

In the paper here quoted, Dr. Davey farther remarked that

342 Gardner. Cranial Deficiency. [May?

the records of any lunatic asylum would afford many in-
stances of individuals who were reduced to a mere vegeta-
tive or organic existence by disorder affecting the brain and
spinal cord ; such patients live, oftentimes, many years with
their cerebro-spinal organism so disorganized as to be per-
fectly useless to them ; " unconscious, without feeling,
emotion or desire, void of thought, without hope, joy or
passion, lost to all normal sensation, or, perhaps, without
feeling of any kind, and incapable of only the most imper-
fect motive power, enfeebled, paralytic, they nevertheless
digest, secrete, absorb, in a word, carry on, year by year,
the strictly vital functions exactly as the mal-organized
Foetus does ; exactly as the frog or fish, deprived of its
brain and spinal marrow did ; and exactly as the polypus is
in the habit of doing." "We have thus referred to a few of
the facts which bear upon Dr. Gardner's case of "Foetal
Peculiarity." These remarks might be greatly extended,
and many other instances adduced.

From what has been shown above, it will be readily seen
that no amount of disorganization, or even the entire
absence of both brain and spinal marrow, is incompatible
with the functions and nutritive processes of foetal life and
that these phenomena in the present case are by no means
such as should excite surprise in view of the wcll-estalished
history of former cases.

In the Museum of the Medical College of Georgia, the
subject of monstrosities has received great attention, and
many valuable specimens referring to the cerebral deficiency
arc there to be found. They are, all of them, of the white
races, like the case reported by Dr. Gardner above, and we
cannot now call to mind a single instance of this kind of
deformity in the pure African race. According to our ob-
servation, idiocy is very rare among negroes, while it is not
uncommon among mulattoes. "We may here further state
that, so far as our own experience extends, congenital defor-
mities of every kind are of very rare occurrence in the negro.
We have never seen among them a single case of club-foot,
and only heard of but one, while a case of congenital ab-

I860.] Bpabks. Dressing of Scalp Wounds. 343

sence of the Patellae* is the only instance of monstrosity in
the aegro, which we can now call to mind. They seldom
are the subject of hair-lip or cleft palate, while we have
Been several cases of both these in the mulatto, and they are
known to be by no means uncommon in the white races of
every country.

ARTICLE XIV.

Dressing of Scalp Wounds with Silver Sutures and Tying the
- Hair. By B. W. Sparks, M. 3)., of Thomaston, Ga.

\_hi the March number of the Southern Med. & Surgical
Journal, for the present year, we commended to our readers
the mode of dressing wounds of the scalp by tying the hair
across the incision, in order to avoid the use of sutures and
also the shaving of the scalp. The following brief note
from our correspondent, gives the details of a case which
will interest our readers, both on account of the use of the
Silver Sutures and as one in which the hair-tying plan was
successfully adopted. h. P. c]

Thomaston, Ga, March 22, 1860.
Prof. H. F. Campbell:

In the March number of your Journal, I noticed your
editorial remarks in reference to wounds of the scalp. Let
me trespass on your precious time, for a few minutes, and
I will relate a case that occurred in my practice during the
past year.

During the month of June last, a young man came into
my office with an incised wound of the scalp, three inches
or more in length. After arresting the haemorrhage and
removing the clots, I applied four or five silver sutures.
After the application of the sutures, I divided the hair into
a number of divisions, on each side of the wound, then
commenced plaiting (instead of tying) the hair into as many
plats as I could conveniently (the more the better). After

*The case above referred to, will be found reported by us in American Trans-
actions, Vol. for 1851, and also in a former volume of this Journal. Casts of
the same will be found in College Museum.

344 Pathology of Qu Pituitary Body, [May,

finishing the plat, I placed it on the wound for a compress,
passed a bandage over the compress of hair. On the eighth
day I saw my patient the wound had healed without any
pain. I removed the sutures, and did nothing more.
Yours, respectfully,

B. \V. Spa

Patholoqy of the Pituitary Body. By Middleton Michel.
M. D.

[Dr. Michel presented to the South Carolina Medical
Association the following interesting case, which we select
from a pamphlet kindly sent us by the author. AVe regret
that our space will not allow us to give more than the report
of the case and the author's conclusions. The pamphlet is
wry valuable as a whole, on account of the profound
research Dr. Michel has made into the literature of his
subject. He seems to have collected the entire record of
both facts and opinion, bearing upon diseased states of that
most mysterious of all objects of the Encephalon The Pitu-
itary Body. The pamphlet is well worthy preserving, as
authority on the subject. Eds. S. M. & S. .Journal.]

In the fulfilment of no special function of which Ave are
cognizant, the secluded and even concealed position of the
Pituitary Body invests it with peculiar mystery in the eyes
of the medical inquirer. As a most dependent and delicate
division of the encephalon we discover it buried in the cen-
tral and deepest depression of the base of the cranium, as
though removed by nature beyond the reach of either ol
vation or research. Hidden in the fossa of the basi-sphenoid,
it lies within osseous parapets and bulwarks on either side
which are lined, enclosed and covered in by reduplicaturea
of dura mater. most securely insured against those destruc-
tive influences which at any time may and often do en-
croach upon directly vital portions of the infra-cranial or-
gans. Never injured by the most fearful accidents invol
the rest of the cerebrum, and often the only remaining in-
tegral part in absolute destruction of the brain, either from
injury or disease, it stands impregnable against assaults of
j very kind save the insidious and searching invasion of cer-

18C0.J Pathology of ike Pituitary Body. 346

tain morbid processes which form a part of the equally i
score history of its di

L consider it, * s, no unimportant labor, while rela-

ting of the following rare and interesting

tetime Bince under my professional care,
to collate ich observations as bear any simili-

tude to it, which t1' literature of our Bcience may present
Offered in the form of a memoir on the diseases of the
pituitary body, it may be viewed perhaps in the light of a
contribution to this part of pathology, and this task I have
undertaken the more willingly, as me reader will perceive
from the few scattered cases on record that the most exten-
sive experience in pathological research has not always fur-
nished a] ' examples.

Wlii have led to the discovery of some

morbid conditions in which the pituitary gland has some-
times been - I which it will be the object of this me-
moir to exhibit, in such order of sequence as the subject
may no where encountered the recital of
a case in which the morbid processes and the symptoms
were like that which i am to describe, unless we except a
very brief statement by Rokitansky respecting cancer of this
b mIv. 1 have, therefore, - to regret that the only case
strikingly like my own, at least in the extent of injury which
the bones of the cranium underwent, leaves me without any
details from the pen of bo distinguished an author, butthr.se
which ] e so laboriously gathers from the labors of the Am-
phitheatre.

Though we may rise from personal and bibliographical
inquiries, such as f now attempt with no better knowledge
than we before p 1 of the functions of an obscure part

oft! phalon, yet I cannot but believe that a careful

path* if its several parts, with observations on such

comitant symptoms as seem to bear a relation of cause
and effect, though not always significant ot the purport of
the organ, will at least be acknowledged as an important
auxiliary in physiological discussion-.

A negro man, Archibald, the servant of Dr. AY. Bess
leu, of Grahaniville, Soutb Carolina, was addressed to me
by letter, and placed under my professional care on the 3rd
o\' March, 1855. A . of middle stature and

robust frame, Archy had for many years pursued the car-
penter's trade to the complete satisfaction of a master, who
looked upon him as one of his most valuable aids. During
a long immunity from disease of any kind, his mode of life

346 Pathology of the Pituitary Body. [May,

hotli moral and physical offered the surest guarantee against
those reverses in health, which are so often the conse-
quences of folly or vice; nor were the approaches of disease
even suspected, when from time to time in the midst of
Labor, he would complain of slight uneasiness about the
head. But the frequency of this occurrence led him to de-
tect, on a narrow examination, some cloudiness in the
vision, and this appeared to give greater distress since it
soon prevented him from "sighting his work with either
eye." Believing that he was becoming near-sighted, he
resorted to the use of spectacles in the vain hope of deriving
some assistance from them, but the cephalalgic and ambly-
opic symptoms, which were first noticed some time in Sep-
tember, 1851, steadily increased. Advancing at first pari
passu, the headache at length assumed an intermittent
character, while the imperfection of sight progressed with
such singular rapidity that he became almost blind. Obliged
to discontinue his work, his sufferings were occasionally
increased by intense pain in the frontal region, accompanied
with a sense of fullness about the orbits. The eyes, how-
ever, preserved their natural lustre, and but for the ambly-
opic symptoms, would have attracted no attention. These
difficulties continued for some months, when it was per-
ceived that the globes of the eyes had obviously increased
in tension and apparently in size. The general health had
undergone no change, and though dejected in spirits, he
seemed full of hope when he came under my personal ob-
servation in March. His appearance and gait were now
very much those of an amaurotic individual; erect, with
the chin elevated, the eyes largely opened, and the pupils
almost immovable, he advanced slowly and cautiously for-
wards, able still to discern dimly the largest objects. The
eyes, perfectly transparent, were resilient not painful upon
pressure, and the pupils were dilated. He had never expe-
rienced photopsic phenomena, hut complained of throbbing
and augmentation of pain upon the inclination downward
of the head, as in stooping, while even the recumbent posi-
tion increased his sufferings. I was inclined to consider the
case one of hydrophthalmia, though it was impossible to
blame either a scrofulous, scorbutic or syphilitic cachexia,
and indeed a more careful inspection discovered in a very
short time that the increased >ize of these organs was only
apparent, as there evidently existed a protrusion of the eye-
bails on both sides. This appeared to me to point uner-
ringly to the presence of an intra-cranial tumor. It were

I860.] Pathology of the Pituitary Body. 847

aeedless \o refer to the interest with which my patient qow
inspired all who saw him, nor to the daily record of a case
in which the insufficiency of remedial agents was s<> clearly
to be tested. Purgatives, alterative doses of mercury, com-
bined with digitalis, squills, and hyoscyamus; hydriodate of
potash, blisters, setons, etc., Pound their alternate place in a

treatment of some weeks, ending in unqualified disappoint-
ment as to the efficacy of any. The ptosis notably pro-
gressing lefl no doubt as to a growth of some sort exerting
pressure from behind simultaneously upon both eyes. The
globes preserved their parallelism and were now most sen-
shive to the touch. There was perceived an (edematous
distension oi' the sub-conjunctiva) areolar tissue, the result
ot* pressure upon and interruption to the circulation through
the ophthalmic vessels. The remarkable extent to which
this chemosis proceeded, as will presently be seen, and the
exacerbations ot' pain so frequently felt within the orbital
cavities, have led me often to believe, that about the end of
April, when these phenomena occurred, some phlegmonons
inflammation of the orbital tissue must have taken place,
tor we were compelled to return to treatment which had
been entirely suspended. Fever supervened, the head
symptoms were so much exasperated that my patient be-
came insomnious, delirious, and at one time almost frantic.
This condition lasted several days, and then left him com-
paratively easy. The conjunctivae were red and considerably
ehemosed, so as almost to cover the eyes, while these pro-
jected entirely beyond the palpebral fissure. The inflections
of these congested membranes advanced equally over both
eyes until their cornea4 were completely covered in. These
denuded surfaces, exposed to laceration from the slightest
cause and bleeding at the touch, became partially protected
by incrustations, forming fungous looking growths upon
the protruded globes, and an exophthalmia of so hideous a
degree as to give the countenance an appearance, which I
shall ever regret not having perpetuated at the time by a
daguerreotype.

Consentaneously with these destructive changes in the
orbit, a train of other phenomena followed in rapid succes-
sion worthy of peculiar attention; in the right temporal
region a swelling made its appearance, at first soft and
painful, afterwards becoming harder and less sensitive ; it
raised the aponeurotic layer of the temporal muslce without
affecting the color or texture of the skin ; pressure upon it
produced no cerebral manifestations, as neither convulsions

348 Pathology of the Pituitary Body. [May,

nor coma ensued. At this stage, deafness to sonic extent
on the right side was added to the other symptoms ; lie bad
occasionally complained of strange sounds in the right ear.
disturbing him by clay and night, w;hieh I presumed were
to be referred to some encroachment upon the auditory
meatus by the tumor, his nostrils also were so much ob-
structed as to prevent smell and to cause a snuffling respi-
ration. I noticed his inability to walk towards me without
assistance, when he would stagger and stumble and almost
fall, from apparently a want of power to co-ordinate his
movements, which reminded me at once of the phenomena
so often witnessed in animals from whom the cephalp-
rachidian fluid has been removed, or upon whom section of
the muscles of the neck has been performed, and which in
him as in them I referred to some unusual pressure upon
the oblongata. There was no hemiplegia nor paralysis,
Dr. Besselleu informed me he remarked a singular pecu-
liarity in the sense of taste which induced a somewhat im-
perative demand for sweets of every kind, so far imperative
that the appetite had quite failed the patient, and these
alone would he eat.

During the entire progress of this case the intellectual
faculties underwent no change commensurate with the
almost universal destruction of the senses. It is true, from
a very early period his indifference to all things about him
an extreme apathy, was the subject of general comment. I
think I also observed a degree of forgetfulness which
showed that the memory perhaps was the only faculty im-
paired ; but in every other respect his rational replies served
only to impress us with a sense of his hopeless despondency*
With a weak but rapid pulse ranging between ninety (90)
and one hundred and fifteen (115), with varied exacerba-
tions of the above symptoms, he continued in much the
same state until September 1st, when, without any previous
abdominal trouble, he was seized with diarrhoea of obstinate
nature, which continued until the 11th, when he died.

AUTOPSY.

The autopsy of this most interesting ease was performed
by my friend, Dr. Besselleu, in the presence of several
physicians; and. I must record publicly my indebted1
to him for the valuable notes taken on the occasion with a
promptitude and readiness which reflect greatly to his credit,
and a precision and accuracy leaving scarcely anything to
be desired.

!0.] hology of the Pituitary Body.

v7hen the calvariun] and dura-mater were removed, the
brain was found injected, though its surface exhibited no
signs of disease. There were bul slight traces of ependy-
mitis. \ the anterior lobes were raised there was discov-
ered, on tin- median line, occupying the site of the sella
turcica, a tumor resembling in size, form, color and consis-
tence a ripe blue fig, which became detached from its infun-
dibular dependence by the very method necessary for its
exhibition. From this tumor a pediculated mass of much
larger size extended beneath ami to the right temporal fossa,
unattached to cither cerebral lobe, forcing its way through
the base, orbito-nasal, and right side of the skull. The
rior and inferior surfaces of both hemispheres retained
the indented impress of the morbid mass. Pressure upon
this latter forced both eyes still further out of their socket.-.
An attempt was made to dissect out the whole tumor, but
its extent, insinuation through the absorbed osseous parts.
and the weakness oi' its sac, rendered this most difficult.
Incisions were then made into the tumor at several points,
when there issued a dark and grumous substance, of a very
offensive odor; this permitted the parts beneath to be
examined, and the extent of injury winch the bones at the
base of the skull bad sustained was found to be considera-
ble ; the almost entire centrum of the sphenoid save its
lesser wings was destroyed, the absorptive destruction had
ravaged all the most cancellated and lamellated fabrics
around, dipping into the ethmos, tearing up the floor of the
orbits, and involving the greater part of the frontal plates
which roof them in; respecting only the denser structures,
as represented in the petrosal and basilar parts of the skull,
it was found to have perforated the squamous portion of the
right temporal, and could be seen protruding beneath the
skin in that region, as had been suspected during life. The
finger introduced recognised disintegrated spiculse of bone
in many directions along the base of the skull in the sphe-
noid region, and could perforate with ease the most atten-
uated points. The nerves were found but little influenced
by the disease around them, and though not changed in
structure, singularly reduced in size; among other circum-
stances noticed, the optic nerves were mere threads and
pressed perfectly fiat, the pons and the medulla oblongata
were so far atrophied as not to exceed the little linger in
size.

EXAMINATION OF THE TUM0S.
A portion of the tumor, with one of the eyes, was placed

350 Pathology of the Pituitary Body. [May,

in alcohol. The eye was perfectly sound, its tunics were
readily separated, presenting no change or deposit of a
malignant kind. The tumor, spherodial and tabulated in
shape, seemed eomposed of a neurilemmatous sac, contain-
ing a diffluent and in part grumous liquid, as though the
parenchyma itself had been resolved into a hematoid fun-
gus. Upon the fibrous sheath of this tumor, vessels rami-
tied in various directions.

MICROSCOPICAL APPEARANCE

It was sometime before I examined any portion of tin
contents of this sac with the microscope. The prolonged
action of alcohol had then evidently altered its nature to
some extent, for I was now able to make sections through
its congealed and coagulated substance, which presented i
section-surface in some respects resembling the fibrinated
coagula and decidua of an abortion, with a somewhat
greater regularity of arrangement. The color was brown
or russet, with an intermixture of pigment deposit, not,
however, to any great extent, and by no means the same
which we see in the so called melanotic tumors. A layer
of sufficient thinness exhibited an ill-defined trellis work of
elementary granules, held together by an amorphous and
hyaline stratum of doubtful character. I examined certain
disintegrated particles which I detached from the centre of
the growth, under the impression that here, where the
alcohol had least affected the mass, I might obtain some
structural feature which would identify it, but save the ele-
mentary granules and a few capillary vessels, I could dis-
cover no nuclei, nor cells either spheroidal, caudate, elon-
gate, or angular. Xo stroma appeared to enter into its
composition.

Notwithstanding so very indefinite a result, there can be
little doubt of the nature of this alien growth. The rapidly
growing acute cancer is always medullary, and such are the
varieties of this class of carcinoma that we may reasonably
expect to find every grade of consistency from that of fibro-
eartilaginous to one of semi-fluid or liquid nature. The
destructive effects of this rapid extension will lead to the
same conclusion. The deep coloration in some parts which
I have spoken of as pigment deposit, was evidently meta-
morphosed hematine, from the extravasate which composed
a great portion of the tumor, and differed perhaps from
melanotic pigment, which is possibly due to a dyscrasial
state of the hematine, if it be not indeed a development

I860-] Pathology of the Pituitary Body. 861

within ik'wIv formed blood cella as some pathologists have
suggested.

The pathological characteristics of this case are the devel-
opment of a bilobular tumor within the sella turcica, and
the osseous destruction accompanying it. The morbid
alteration which the pituitary here underwent, was, as we
have mtu. one of a cancerous nature, and I now propose,
in Bearch of other varieties of the same affection, to examine
the diseases to which this pari appears to be Liable. But
alterations in the texture of this cerebral hypophysis are not
well determined, and an attempt to discuss them in a con-
neeted order will scarcely be satisfactorily accomplished.

Until this occasion, I had met with but lew changes in
the structure o[' the pituitary body, most frequently finding
it unaffected amidst remarkable evidences of disease through-
out the rest of the encephalon. Atrophy I remember to have
noticed in the autopsy of an aged woman, whose brain,
condensed and tinner than normal, did not nil the cranial
cavity. After removal, it exhibited so diminutive a nodule
attached to the tuber cinerum, that a Bearch was made in
the Bupra-sphenoidal fossa, for the body, which we sup-
posed was accidentally detached. In this instance, atrophy
amounted almost to the absence of the part. Atrophy may
result from mechanical causes, as in chronic ependymitis,
when effusion in the middle ventricle exerts pressure upon
this part. It lias been noticed by most authors, especially
by Morgagni, Wenzel, Cruveilhier, Rokitansky and Lebert.

Hyperemia, unaccompanied by meningeal congestion,
when it does exist, must frequently escape detection.
Kokitansky* is the only writer who speaks of its indepen-
dent existence, as occupying the anterior vascular lobe and
infdndibulum, in young persons. He even mentions apo-
plectic extravasations in its substance.

If we are warranted in drawing any conclusions respect-
ing the nature or the functions of this body, from re-
searches into its diseases and their most frequent symptoms,
they would seem to be :

First, That the pituitary body, however largely devel-
oped in some animals, is not a primary division of the
brain, or a true encephalic ganglion, since its complete
destruction is never accompanied by loss of intellection,
motion or sensation, beyond what may be satisfactorily ac-
counted for by the necessary pressure which the morbid

*Rokitansky's Patholog. Anatomy, Phil, ed- vol. 3, p- 335, 1855.

352 Bloodletting in Pregnane'/. [May,

growth exerts upon more essential parts of the encephalon.

Secondly, That from several of the morbid pi
enumerated in this memoir, Ave have strong proof of the
identity of the nature of this hopophysis with certain
called vascular glands, such as the thyroid, thymus, spleen,
and suprarenal capsules.

Thirdly, That while the diagnosis of its morbid condi-
tions is rendered somewhat obscure from the abe
any ascertained function of the part, ye1 their almost con-
stant connection with the simultaneous production of amau-
rosis in both eyes, with absence of symptoms of cross paral-
will indicate the seat of the disease, when compared to
morbid states of either hemisphere.

And fourthly, That the long continuance of disease in
this situation may propagate inflammatory action to neigh-
boring parts, followed by apathy, somnolency, syncope,
cophosis, and other symptoms obscuring the diagno

On Bloodletting in Pregnancy. By M. Silbert.

This is one of the Prize Essays of the Academie de 3fede~
cine. The author believes that as a consequence of the re-
action against the abuse of bleeding in pregnancy, practi-
tioners in our own times are too sparing in its employment.
There is, in fact, a tendency to the same exaggeration with
respect to the chloro-ansemia of pregnant women, which
formerly prevailed with regard to plethora.

i; That great consideration should be paid to ehloro-
anaemia in the pathology of pregnancy is right enough, but-
only on the condition also of not overlooking plethora,
state of complete reality, and which did not exist merely ii
the imagination of our predecessors. It is only by study-
ing pregnancy under this double point of view, and takiiu
into account at the same time the 'nervous condition' an<
albuminuria, which also play their part in the production oi
the accidents with which it is accompanied, that we cai
embrace the entire truth. This is not done by sacrificinj
one point of view to the other.

" The determination of the relative frequency of th
different conditions as causes of the diseases of pregnancy,
would be of very great importance as regards the general
indications for bleeding; but this point of medical statistics
is far from being elucidated, and it is not in a restricted
circle like Paris that the elements of a very exact apprecia-
tion are likely to be obtained. For the practitioners of

! ,).] Bloodtettwg in Pregnancy, 858

groat cities, whose observations are for the mosl pari made
on women etiolated by misery in the hospitals, or relaxed
by all the delicacies of luxury in private practice, chloro-
anaemia and the 'nervous condition' predominate in the
pathology of pregnant women. But the country practition-
er attributes to the richness and exuberance of" the blood
most of the accidents which accompany gestation." (tome
xxi. p. 117.)

Having premised thus much, M. Silbert divides his sub-
ject into three parts; in the first he treats of its history, in
the second he considers the general indications for bleeding
in pregnancy, and in the third he passes in review the par-
ticular cases which may call for its administration. We
pass over the historical part, and proceed to the next.

<;i:XERAL CONSIDERATIONS OX BLEEDING IN PREGNANCY.

The modifications which pregnancy produces in the sys-
tem are of two kinds: first anatomical and functional, which
are constant and essential to pregnancy, having their seat
in the uterus itself; and secondly, sympathetic, which are
eminently variable. The accidents which are due to the
mere physical development or acquired functions of the
uterus are admitted at all hands to be best allayed by anti-
phlogistic treatment. The sympathetic modifications,
which are of great importance in the pathology of preg-
nancy, are referable to three heads:

(1), to disturbances of the nervous S3'stcm ;

(2), to notable changes in the composition and quantity
of the blood ; and

(3), to the presence of albumen in the urine.

These three conditions then have to be considered in re-
lation to the question of bloodletting.

DISTURBANCES OP THE NERVOUS SYSTEM.

To this condition must we attribute not only the extreme
moral irritability which some pregnant women exhibit, but
also a good share of those functional disorders which are
so common, so intense, and so ob.stinate, and which have
been so frequently attributed to plethora ; as vertigo, loss
or perversion of the senses, and disturbances of the circu-
latory, respiratory, or digestive functions, as shown by pal-
pitations, syncope, vomiting, etc.

These generally disappear or become diminished with the

progress of preguancy in women whose nervous system has

only become disturbed by the fact of the pregnancy itself;

but it is otherwise with those in whom the pregnancy finds

23

364 Bloodletting in Pregnane?/. [^y,

this condition of the nervous system already acquired.
This "nervous condition" has been laid down by Sandrasas
a formal contra-indication to bleeding, when it is uncon-
nected with cerebral plethora, and the prohibition is justi-
fied by the close relationship which usually prevails between
impoverishment of the blood and the production of nervous
disorders. But in pregnancy the diminution of the globu-
lar element of the blood will not explain most of these
nervous disturbances, inasmuch as these in general disap-
pear before the blood has undergone any notable improve-
ment in this respect.

The sympathetic excitement is in many cases the direct
consequence of the irritable state of the uterus, and capa-
ble of relief by small general or by local bleeding. More-
over, the "nervous condition" is an unequivocal cause of
uterine plethora. The women who menstruate most are
not the strong and plethoric, but the nervous and delicate.
Great care is indeed required in employing bloodletting in
the nervous affections of pregnancy, especially towards the
end of this, but when the state of the strength permits it
the contra-indication must not be regarded as absolute.

MODIFICATIONS IX THE COMPOSITION AND QUANTITY OF THE

BLOOD.

Modern researches have shown that

1st. The globules diminish from the commencement to
the end of pregnancy, their proportion rapidly decreasing
from the seventh month.

2d. The flbrine, slightly diminished during the early
months, is then increased somewhat to the seventh, be-
coming much augmented during the two last months.

3d. The albumen diminishes progressively, though only
to a slight degree, throughout the whole of the pregnancy.

Although these modifications cannot be called pathologi-
cal, yet is the relation which such blood bears to choro-
ansemia so strong as to lead to the same pathogenic charac-
ter being attributed to the latter as formerly attached to
plethora. M. Cazeau's views concerning the agency of
ehloro-anaemia are certainly too exclusive. The condition
of the blood in pregnancy is, in fact, quite peculiar and
special.

In some exceptional cases, the chloro-anamiia may pre-
vail, but it is rather as a coincidence and exaggeration of a
condition already present, than a consequence of the sym-
pathetic reaction of the uterus. But true plethora may also
prevail in women notably predisposed, or it may do so tern-

I860.] Bloodletting in Pregnancy.

porarily and at different Btages of the pregnao
in whom it is only a result of the increased vitality
(lam on pregnancy; and depletioE requires to Be used
with more caution when plethora is a to mporary, accidental
condition, than when it is a habitual - srravated

pregnancy. Even in serous plethora, in which, witl
diminuti globules, in-

crease of serum, and in which ferruginous preparation may
be called for, the mass of the blood beii

fill depletion is not the loss indicated. Merc mediae
plethora, determined by the pressure of the uterus during
the latter months, may also call for palliative bleeding.

ALBUMINURIA.
Although pregnancy may run through its course quite
uninterfered with when albuminuria is present, at other

times it becomes a most grave complication, signally favor-
ing the production of sanguineous or serous congestions,
which in a great number 01 cases are the point of departure
of alarming accidents.

Bleeding may often be advantageously resorted to in or-
der to ward off such consequences, when albuminous
nephritis coincides with pregnancy, and when the condition
of the urine, analygous to that observed in the anasarca
consecutive to scarlatina, implies renal congestion.

Albuminuria, considered in itself, is most often connected
with asthenia, and therefore bleeding is contra-indicated;
but the peculiar conditions observed in the pregnant woman
often compel practitioners to depart from this rule, no one
hesitating, when uterine or cerebro-spinal congestions be-
come menacing, to have recourse to this means.

In the sections on the inconveniences and dangers of bleeding
in pregnancy, the author makes several quotations, in order
to show that injudicious depletion during pregnancy, by
impoverishing the blood, may give rise to abortion, and
predispose to disease, especially to puerperal fever.

We pass on to the third portion of the work,, treating of
the particular circumstances which may call for bleeding.

I. BLEEDING IX THE DISEASES PROPER TO PREGNANCY.

As long as the exaggerated ideas concerning the plethora
of pregnancy prevailed, bleeding was performed without
any reserve in all diseases of pregnancy, and although any
such excess would now be unjustifiable, yet does bleeding
still constitute our principal mode of treating such affec-
tions. This arises from the fact that whenever they reach

356 Bloodletting in Pregnancy. [May,

a certain point, the usual result is the product of conges-
tion.

The causes of the diseases of pregnancy are (a) the ana-
lical and functional changes in the uterine system, and
the fluxion of which the pelvis is necessarily the seat during
ation; (b) the mechanical obstacle which the develop-
ment of the uterus opposes to the free play of the organs;
(') the sympathetic reaction excited by the uterus in certain
ins; and (d) the influence which the general modifiea-
t pna of the nervous system, the changed conditions of the
blood, and the existence of albuminuria, exert upon the
economy.

Any of these four causes may act in an isolated manner,
hut usually more than one act together, and concur in the
production of the accidents. It would be difficult, there-
fore, to consider the diseases of pregnancy by distinguish-
ing them according to the causes which give rise to them;
and the author prefers dividing them into idiopathic and
sympathetic diseases. The former have their seat in the
uterus and pelvic organs, and are the result of anatomical
and functional changes; and the others interest distant or-
gans, being due to the reaction which the condition of the
uterus exerts upon the entire economy.

IDIOPATHIC AFFECTIONS.

(a) Uterine Plethora or Congestion. This may be some-
t'mes dependent upon a state of general plethora, but it is
o'tener found in nervous, albuminuric, and hydropolyamic
s ibjects. Not only does uterine plethora exert a great in-
11 icncc on the production of uterine haemorrhage and pre-
mature contractions, but it determines almost the entire
pathology of the ovum, placental congestion and apoplexy
being, in fact, intimately dependent on it. Although it
may appear at any period, it is yet during the first half of
pregnancy that it is most commonly met with. Bleeding
is the treatment indicated, the amount of this being regu-
lated by the nature of the cause giving aise to the plethora.

(b) Haemorrhage Is commonly a consequence of uterine
plethora, and it should be treated by bleeding, when there
is evidence of the permanent operation of an active cause,
and especially during the first six months. At a later period
greater circumspection is required.

(c) Premature Contraction Is a frequent consequence of
congestion, and especially of haemorrhage, and bleeding is
a powerful means of arresting it.

(d) Amoug other pathological conditions, dropsy of the

1800."] Bloodletting m P //.

amnois and hydrorrhea admit only of bleeding when Bigns
of congestion and plethora are present.

(<) Uterine Neuralgia [s sometimes dependent on ple-
thoi

(/) Uterim Rheumatism Is usually best treated by de-
pletion.

Passing on to the affections of other organs than the
uterus, which arise from the physiological fluxion taking
place t wards the pelvis, we hare congestion of the broad
ments, which, although a rare affection, must still be home
in mind. The hemorrhagic molimen of the veins of the
rectum, giving rise I i rrrhoids, may become an active

cause oi abortion. When connected with a state of ple-
thora bleeding Bhould be resorted to, while when the
haemorrhoids are inflamed and painful, leeches may be safe-
ly applied, though they are often but of little use.

Cystitis is not a rare occurrence in pregnancy, and the
softening of the pelvic ligaments, which is so constant an oc-
currence, may go on to a true inflammation.

SYMPATHETIC AFFECTIONS.

The great benefit derivable from blood-letting in the
idiopathic affections of pregnancy is not obtained in the
management of the sympathetic affections.

(a) Affections of the Breast. Although it is rare for the
changes which take place in this organ to assume a morbid
character, yet in some instances a true phlegmasia may be
developed, and depletion be called for.

(b) Disturbance of the Digestive Organs. The stomach is
the organ which, of all others, is most readily and most
deeply influenced by the sympathetic reaction of the uterus.
In the case of obstinate vomiting, in place of applying
means after means to the stomach itself, our attention
should often be turned to the uterus, whether for rectifying
malposition or abating congestion and inflammation.

(c) 'Neuralgias. The various forms of these (as cephal-
gia, odontalgia, tic douloureux, vulvar pruritus, &c.,) to
which pregnant women are liable, have almost ceased to be
treated by bleeding since the time of Vallex ; but that
author attributed too much to the agency of asthenia in the
production of these affections, for depletion may be advan-
tageously used when the patient is not anaemic, and symp-
toms of general excitement arc present.

(d) Vertigo and syncope should be treated by bleeding or
not according to the nature of the cause which has produced
them.

358

Bloodletting in Pregnancy.

[May,

i. i Eclampsia. Whatever difference of opinion may pre-
vail with respect to the nature of this, all are pretty well
agreed as to the necessity of bleeding ; and not only is this
required in the actual attack, but as a preventive, and espe-
cially when albuminuria is present or eclampsia has occurred
in a former labor.

(/) Partial paralysis is sometimes observed towards the
end of pregnancy, chiefly in primiparse. The causes are
often obscure, though the affection usually seems connected
with chloro-ansemia, hyastasia, or albuminuria. It usually
disappears of its own accord, and bleeding should not be
resorted to except in the robust and plethoric.

(//) Disturbances of the respiratory "i><i circulating organs,
The disturbance of respiration during the later months, is
due to a mere mechanical cause, thrusting up the dia-
phragm : but when dyspnoea is observed at an earlier period
it may be due to the nervous condition or to congestion or
(.edema of the lung, and according to the nature and preva-
lence of these causes, the treatment with regard to bleeding
must be regulated. In some case- palpitation of the heart
is also due to local congestion, and may call for depletion ;
but such cases are rare. Cough, when dependent upon
Buch condition, is best relieved by moderate depletion.

(Ji) Dropsy of the cellular t'Ssue. This is not always due to
the obstacles offered to the venous circulation, or to the co-
existence of a disease of the heart, and albuminuria must
be taken into account, in consequence of the frequent occur-
rence of convulsions when it is present.

II. ON BLEEDING IX THE INTERCURRENT DISEASES OF PREGNANCY.

For the bulk of these the treatment differs but little from
that winch is proper in the non-pregnant condition. As a
general rule, prudence in bleeding is advisable; but there
are cases in which the greatest energy is alone sufficient,
for not only may some of these affections exert an injurious
effect upon the progress of gestation, but they themselves
may be influenced by the changes incident upon the in-
crease of size of the uterus. Expectation, which would he
proper in the unimpregnated condition, may be misplaced
here. The superabundance of fluids, or polyeemia, so fre-
quently met with in pregnant women, should also be borne
in mind as an additional reason for employing the lancet.

III. ON BLEEDIXt; TX NARROW PELVIS.

The author agrees with M. Depaul, that in certain a
of narrow pelvis it is preferable to seek to diminish the size
of the foetus by rigid diet and bleeding, to resorting to pre-
mature labor. '

L860.] Diseases of the Ear. 859

77a Diagnostic Tube and the Diseases of th Middle Chamber
' the Ear. By Dr. W. Kramer. (Translated from the
Gazette Medicale, for the Nashville Medical Record.)
The diagnostic tube is nothing but a tube of vulcanized
caoutchouc, very Boft, of three-eighths of an inch in diame-
ter, and about two feel Long. ( me of its extremities, which
is to be introduced into the auditory meatus of the patient,
tapers off, while the other has the same diameter as the rest
o( the tube ; this latter extremity, when placed in the audi-
tory meatus of the physician, is retained there by its own

elasticity. In order to ascertain the diseases of the middle

.chamber with the aid of this instrument, we must provide

four catheters for the Eustachian tube, corresponding
numbers one, three, six and seven of the screw-plate of M.
Charriere. Number one is so fine as not to -permit the
entrance of the point of a very tine pin into the orifice of
its beak; number two corresponds to the normal diameter
of the tube at its narrowest point ; while numbers three and
i'ouv have a wider calibre.

To proceed to the examination of the middle chamber,
the physician introduces into his auditory meatus, say the
left, the larger extremity of the tube, and into the right
meatus of his patient, opposite which he places himself, the
tapering extremity. If the tube is not retained by its own
elasticity, it is held there by the patient, or by a third party :
the catheter is then introduced into the right tube, and the
physician makes an insufflation ; the acoustic effects of this
operation are transmitted with all their gradations of inten-
sity or tone to the ear of the physician, exactly as if it were
applied directly to that of the patient.

AVlien we practice insufflation in a sustained manner, and
with moderate force, with catheter number one, then, if the
ear be sound, the air makes its way into the cavity as far
as the tympanum, and we hear a continued blowing, soft
and clear, like that we perceive if we blow into one of the
extremities of the tube, the other being fixed in the meatus.

Whenever insufflation produces acoustic effects different
from this, we must suspect that there exists an organic
affection of the middle chamber, though the certainty of
that proposition has not yet been submitted to the vcrinca-
tion of autopsies. Hales, whether mucous or sonorous,
(metallic?) indicate evidently either a mucous or sero-
mucous secretion on the one hand, or, on the other, a total
absence of secretion; if the stream of air winch, penetrates
the middle chamber is very fine, and interrupted, the calibre

cIGO

Diseases of the Ear.

[May,

of the tube must be diminished ; if the blowing sound,
which denotes the penetration of the air, is wholly sup-
pressed, the tube must be completely obstructed. In what
follows, I shall often have to say, for the sake of brevity,
the air penetrates the tube, etc.; it is sufficient that the
reader is apprised, so as to avoid all misunderstanding.

In these researches it will be well to use at first catheter
number three, to produce a current sufficiently energetic ;
if the air penetrates promptly and freely, we repeat the
insufflation with catheter number two; then, if the result is
the same, with number one.

So long as the air enters freely with this number, we are
assured that there exists no obstacle, fixed or movable, in
the middle chamber, and of course not in the Eustachian
tube. When, on the other hand, the air does not penetrate
at all, whatever be the catheter employed, we cause the
patient to imitate the motions of deglutition, that the air
may be pressed more powerfully from the side where the
tube enters; if, then, no penetration takes place, it is cer-
tain that the tube is the seat of stricture very extensive and
very resisting, or else that it is rendered impervious by
adhesions: to decide which of these lesions we have to deal
with, we must have recourse to catheterism with catgut.

In all the cases where the air does not penetrate, we hear
a rustling, more or less distant, according as the obstacle is
situated more or less distant from the membrana tym/p
it is not always easy to distinguish this noise from the faint
blowing which one hears when a column of air makes its
way into the tube.

I have now for several years been applying this mode of
investigation to a great number of diseases of the ear in
which the tympanum was unaffected, and have never failed
in such cases to meet with the symptoms of a catarrhal
inflammation of the mucous membrane with superficial and
interstitial exudation together; or exudation alternately free
and interstitial, or with complete absence of secretion.

A.s the mucous membrane of the middle chamber and the
Eustachian tube is entirely identical, we may expect this
affection, when present, to invade it throughout its whole
extent ; it is especially in inflammation of that portion of
the membrane which covers the fenestrum rolundum that
derangements in hearing are to be calculated upon.

I have never yet determined infallible signs of phlegmo-
nous inflammation of the middle chamber where the tym-
panum is not perforated. I must say the same of caries,

1860, | 861

and other important degenerations. Ajb regards anchyl
of die stapes, with atrophy and paralysis of the mus
which move the ossicles of the ear affections, the .

ence of which is as yet extremely problematical it
will no1 be possible _nize them with the aid of diag-

nostic tul

The causes of catarrhal inflammation of the middle
chamber are chiefly cold, whether it acts exclusively on the
organ of hearing, or whether its more general action on the
tern produces at the same time c >ugh, catarrhal,

ric or other fever. rl he cold generally takes placi
the effect of a current of air, or the penetration of cold
water into the meal

The pr of the affection is nearly always essentially

chronic, rarely subacute. Exacerbations are common as the
result of renewed cold, and especially in the course of febrile
diseases; the aggravation of the catarrh of the chamber
generally yields at the same time with the deranged condi-
tion which I - occasioned it, but it as often happens that
3, the only subjective symptom of the diseases, is
permanently aggravated at each exacerbatii

It is rare to observe the passage of one of the varieties

idicated into another ; and there is perhaps no ex-

le of their becoming the origin of other affections of the

car. such as inflammation and ulceration of the membrana

tyrrvp

The prognosis varies according to the anatomical charac-
ters; that form which is not accompanied with free exuda-
tion on the surface of the membrane is much easier to cure
than that where the exudation is interstitial. In all cases
it is upon local treatment that we have most to rely; even
where the patient is affected with a manifest dyscrasie, gen-
eral constitutional treatment, for the most part, exerts no
sensible influence on catarrh of the middle chamber. It is
only in very recent cases, of not more than a few weeks'
duration, thai staying in a heated atmosphere, free diapho-
resis and revulsives can, by themselves, cure this affection,
whatever may be its variety. Let us now separately study
each of these varieti .

I. Catarrhal inflammation of the middle chamber, with free

(superficial) exuda

In practicing a strong insufflation with catheter number
three, the air immediately penetrates, freely and without
interruption, producing rales, more or less abundant. The

362 Ureases of the Ear. [May,

patients often experience a considerable shock during this
operation; it is almost always followed immediately by a
remarkable diminution of the deafness, and of the ringing
in the oars, which frequently even disappear together.

This improvement ordinarily diminishes at the end of
some hours, but by repeating the insufflation once or twice
a day, we often obtain a cure after a longer or shorter
period, and alter frequent il actuations for the Letter and
worse. The mucous rale is the first of all the symptoms to
disappear, then the insufflation may be freely made with the
catheters, numbers one and two, which prove that the mid-
dle chamber is no longer the seat of any material obstacle.

Cn recent cases we often obtain a cure at the md of a few
days. Old cases always demand treatment for three or four
weeks, and almost always for longer. To anticipate relapses,
we should alwavs watch the condition of the car during
several weeks, or even months, after the cure, and. in case
of need, have recourse from time to time to our insufflations.

In refractory cases it is advantageous, after having evac-
uated the mucous accumulations of the middle ear by insuf-
flation, to inject into the Eustachian tubes, with the aid of
catheter number one,- some drops of a warm solution of
gum ; for that purpose we fill the catheter with the gummy
solution, and stoj) its larger aperture ; then we place the
beak of the catheter in the Eustachian tube, we unstop the
aperture, and practice a rapid insufflation, which makes the
liquid penetrate into the chamber.

When relapse recurs several times, we inject by the same
proceeding a dilute solution of the chlorohydrate of ammo-
nia, ten or twenty centigrammes to thirty grammes of water,
or of iodide of potassium, from twenty-live to fifty centi-
grammes with the thirty grammes of water. These means
diminish pretty efficaciously the exaggerated mucous secre-
tion.

In cases where inflammation is accompanied by fever,
with severe lancinating pains in the ears, without the mem-
brana tyrrvpani being affected, we prescribe repose in bed, and
drop some warm olive oil into the meatus. When we have
thus caused the pains to cease, we renew the insufflations.
It is advantageous to put the patient on meagre diet, and
to keep the bowels open : we ought also to interdict them
the use of cold lotions and baths. Any dyscrasies with
which they may be affected have no connection of causality
with catarrh of the middle chamber, yet it will be all the
more necessary to combat them, after having obtained a

I860.] Bimses of the Ear.

(nrc with topical applications, in order to provide againsl
relapses.

II. Catarrhal inflammation of tht middle chamber, with fra
and interstitial exudation. [Stricturi of the Eustachian tube,)

The air, even when injected with force, only penetrates
in small quantity, and mosl often not at all, unless the
patient exercises at the same time the movements of deglu-
tition ; the Mow ingsound which it produces has, in addition,
a moisl character. Installation perceptibly diminishes the
deafness and the ringing of the ears; sometimes, indeed.
these symptoms entirely disappear for some Lours. This
improvement acquires a greater duration if the insufflations
be frequently repeated, and especially in those eases where
we practice injections of gum-water; the amendment is.
moreover, nmeh slower, hut at the same time its progress is
more regular than in the first variety.

In any ease, we ought not to repeat the injections twice
in one day. or we shall almost inevitably produce ringing
in the ears, a sensation of fullness and heaviness in the
head, agitation, etc.

There are eases where we are very soon enabled to intro-
duce air freely with catheter number three or four, and
where this insufflation produces a more marked improve-
ment than under ordinary circumstances, but where this
improvement is also much more transitory, not lasting
longer than a quarter of an hour or a little more. In these
cases the complete cure demands a much longer time, be-
cause the insterstitial exudation predominates over the free
exudation; the tube is then narrowed. We must, under
these circumstances, allow an interval of more than twenty-
four hours between the insufflations, and accompany them
with the gum-water injections.

III. Catarrhal inflammation of the middle chamber, with inter-
stitial exudation. (Stricture of the Eustachian tube.)

The air only penetrates when the insufflations are made
with catheters numbers three and four, and even then the
patient has to make the movements of deglutition : at the
same time the penetration is always made in a very fine
stream, and frequently in jerks, and so as to produce only a
feeble sound; it always increases the tingling of the ears
and the deafness, and after the insufflations the patients
often experience a sensation of weight and fullness in the
ear and the head. When the air does not penetrate at id I
into the chamber, we inject into it a drop of some inert

864 Diseases of the Ear. [May,

liquid, we hear a Bingle isolated bubbling sound when this
drop makes its way into the chamber. In cases where this
injection is impossible, we must introduce into the tube,
with the aid of catheter number two, a piece of catgut, to
ascertain whether there exists or not an obstruction pro-
duced by adhesions. Cases sometimes occur where the tube
is not obliterated, and where it is nevertheless impossible to
introduce the cord.

The indication which naturally occurs to us in this variety
is to aim at producing a resorption of the interstitial exuda-
tion ; for this purpose iodine, mercury, Zittmann's decoction,
Russian baths, thermal sulphur waters have been commen-
ded, also water treatment, applications of nitrate of silver
or tincture of iodine to the pharynx or velum palati, but all
these means are found unsuccessful except in very recent
cases.

In inveterate cases energetic insufflations with catheters
numbers three and four, ought to be avoided, in conse-
quence of their irritating action, and we only have recourse
to them at all for the purpose of ascertaining the progress
of the cure. If we have to do with a young patient, provi-
ded the insufflation with catheter number three produces
any perceptible sound during the movements of deglutition,
we inject, with the aid of catheter number one, some drops
of the solution of gum, of sal-ammoniac, or iodide of potas-
sium. We must abandon those measures if they do not
produce an improvement within two or three weeks. We
must then introduce into the tube a piece of catgut with the
aid of catheter number two, the extremity of which has
been softened; we make it penetrate to the depth of an
inch, and continue there for five minutes; we repeat this
operation every day, or alternate it with injections as pre-
scribed above. The results obtained by these means are
not very brilliant, but I know of no other medication which
gives more satisfactory results.

IV. Catarrhal inflammation of the mucous membrane of ilic
middle chamber ; with suspension of all secretion.

The air penetrates easily and freely, with a dry and clear
sound, even with catheter number one, without improving
the deafness or the sensations excited in the ear; these
symptoms are sensibly aggravated when a strong insuffla-
tion is made with catheter number three; the patients then
complain of a painful fullness in the ears.

"We must, under these circumstances, seek to re-establish

18(30.] Croup Pro 865

tlu' normal sero-mucous Becretion; when this result is ob-
tained, the blowing resumes its softer sound. The n
efficacious means ot doing this is the injection of a dilute
solution of caustic potassa, (six drops of caustic ley with
thirty grammes of water.) We make these injections with
catheter number one ; they oughl not to be repeated every
day, except in cases where they do nor provoKe or aggra-
vate the sensation of fullness of the ear. When they do
produce that result, we must wait before repeating them,
until that symptom lias disappeared.

The Croup-Process. By Dr. Porges, Physician for Diseases
of Children at Pesth.

The cause of this morbid process is still involved in much
obscurity, notwithstanding the efforts of many experienced
and qualified physicians. A longtime may yet elapse, and
many ingenious theories he conceived by anatomists and
practitioners, before the true one is established. "Wc are
justified, therefore, in removing the discussion of this mys-
terious process, by making the following attempt at its
explanation.

The characteristics of the croup-process are :

A. The fibro-albuminous exudation as a symptom of in-
flammation.

B. Paroxysms of suffocation terminating in death.

A. The fibro-albuminous exudation as a symptom of inflam-
mation.

Under this head are to be considered the following points :
1. Are the symptoms of croup those of a genuine inflam-
mation ?

a. From a clinical point of view.

b. From an anatomico-pathological point of view.

For the sake of greater clearness, I may be permitted to
compare the course of croupous pneumonia with laryngo-
tracheal croup.

a. From a cluneal point of view.

CROUPOUS TNKUMOXIA. LAHYKGO-TRACHEAL CROUP.

High fever and symptoms of inflam- Ferer and inflammatory symptoms

mation from the beginning. are often absent in the beginning.

Local pam. local burning heat upon Seldom are there local pains no heat

the corresponding wall of the thorax, of the larynx

Crackling ami rattling respiration; Sibilant respiration, bruit de drap ;

sputa yellowish, afterwards inspissated, sputa always albuminous and coagu-
lated.

With increasing illness the circum- Face always pale, except during the
scribed redness of the face becomes paroxysm of suffocation '.he skin mo-
darker, the skin drier, and the body derately warm, or cool and moist,
hotter.

3G6

7 he Oroup Process.

[May,

The mouth hot and dry.
Pulse hard and full.
Dyspnoea general, and gradually in-
creasing.

Delirium.

After exudation the inflammation in-
volves the adjoining or opposite parts-

The more abundant the exudation,
the more violent the symptoms.

The termination is different, accord-
ing to the severity of the disease. In
most cases, it is in recovery, and but
seldom in suppuration, gangrene, etc.,
etc

The mouth warm and tongue moist.

Pulse soft and small.

Paroxysmal dyspnoea, often greatest
in the beginning.

Intelligence clear until death.

The exudation is repeatedly deposited
oftentimes for a fortnight afterwards
in the trachea and larynx, and ex-
tends in a third of the cases to the
bronchii.

The exudations are usually abundant.
and, with the exception of paroxysms of
suffocation, the symptoms are obscure
and threatening.

Recovery is rare, exudation continues
until death by suffocation ; the tissues
and mucous membrane remaining un-
changed.

b. From an anaiomico-paihological point of

There is an abundant development of
cells, a moderate exudation of fibrin
and extravasation of blood.

The exudation undergoes metamor-
phosis.

The mucous membrane and the sub-
mucous cellular tissue exhibit changes
corresponding to the condition and
course of the disease. Thus we find
them dissolved, thickened, softened,
hardened, suppurated, gangrenous, etc.,
etc.

Trifling development of cells, exces-
sive fibro-albuminous exudations, with-
out extravasation of blood.

The exudation is found always the
same, even in the cadaver.

The mucous and sub-mucous cellular
tissues exhibit no changes, or but very
slight changes, which do not in the
least correspond to a disease affecting
tissues so deep as these.

From this comparison, it follows that laryngo-tracheal
croup is, 1st. From its want of symptoms, not a genuine
inflammatory disease. 2d. It is not a local disease, because
the tissues of the larynx and trachea are not id the least
changed by it.

We find, then, that the larynx is only the theatre or point
where the disease exhibits itself, and the question now
arises as to its proper seat. Is it in the blood? In severe
and obstinate acute, as well as chronic diseases, it has been
usual hitherto to attribute to the blood a peculiar morbid
activity, producing, according to the process existing at the
time, materies morhi, which, circulating, is at length thrown
off with more or less disturbance in any predisposed locality,
leaving the blood in a purified and restored condition. This
doctrine of crasis or discrasia of the blood, which speaks of
syphilitic, arthritic, or scrofulous ophthalmia as a syphilitic,
arthritic, or scrofulous discrasia, and of croup and other
inflammatory diseases as a fibrinous crasis or discrasia, etc.,
is now exploded.

The blood is the liquid life that is. it contains all the

L860.]

principal elements of the human organism, partly in a liquid

and partly in a plastic State. Bui all its morphologic and
amorphous parts are introduced into it. and are no more

the product of its activity man gold is the product of gold-
carrying rivers. The blood-corpuscles come from the liver
and the spleen, the albumen from the Lymphatic glands, and
the salts are introduced by endosmosis. Vital Force, then,

may l)o wholly confined to the restoration of the stcechio-
metric <>r i lemental relations of the organism, to the pre

vation of the crasis or constitution peculiar t-> the individual,
and to the equalizing, by means of exosmosis and endos-
mosis, the unequal plus ov minus existing at any time in
those Beveral respects. The blood, therefore, in its course
mer< ives and delivers. It may even receive obnox-

ious Bubstances, which temporarily change its composition
or partly destroy it, as, for instance, carbon; but it cannot
produce-or develop substances eitber good or bad; and ao
far as this is concerned, there can be no question about dis-
crasia. The idea that the blood can produce materies morbi^
to be ultimately deposited in some irritated or predisposed
organ, must henceforth be given up. Tbe blood can carry
tbese morbid elements to any organ, but some otber organ
must previously have introduced them into tbe blood.

In regard to croup, tberefore, it follows that tbe blood
itself cannot form, but only convey to tbe larynx tbe morbid
products peculiar to this disease, and that their origin must
be sougbt for elsewbere than in tbe blood.

Xow, since tbe albuminous material, tbe presence of
which forms tbe most essential symptom of tbe croup-
process, can be produced neither by tbe mucous membrane
nor by tbe blood, tbe scat of tbe disease must be in tbose
otber organs which are constantly producing and restoring
albumen to tbe blood.

Tbe laboratory lor albumen, both in bealtb and disease,
is tbe lymphatic glands. Tbe opinion of pbysiologists, that
albumen and fibrin are used in tbe organism in tbe same
form as offered in alimentary substances, cannot, in tbe
progress now making in chemistry and physiology, be long
maintained.

Tbe circulatory system, tberefore, is simply a system of
tubes, wbose office is to distribute tbe blood-making ele-
ments introduced into them from without, which, entering
into combination with various other ingredients of the food,
become then qualified and capable for the maintenance of
the individual organism. Doubtless human albumen is

368

The Croup Process.

[May

more perfectly fitted for the construction of organs w,hich
are the media of thought, feeling, and will, than the albu-
men of plant j.

The normal as well as abnormal production of albumen
must, therefore, take place in the lymphatic glands, and in
the case of croup especially, in those so largely distributed
about the larynx and trachea ; and the extensive network
of lymphatic vessels with which these glands are connected
supplies them constantly with fresh material.

Increased formation of albumen also takes place in pneu-
monia and other inflammatory diseases of the mucous
membranes. The albuminous exudations of croup are dis-
tinguished from all similar ones, however, aside from their
specific inherent qualities, by the fact that they do not
undergo any decomposition, but are always expectorated,
vomited, or evacuated unchanged and spontaneously, and
without any oppression of breathing, if deposited, in the
first instance, in bronchial tubes of the second size.

A state of increased productiveness on the part of an
organ presupposes a state of irritation. Can this be proved
true of the glands in the case of croup ?

So far as regards the pathological anatomy of croup, the
results are altogether negative. Barthe merely says, "that
the bronchial glands are generally large and soft."

The proximate cause, however, of the irritation of the
lymphatic glands is probably a miasm, having the same
affinity to these that typhoicl-miasm has to the abdominal
glands. The glands receive the miasm in the first instance,
are affected by it, react with increased energy, and pour
out, with slight symptoms of local inflammation, their pro-
ducts upon the larynx and other organs. If asked, why to
the larynx ? we answer, that this organ, so prominent fte
intermediate agent between the individual and the external
world, is, at the age of from three to seven years, in full
course of development, and consequently in a physiological
state of excitement, and for that reason a point less likely
than another to resist disease.

Cold, mechanical irritation, or chemical agencies, do not
produce croup.

B. Paroxysms of suffocation terminally"] in death.

These have been quite ingeniously explained by referring
them to the swelling of the mucous membrane, especially
of the glottis, and to the diminution of the calibre of the
trachea, from the exudation poured out upon its inner sur-

I860.] The Group Process. 869

faro. The following facts, however, are inconsistent with
this explanation. Paroxysms of suffocation frequently ap-
pear before any cough is heard.

In simple laryngitis, swelling, croupy sound, and exuda-
tion appear without such attacks; they occur even when
qo false membranes can be detected during life, or found
after death; or when such membranes are do longer found
in the larynx, hut in the deep-seated bronchial tu\)v^ only.

They terminate without the exudation being removed; and

finally, that in similar diseases, such as severe catarrhal
inflammation of the lungs, extensive pneumonia, or pleuritic
effusion, however severe maybe the dyspnoea, no paroxysms

of suffocation appear.

Then another explanation was suggested. It was said
that "the muscles of the larynx arc infiltrated, cedematous,
and therefore unable to keep open the glottis." Aside
from its incorrect physical basis, there should, according to
this explanation, be no paroxysms at all, for the patient
would be suffocated at the moment such infiltration oc-
curred.

Thus, finally, croup is to be explained as something inter
mediate between the inflammatory and spasmodic diseases
of the respiratory organs.

I consider the paroxysms as spasms, which are produced
by the influence of the croup-miasm on the nerves of the
neck, similarly to what we find occurring in the case of
typhus.

That croup, however, is due to a miasm, is indicated by
the following :

(a.) By the adynamic character of the reaction, as shown
by the small, weak, and quick pulse; the somnolence; the
contradictory nature of the symptoms, as shown by a cool,
pale, moist skin, with absence of thirst, in a disease so
severe and acute as this ; from the fact that the longer the
duration of the disease, the quicker become the movements
and the clearer the sensorium ; that sudden attacks of
laryngeal breathing occur in the midst of the most perfect
health ; from the livid redness and gradual oedema of the
parts predisposed to exudation ; that death occurs without
much, and frequently without any, exudation.

(b.) Epidemics are caused always by a miasm. Sporadic
croup, like sporadic typhus, is also a miasmatic disease.

From what has been said, it follows that croup is a mias-
matic disease, involving primarily the lymphatic glands of

aro

A few Particulars

[May,

the respiratory organs, and localizing its products on the
mucous membrane of such organs.

I may be permitted to add a few conclusions derived from
experience.

1. That there exist family predispositions to croup ; the
disease affects lymphatic children.

2. Croup results as little from laryngeal catarrh as typhus
from gastric fever. A catarrh may arouse, however, the
predisposition to the miasm.

3. Emetics arrest croup if administered at the time of
miasmatic infection ; but can this time be ascertained with
certainty?

4. There is no direct treatment of croup. We know
neither the nature of the miasm, nor have we a specific
antidote for it. The indirect method of cure consists in
depressing the increased activity of the lymphatic glands.
From the traditional treatment, with very rare exceptions,
I have seen not the least benefit.

5. Emetics, as avcII as tracheotomy, fulfil only vital indi-
cations.

0. Depletion has just as limited an application as in
typhus.

7. Cauterization can disturb the localization, and post-
pone, but cannot stop, the course of the disease.

8. In the milder forms of the disease, where the morbid
process becomes speedily exhausted, the miasm being less
concentrated, recovery may, but seldom does, take place.

9. As all miasmatic diseases may develop contagion,
children' should be kept from croup patients.

10. The fever is the only criterion of the course of the
disease. As long as the pulse does not return to its normal
standard, the prognosis is doubtful. Translated for the
American Medical Monthly, from Wiener Med. Wochensckri/%
No. 31, 1859.

[Note. Some errors, either of translation or typography,
have evidently crept into the above article ; we have cor-
rected one by conjecture, but must leave others as we find
them. Eds. Nashville Med. Record.

A few particulars respecting Woorara.

M. Bonvier, relying upon a work published by M. Rev-
noso, gave, at a late meeting of the Surgical Society of

Paris, the following
of woorara :-

particulars respecting the composition

18G0.] Respecting Woowra* 871

There is true and false woorara; the two are vrery differ-
ent, but extremely difficult to distinguish from each other.
The true woorara presents, moreover, several species. The
substance is, therefore, not always obtained of the same
strength ; it cornea from different countries, and is extracted

from one oy several plants, Which contain one identical
principle, the character oi' which is to cause death when
injected into the blood, and to be innocuous when taken
into the stomach.

There is, however, one sort oi" woorara which acts on the
gastric mucous membrane of certain animals, at given ages :
which circumstance would tend to show that much diner-
enee exists in some samples of woorara.

It is well known that it is not always prepared from the
same plants, nor from plants of the same nature. It has
even been shown by M. Chombrook, that one kind of
woorara is obtained from a great number of plants, almost
as great as the number of ingredients entering' into diascor-
dium or theriacum.

Amongst the plants used are some strychneae, but the
rest has not as yet been determined botanically. It is
doubtful whether snake poison is mixed with it.

Gunelli is the first who, in 1758, insisted upon the innoc-
uous nature of woorara when taken into the stomach.
Laeondamine and Humboldt corroborated his statements.
Men can eat with impunity animals killed by woorara.
Death by the poison occurs generally by paralysis of the
motor nerves.

It is of importance to try the woorara in various manners
before administering it to a patient, and to ascertain whether
it produces no poisonous effects when introduced into the
stomach, and also whether it paralyses motor nerves with-
out affecting the nerves of sensibility. These precautions
are indispensable, for there is a kind of woorara which may
kill by gastric absorption.

As to the occasional incflicacy of the poison when inocu-
lated, the experiment of M. Dequisc may be mentioned.
This surgeon had been given, by a traveller, a quiver full of
arrows, said to be poisoned with woorara. He found, how-
ever, on trying them upon a dog, that they produced no
effect. If we consider the woorara as an extract, such a
result need create no surprise, as extracts are very liable to
change.

S72 Leucocythcemia. [May,

Lencoeythcerma. [Translated for the Boston Medical and
Surgical Journal from Xo. 29 of the AUgemeine Wi
Zeitung, for 1858.] By B. Joy Jeffkibs, M. D.

Enlargement of the Spleen and Liver; Increase of the
number of White Corpuscles during Life.

Elizabeth Hallwachs, ret. 45, Catholic, midwife, from
G rinsing, mother of live children, (the youngest being now
18 months old) had always been healthy. In AngO
last year she was for the first time attacked with chills,
without being able to recall any exciting cause. Two days
later, at about the same hour, she had a similar attack.
Fourteen days afterwards, there was a recurrence of the
chills for eight days, in daily returning paroxysms.

The patient first noticed at this time, in the left hypo-
chondriac region, a tumor which was not painful, and of
considerable size (according to her statement about that of
the list). It was therefore of some size before discovered by
her.

Since January of this year the patient had had pain in
litis tumor, which had become as large as an infant's head,
and had lost, as she thought, its mobility.

During February and March, she was quite comfortable
for six Aveeks. But after this the chills returned with
greater frequency, and the pain in the tumor became more
Bevere, particularly after the fever turns ; so that, March
2'2d, she appeared as an out-door patient on Prof. Oppol-
zer's clinic. There was at this time a tumor that reached
inwards as far as the navel, and downwards to within three
inches of the symphysis pubis. It evidently belonged to the
spleen, and the patient was ordered quinine.

Since then, however, the chills and fever returned daily,
and were increasing in intensity and duration. The attacks
that at first only appeared once, now came thrice, and even
four limes during the day, and began to lose their typical
character. The patient had. at the same time, constant
diarrhoea, with pain at stool. She also lost her appetite,
and had a "bronchial catarrh." with purulent sputa.

She accordingly entered the Hospital April 1st, when her
condition was as follows:

Body of medium height; muscular system feebly devel-
oped; skin of a pale brown color: eyes sunken, sclerotica
not yellow, the vessels moderately injected ; forehead had
Lied "chloasma uterinum;" tongue dry, white coat
on its edges. The jugular veins strongly dilated with blood,

I860.] Li ucocythcemia.

and plainly undulating even during the interims
feVer; no murmur in them. Carotids strongly pulsating.
Glands of the throal and neck Blightly enlarged. !
ination of the chesl normal; the breasts still swollen and
hard (the patient had only a short time previously weaned
her child).

Examination of the chesl gave the following physical
signs:

[n the righl axiliary line, dullness from the eighth rib
downwards; in the mammillary line, from the sixth rib,
and in the parasternal line the same to the ensiform cartil-
age of the sternum. In the left parasternal line, dull
from the upper edge of the third down to the sixth rib. and
from here downwards tympanitic. In the mammillary and
axillary linos, dullness from the under edge of the seventh
rib downwards. Impulse of the heart between the fifth and
sixth ribs plainest in the parasternal line. Heart's sounds
normal : second sound over the pulmonary artery, not much
accentuated ; first sound over the aorta, dull : second, loud.
.Dullness overthe liverreaches in the mammillary line from
the sixth rib to an inch and a half below the edge of the
ribs: in the axillary line, it begins at the eightlr rib. In
the median line, the left lobe of the liver reaches from the
sixth rib to an inch below the xiphoid cartilage. Enlar
nient of the liver is therefore evident. Its right lobe extends
lower than the left. On the left, the dullness over the liver
is separated from that of the region under the ribs by a small
intervening tympanitic space. Percussion in the right
inguinal region, clear and full. Dullness from faecal ma
to a slight extent, over the crest of the ileum. Liver not
sensitive to pressure.

As was said above, the dullness begins on the left side at
the under edge of the seventh rib. This is also the upper
edge of the tumor now to be described. This tumor extends
furthest towards the right side below the navel, i. e., to the
outer edge of the right recti muscles. At the navel it pro-
jects an inch beyond the median line; above the navel, to
the median line ; five inches under the navel, one inch over
the median line. So that the tumor has a periphery convex
towards the right side. Posteriorly, it reaches to within
two inches of the vertebral column. Its inferior ed<re is
hounded in the iliac region by the crest of the ileum ; fur-
ther forwards by Poupart's ligament. In the median line,
it reaches to v " i an inch of the symphysis pubis. The
superior bore., of the tumor can only be determined by

374 Leucocythcemia. [M*y>

percussion; its other limits by palpitation also. Over the
tumor percussion is flat; on its edges, slightly resonant and
tympanitic; in the neighborhood clear and tympanitic. The
tumor is therefore surrounded with organs holding air. The
surface of the tumor is even, and its consistence hard and
uniform. The lower edge is blunt ; the right edge has six
perceptible notches, the deepest one (which is two inches)
lying under the navel. JTo perceptible fluctuation over the
tumor. Its elasticity but slight. The tumor can be moved
within certain limits from one side to the other, and also
upwards and downwards. Its position changes with that of
the patient. During inspiration, it falls somewhat lower.
In the region of the tumor, and especially towards its pos-
terior border, the patient has continuous, severe, burning,
and lancinating pains, even when she is quiet and has no
fever. Lying on the right side decidedly increases the pain.
The attacks of fever commence with coldness of the lower
extremities, creeping upwards as far as the arms, and then
changing to heat and burning thirst These now (at the
time of her reception) come on three or four times during
the day. At these times the pain greatly increases, especially
during the cold stage.

The inguinal glands are somewhat swollen. The pulse,
during the fever, 128 ; between times 84, soft and full.
Dejections, since a few days, normal. Secretion of urine
not altered. Urine of normal specific gravity, rich in uric
acid, and holding a trace of albumen. The digestion, during
the intermissions of the fever, not much disturbed.

An examination of the blood, taken by a local venesec-
tion, (ordered by Prof. Oppolzer on account of the enlarge-
ment of spleen and the fever) showed a relative increase of
the white corpuscles. On coagulating, the blood formed a
large white clot, under which were white granules the size
of a millet or hemp seed, round, and streaked in appear-
ance, composed, under the microscope, of white blood cor-
puscles rolled together. There was. in addition, also a
large red clot. \Ve had, dierefore, blood, leukemic to a
small degree.

The following comprise the data from Prof. Oppolzer for
the diagnosis of the case.

1. As regards the tumor in the left hypochondrium of the
patient, it answers to the greatly enlarged and hardened
spleen, which is shown by its position, its surroundings, the
percussion, its movement during inspiration, absence of fluc-
tuation, and the peculiar notches on its inner (anterior) edge.

I860.] /. ucocytha mia, 875

We have here, therefore, a splenic tumor, and. moreov< r,
that form which occurs with leukaemic blood\

The enlargemenl of the spleen in our case is a chronic
one, as shown by the duration of the disease, the --rent in-
crease of si/A1 of spleen, and, finally, the absence of any
injury, pyaemia, or inflammation in the heart, as primary
lesions.

Of chronic splenic tumors, are to be excluded the larda-
eeous {speckig) and colloid forms, such as accompany consti-
tutional syphilis, the mercurial cachexia, rachitis, scrofula,
. fee., and which are generally associated with colloid degen-
eration of the liver and kidneys or albuminuria.

The "pigment spleen," after intermittent, has as little
connection with B decided increase of the white corpuscles
as the lardaceous degeneration. This leukaemic condition
of the blood corresponds more to Yirchow's so called chronic
splenitis. Anatomically a "flesh spleen" (Fleischmilz),
a result of Virchow's "parenchymatous inflammation."
where the capsule is thickened, the trabecular tissue hyper-
trophied, the intervening pulp hard, the parenchyma-cells
in large numbers, and in many cases yellowish or reddish-
brown formations. In all probability we have such a tumor
as this in our case.

The question whether the leukemic splenitis is in fact
very different from the splenic tumor of intermittent (since
the clinical course of the two diseases are in many respects
similar), may be so answered. An increase of the white
corpuscles of the blood occurs in intermittent, and also in
typhus, pneumonia, during pregnancy, in the puerperal
state, in tuberculosis, with cancer, in anaemia and inanition.
But in these diseases the leukaemia is only small in amount,
disappears again, and the patients convalesce. If leukaemia
was identical with intermittent, patients with the latter,
living in the malarious regions, and having enormous en-
largement of the spleen, would exhibit a decided increase
of leukaemic blood and all the peculiar lienteric symptoms
of the disease.

Enlargement of the liver is very often associated with
chronic splenitis, and Virchow mentions having found white
corpuscles in the liver, wThich appeared precisely similar to
the corpuscles of the spleen. In our case, also, there is en-
largement of the liver.

2. The presence of leukemic blood must be proved, in
order to confirm \ diagnosis.

In the first plac . X is to be remembered that leukaemic

376 Lcucocythcemia. [May,

blood may be confounded with that of lipaenria, and, more-
over, tlic character of the blood corpuscles may be altered
by an increase of their coloring matter mdanoemia.

As regards lipaemia, the milk-white color of the serum of
the blood is here occasioned by its richness in fat. If we
shake up the serum with ether, the fat will be freed, which
will not, therefore, be the case when the white color is de-
pendent upon the presence of white corpuscles. Lipaemic
blood occurs especially in hard drinkers, in pregnant wo-
men, and those in the puerperal state.

Our patient's blood was not lipamiic, but leukemic. Its
redness was caused by there still being a large number of
red corpuscles present. (Their decrease is the principal
characteristic of leukaemia.) Purely white blood has only
been seen at post movtems / during life its color is generally
only somewhat brighter, like raspberry syrup, and in the
severest forms grayish red.

The diagnosis founded on the two points above men-
tioned w^as confirmed by the further progress of the disease,
as will be seen further on.

As regards the character and form of the disease, it must
be first said that the leukaemia is only to be considered a
symptom. In the beginning of chronic inflammation of the
spleen it is but slight, as was very markedly the case with
our patient. Virehow records several cases in which, in
spite of the size of the splenic tumor, there was at first no
leukaemia, and where it did not appear until after several
months.

Leukaemia is therefore a secondary appearance, that occurs
with splenic tumors, and (which was not previously men-
tioned) with diseases of the lymphatic glands.

In the four cases that Prof. Oppolzer has seen up to this
time, the lymphatic glandular system was but once the
starting point of the disease, in which case all the glands of
the body were considerably swollen, but also elastic, having
the feel of lipoma, particularly on the neck. These tumors
developed by sudden enlargements, without any particular
pain, and whilst the other functions of the body were nor-
mal, notwithstanding the paleness and emaciation. The
symptoms of leukaemia afterwards showed themselves in
their fullest extent, and the patient succumbed to the
disease.

Lately some cases have been seen, where cancer was
mentioned as the cause of leukaemia. In one of Heschl's
there was degeneration of the lymphatic glands, and in

I860.] /. ytheemia, 877

Borne other cases of English observers neither the spleen
nor the glands are said to have been affected.

Before Vlrchow introduced the leukaemia into Bciei

similar oases were explained as pyaemia. Neverthel
Bennett, who introduced the name of kukoeytficemia (which
has now, and, in fact, with better right, spread abroad as
potyleukocythsemia), has endeavored to defend his right of

priority.

No satisfactory explanation of leukaemia exists as yet, be-
cause the formation and degeneration of the blood corpus-
cles, and the part which the spleen and lymphatic glands

play in this, is not at all settled.

If we lay stress only on the increase of the white corpus-
cles, all attempts to explain the difficulty of breathing, the
loss of muscular power, in short the ehlorotic appearances,

are useless. The diminution of the red corpuscles must
also he explained, which has not yet been done by the
vaguest hypothesis, although the increase of the white cor-
puscles has been said to be caused by those in the spleen
passing into the stream of the blood.

The distinction that has been made between the white
corpuscles and pus corpuscles amounts to nothing, when
we remember that the size of cells suspended in a fluid de-
pends upon the density of that fluid, and that the (larger)
pus cells are floating in a thinner medium than the white
blood corpuscles ; and, moreover, that we have different for-
mative cells before us, which would, naturally in some
measure differ from each other in appearance.

The same applies to the corpuscles in the lymphatic
glands when compared with those in the spleen.

The viscid character of the corpuscles, and their rolling
and sticking together so easily, would explain why in leukae-
mia the capillaries are so readily plugged up and metastases
follow in the later stages of the clisease.

There is no ground here, however, for the theory of those
who would assume a plugging up of the capillaries of the
lungs with pus in pysemia.

As to the causes of leukaemia, there is but one thing yet
ascertained, namely, that in the cases that have occurred
with women there was derangement of the menstruation,
and that the disease was developed during the puerperal
state : as was also the case with our patient.

One of Prof. Oppolzer's cases was a day laborer, who
worked as a digger in a marshy place. Without having had
any intermittent, he suffered from a splenic tumor, dropsy,

378 Leucotyth&mict. [May,

and nasal haemorrhage, of which latter trouble he finally
died through anaemia. The other eases were of no particu-
lar etiological interest
Leukaemia has been seen at different periods of life, in

both sexes, and with various constitutions. Intermittent
fever is rarely a cause of the chronic splenitis in Virchow's
acceptation.

The appearances in the disease are not yet sufficiently
classified to establish its symptomatology. A variety of
symptoms have been ascribed, which in fact are really not
peculiar to it.

The color of the skin in most of the cases was pale, with
a shade of yellow, as there was generally enlargement of
the liver.

In all cases Prof. Oppolzer observed pain in the spleen,
with the exception of the leukemia above spoken of, which
was accompanied by affections of the lymphatic glands.
The pain came on at intervals, accompanying an increase
of the fever, as in our case.

The principal symptom is the fever, which has a typical
course, is accompanied with heat and chill, irregular in its
duration and times of returning, appears on an increase of
the pain, and is not generally much improved by quinine.
There is generally emaciation during the later stages. The
debility which is so constantly present, just as in chlorosis,
may depend, like the difficulty of breathing and the mental
depression, upon the diminution of the red corpuscles.

The augmented accumulation of white corpuscles may
cause in the later stages great difficulties in the circulation,
inflammation and metastases. Hence came the idea of re-
garding the disease as pyaemia. In this view the most
common occurrences are thrombus in the vessels, with
phlegmasia, bleeding from various membranes, particularly
of the nose, even to complete exhaustion, peritonitis, pneu-
monia (in one case of Prof. Oppolzer), formation of absces-
ses in the skin, furuncles, carbuncles, &e. Dropsy occa-
sionally occurs, but it seems generally to be produced by
the splenic tumor. It is by no means constant. Altera-
tions in the digestive tract are not very marked, or at least
do not seem to he immediately connected with the disease
in the blood. For example, when our patient was troubled
with diarrhoea, the leukaemia was certainly still very incon-
siderable. The urine held a good deal of the urates, and
afterwards free uric acid, which is especially connected with

18i)0.] Leucocythasmkt 87fl

the disease of the spleen, for this formation of uric acid
occurs also in intermittent fever.

The "key-stone," however, is generally the hectic fever,

with a fatal termination, or death is caused by one of the

above mentioned secondary appearances.

The prognosis is most unfavorable. At least no ease of
lienteric leukaemia has asyel been seen that was net fatal.
The other form has not been often enough observed to de-
cide this point as respects it, still the termination lias always
been fatal. Qurtreatment can therefore only be directed
to the symptoms, since we do not know the nature or ex-
citing cause of the disease.

The few therapeutical deductions from the previous cases
which are applicable to leukaemia, will be spoken of in their
application to our case.

The following* was the course of the disease with our pa-
tient :

When she entered the hospital, a few leeches were applied
over the spleen, without relieving the pain in the slightest.
Sulphate of quinine was ordered at the same time, also
without much effect, for on the 4th of April, when the
patient had already taken forty-two grains of quinine, the
attacks of fever were still very severe, and one that begun
at 3 o'clock, P. M., lasted till the next morning. The con-
dition of the patient, aside from the fever turns and pains
in the spleen, was satisfactory. The bronchial catarrh that
had for a long time troubled her, entirely disappeared, the
diarrhoea had yielded to treatment, and the appetite was
pretty good. The fever paroxysms and severe pain lasted
in spite of the quinine. The leeches and warm applications
were repeated, and continued up to the 9th.

Examination of the blood during this time, showed a con-
tinued increase of the white corpuscles.

On the 8th and 9th, the patient, under the use of quinine,
had no chills, but they returned on the 10th, and lasted an
hour and a half. On this day Fowler's solution was given,
in order to allay the feverish symptoms.

A physical examination, on the 19th, showed a new en-
largement of the spleen. The digestion still good, dejections
somewhat loose. Urine held urates, but not so much as at
the commencement. A trace of albumen was present* On
the 20th, the patient again had fever, from which she had
been free for two days. Resort was therefore again had to
quinine, and large doses of it finally prevented the parox-

380 Leucocythamia. [May,

ysms of fever from returning so often, and the pain was
entirely relieved for a time.

This relatively favorable condition lasted till the begin-
ning of May, when, without any apparent cause, the
paroxysms of fever returned with still severer pain. At the
same time the patient had oppression at the chest, diarrhoea,
and the dejections were mixed with mucus and epithelium.
The salicin, of which she took two scruples, had no effect.
( )n the 9th of May, leeches and quinine were again ordered.

( hi the 18th, after four days' relief, the patient was again
attacked with high lever and severe pain in the hypochon-
drium, and with this, headache, diarrhoea and strangury.
In the intermissions, pulse 100. Frictions of sjdritus saponatus
were used, and extract of Colombo, with tannin, given to
check the diarrhoea.

The patient went on in this way, her condition sometimes
made worse by the fever and pain in the spleen, the diar-
rhoea and loss of appetite, and sometimes better by the
remission of the fever, especially after the use of Peruvian
bark, which often was effectual for some time together.

On the 7th of July, the patient complained for the first
time of pain in the thighs. Coagulation of blood was dis-
covered partly in the deep and partly hi the superficial
veins, especially on the left leg. A hard cord was felt on
the inner side of the left thigh, and a reddened streak over
it. The same sort of cord was felt under Poupart's liga-
ment.

There was oedema in the neighborhood, and the skin was
red. These coagula corresponded to the saphena vein, but
as that alone would not explain the interruption to the cir-
culation, the crural vein must also have been affected. The
patient felt very weak, complained continually of severe
pain in the foot; the pulse was quick (120) and small ; and
the appetite quite gone. Cold applications of Goulard's
lotion were made to the foot, strong doses of morphia given
internally, and the leg raised.

On the 8th and 9th (July) this condition continued, the
oedema having somewhat decreased, however. Xo metas-
g to he found. Lately the urine lias held a great deal
of the urates. The blood has been comparatively richer in
white corpuscles. The sleep bad the pain insupportable.
The cold applications were continued, and also morphia, in
stronger doses (^ gr). This condition lasted, with slight
intermissions, till the 13th.

On the 13th, the patient looked cadaverous, was very

18G0.] Extroversion of the Bladder.

emaciated and extremely weak. Splenic tumor no1 very
sensitive. No chills. Less pain in foot. Less oedema.
The corded feeling of the vessels still perceptible. Pulse
frequent (100), intermitting, small. Metastases or bleeding
havenot occurred. Trine rich in urates, thick, cloudy, pale
brown. Lactucarium was given as a narcotic. Ai'tera
short agony, death followed on the evening of the 14th.
As regards the therepy, we may gather from the con
and progress of (lie disease, that of all the remedies used to
allay the lever and relieve the pain in the Bpleen, quinine
and cortex Peruvianas alone were of service, and only in
a certain degree. Narcotics, bleeding, &c, were in this
case almost o\' no service. Whether the use of the Carls
baths, Marien baths, or the waters of Kissing would be ad-
vantageous in the beginning of leuksemia, is doubtful.
Hardly any other opinion could be held respecting* the
effects ofmoxae, acupuncture and similar procedures in use
anions; the natives of the East.

Extract from the Records of the Boston Society for Medical Im-
provement By Fbancis Minot, M. D., Secretary.

Extroversion of (he Bladder. Dr. Jaekson reported the
case, which lie had recently seen, and which resembled es-
sentially, that of the man (Ilayden) who has so often exhib-
ited himself here, and whose condition lias been fully
described by Prof. L. A. Dugas, with general remarks upon
.extroversion, in the Southern Medical and Surgical Journal,
for April, 1840. The subject of the present case was a
healthy, intelligent Irish journeyman cabinet maker, from
Brooklyn, N". Y.; forty years of age, but looked ten years
younger. The mucous surface of the bladder was covered
to a considerable extent by a very thin cuticle. "No trace
of navel. Hernia on each side. Ends of pelvic bones in-
distinctly felt. Testicles in the scrotum. The glans penis
has a bilobed look, as usual; and being separated from the
bladder by slight pressure, as the man lay upon his back in
a strong sun-light, something like a caput gallinaginis could
be seen, with the openings of ducts upon each side. Frse-
lmiii well developed, and the prepuce in accordance with
the glans. The man says that, so far as he knows, his
sexual feelings are as strong as those of any man, that he
occasionally has a seminal discharge, and " can draw it."

382

Carbonate of Lithia in Gout.

[May,

Carbonate of Lithia in Gout.

Experience has taught that, in the great majority of cases,
new remedies fail to answer the expectations, not only of
those who first advocate their use, but still less of others
who have no personal interest in their success. Yet we
arc hound to lend an unprejudiced ear to any suggestion
which comes from one, whose name is associated with
honest and successful labor in the investigation of disease.

These considerations lead us to call attention to the use
of a new remedy proposed by Dr. Garrod, in his work on
Gout and Rheumatic Gout, a notice of which we find in the
Lancet for December 24, 1859. As the author's views of
the pathology of the disease have an important bearing
upon the treatment, we give some of them here. He says,
" there can be no doubt that the essential component in
gout deposits its urate of soda, which always assumes a crys-
talline form." This he considers a pathognomonic lesion,
as it is not noticed after rheumatic or any other inflamma-
tion, and was invariably found in the numerous examina-
tions of patients who had had the disease in all its forms.
In continuation, he says :

" Other matters are, indeed, often present, in varying
quantities, derived from the tissue in which the deposition
has taken place ; but the large amount of phosphate of lime
Avhich is occasionally met with, is probably derived from
secondary deposition, from the urate of soda acting as a
foreign body, and producing ordinary inflammation ; and
thus, as in the case of the formation of cretaceous tubercles
in the lungs and elsewhere, giving rise to phosphatic exuda-
tion, which must be regarded, not as related to the disease
as gout, but as the result of common inflammation only."

In connection with this, the results of Dr. Garrod's
analysis of the blood, as given by the reviewer, are inter-
esting, showing, as they do, that the

"Healthy blood contains the merest trace of uric acid or
acid of urea, so small as to be in general undiscoverable,
except by the most minute and searching chemical exami-
nation, and not always then.

"That, in gout, the blood is invariabty rich in uric acid,
which exists in the state of urate of soda, and can be sepa-
rated from it, either in the form of the crystalline salt in
acicular needles, or as rhombic crystals of uric acid.

"That, in acute rheumatism, the blood is free from uric
acid, or at least contains no more than in health.

1800.] Ootrbomte of IAtkia in Ghut. B88

"That the serum obtained by the action of an ordinary
blister yields uric acid when the blood is rich in this prin-
ciple, excepl when the blister is applied to a surface affected
with gouty inflammation.

"That the perspiration seldom contains uric acid; but
that, in gout, oxalate of Lime may be crystallized from it,
as also from the blood,"

"The urine," we are told, "in the earlier stages of gout
is scanty, and the uric acid, measured by the twenty-four
hours' excretion, also diminished; that this acid is thrown
put in much Larger quantities as the disease is passing off,
and that then amounts even far above the patient's daily
average may be excreted."

In the chronic stage, the quantity of uric acid excreted
becomes still smaller.

The treatment which the author considers the most advi-
sable, is the following:

"The diet should be very light, and chiefly amylaceous;
diluents freely used, but no alcoholic stimulants allowed,
unless in exceptional cases. The medicinal treatment should
consist in the administration of some simple alkaline saline,
combined with a moderate dose of colchicum; if necessary,
purgatives may be given, selected according to the habit
and condition of the patient. In the majority of cases, this
will be found to be all that is necessary; but in some in-
stances certain modifications may be essential ; for example,
if there be plethora, the question of the abstraction of a few
ounces of blood may possibly arise; and, on the other
hand, if the vital powers are at a low ebb, and great vascu-
lar and nervous depression exists, ammonia, in the form of
the sesquiearbonate, may be desirable, in addition to, or as
a substitute for, other salines ; at the same time, colchicum
should be altogether omitted, or used with the greatest
caution. The only application required, in the majority of
cases, is cotton wool covered lightly with oiled silk, which
forms a protection to the. joint; but now and then an ano-
dyne may be advantageously used, and a small blister is
occasionally of service."

In chronic forms of gout, Dr. Garrod considers that the
following are the indications necessary to be fulfilled:

"First, to treat the chronic forms of gout by less heroic
means than those employed in the acute disorder.

"Secondly, to render the blood pure by augmenting the
various secreting functions, more especially of the kidneys
and skin.

384 Stomatitis Maierna. [May,

"Thirdly, to restore the power of the digestive organs,
which are usually much impaired in chronic gout.

"Fourthly, to attend to the local mischief which the long-
continued gouty inflammation induces in the articular
structure.

"And, lastly, to carefully regulate the diet, and pay
proper attention to regimenal means."

In conclusion, he proposes, as a new remedy, the carbon-
ate of lithia, which possesses a very remarkable property,
"that of forming the most soluble salt of uric acid known."
As this is rare, we give the following facts concerning it,
for which we are indebted to Mr. Blackmore. Lithium
exists only in a few minerals, the most common of which
are spodumene, found at Killiney, near Dublin, Ireland,
and lepidolite, a Swedish mineral. This metalloid is white,
like sodium, and becomes oxidized immediately on expo-
sure to the air. The mineral waters of Pyrmont, in Ger-
many, contain, in 16 ounces, 0.0030 grains of carbonate of
lithia ; those of Mariensbad, 0.0675 in the same quantitv ;
those of Achen, 0.0006 : and those of Winterbach, 0.0030
of sulphate of lithia. These springs have, for many years,
been regarded as peculiarly efficacious in this class of
affections.

Stomatitis Matema. By L. S. Ellis, M. D., Chicago, 111.

This disease lias, of late, elicited much attention from the
medical profession. Its severity and obstinacy have been
not a little magnified ; its pathology pushed far into the
mysterious; its treatment as varied as speculation, and
speculation verged near upon absurdity. It has been rep-
resented as a new disease, which the oldest practitioners
"have never yet met with," and a recent writer "could not
find a single reference to this disease in any of the works of
Practice, or Special Diseases of Females."

P>r. Dunglison, in his Practice, printed in 1842, vol. 1, p.
31, says: "It is not common with us, but it is said to be
very often met with in moist countries, as in Holland, where
it reigns at times epidemically, and is a serious affection,
attacking adults, and child-bed females especially." Again,
on p. 32, "the author has observed some obstinate cases in
women who were nursing, the affection appearing to be in-
duced by the constant drain from the niother interfering
with nutrition."

I860.] natitis Materm.

in Bell & Stokes' Practice, 1845, I Bnd, "There isyel o
kind of sore mouth, which, as far as our presenl knowf

nds, is seen only in women during lactation." Vol. 1,
page

Dv. Wood gives the disease an extended review, a the
relative importance of the disease demands.

The medical literature of this malady is more abundant,
and in our country, extends back at least thirty .wars. I
have not ye1 Been any Buch evidence as to induce me to
believe that the disease is of modern date. Thegreal source
of modern improvement in medicine consist- Lore

accurate isolation and discrimination of particular disi
This accurate discrimination of disease alike tends to the
advancement of our profession, and to individual success.
In many cases whal were considered symptoms by old au-
thors, are now exalted into the ranks of distinct diseases.
Also, by reference to authors as old as Cullen, we find whole
groups of distinct diseases grouped under one head or class,
determined by locality. Tims, under the title of Hepatitis,
Cullen gives hut three pages to diseases of the liver. While
thus he makes no mention of such diseases as fatty deg<

or cyrrhosis, no one will claim that such maladies had
no existence in his time. I believe that wherever a like
combination of influences exists, there like consequences
will follow.

Views of the pathology of this disease are as adverse as
the localities of the authors. A recent writer says, " In all
these cases I have seen inflammation of the cervix uteri and
of the superior portion of the vagina." Another finds the
^a belli in "miasmata," in " biliary derangement," and
in 'Ithe influence of gestation and lactation." Another
dives deep into that medical arcana, the blood. That inner
temple of mysteries holds a wondrous amount of vagaries,
whose warrings, if visible, would reveal to us a terrible
pandemonium in that "liquid flesh" of our-.

The most positive testimony exists as to the unlimited
extent of the prevalence of the disease. Proof is as abun-
dant as of any disease whose history has been so rcce
written. None will doubt its existence in Illinois. Prof.
M. M. Pallen speaks of it in Missouri; Dr. Shanks in Ten-
nessee ; Dr. Brandon in Georgia ; Dr. Armor in Ohio : Dr.
Dunglison in Pennsylvania ; Dr. Backus in New York; Dr.
Hale in Massachusetts; Dr. Marshall Hall in England ; M.
Guersent in France and in Holland. Names could be cited
by score.-, showing that the disease is not confined to mala-

386 Stomatitis Materna. [^fay,

rious districts of our country. It occurs alike on the moun-
tains of Now England and New York, as well as on the
prairies of Illinois. It exists in England, where Dr. Watson
says, " Intermittent fever is known to us only in its group
of symptoms." Likewise on the continent its existence
with malaria exclusively is without proof. Before we accept
this dogma of its malarious relation, we ought certainly to
have some positive proof of its obeying malarial laws ; proof
that it occurs in greatest extent and severity at the same
seasons ; decreases in cities ; vanishes with the settlement
and cultivation of our country, instead of with the " early
health >i physical development of the daughter." On the con-
trary, I have observed it at all seasons, following not in the
channel or seasons of epidemic malaria, but after fortuitous
occurrences with those whose idiosyncracies predispose to it.
As before intimated, the blood has been obliged to assume
the burden and responsibility of this disease. As a scape-
goat of physical aberration, it has borne, not only the disease
in its obscurity, but its task-masters into still greater mys-
ticism. In this connection I cannot forbear quoting from a
recently promulgated theory, especially illuminating :

" Of its dependence upon the depravity of the blood, I
have no doubt. I consider the health of this vital fluid de-
pendent upon the harmonious action ot all the assimilative
organs of the body, and a due supply of pabulum of proper
blood food.

" If any one of the tissues fail to be nourished by an error
of nutrition, I think the elements of that tissue remain as
abnormal constituents of the blood ; and that the elimina-
tion of those particular elements by their natural elective
power, alone can render it normal for the production of the
other tissues.

''The development of hair upon the foetus in utero, is in
obedience, I think, with this general law. AVe know of no
other physiological utility, as it almost always, very soon
after birth, gives place to a reproduction. If its elementary
constituents are eliminated in the progress of foetal develop-
ment, that the blood, after this assimilation, might be in its
integrity for a second assimilation to nourish another tissue ;
and the" succession of these assimilations maintain not only
the proper constituents, but the constant normal catalysis of
the blood, then we see how necessary are the development
of all the uses in utero, as well as after birth. And the de-
velopment of rudimentary structures in the one sex when the

I860.] Stomatitis Materna. 887

requirements of organs are confined to the other^ as in case
of the mammary gland, etc."

To know what the above means, what are its relations to
Stomatitis Materna, and how it proves it a blood disease,
the inquirer must refer to Trans. 111. State Med. Society,
1859, p. 4:1, et. seq.

Is it "a blood disease?" [f so, where is the proof? Do
the speculations o( writers make any approximation to
proof? .Does the successful therapeutic management of the

disease, even by SUCh theorists themselves. afford any sup-
port to their theories? If any knowledge of practical value

i- to result from theory, it seems it ought, in sonic manner,
to be supported by microscopical investigations, corelative
symptoms, ami therapeutical applications. Dyspepsia may
l>e accompanied by a "paucity of blood corpuscles." Is it,
therefore, a blood disease ? Prolonged lactation will favor
'impoverishment of blood, impair nervous agency, and
derange the secretions." Is it a blood disease ? Why not
come to the obvious and palpable conclusion, that the
stomach is primarily at fault that the "impoverished
blood," the "deranged biliary secretions," the "constipated
bowels," the "irritated stomach," the "acid urine and
saliva," and the ulcerated tongue, are but symptoms of the
central derangement are but indices of impaired digestion,
not in the nursing woman alone, but in the dyspeptic man
and child.

In all eases falling under my notice, I have found evi-
dence of impaired function of the stomach. This will be
found a leading characteristic of the malady if attention is
directed to it. These functional derangements do not follow
as a sequence of the stomatitis, but are found to precede it
in many cases a long time. Women who have had this
disease many times, learn by experience to avoid indigesti-
ble substances, especially such as induce acidity of the
stomach. I have observed connected with this disease, loss
of appetite and taste, acidity of stomach, gastric uneasiness
after eating, constipation or diarrhoea, persistent or alterna-
ting, biliary derangement, &c. Following these as a se-
quence in long continued cases, comes in a long train of
"diminution of blood corpuscles," "anemia," "land
scurvy," " modification of condition of blood," &c., of va-
rious authors.

Eapid decay of the teeth is also apt to occur in this train
of symptoms; a circumstance I have always referred to the
acid secretion acting on the teeth. Herein is the explana-

388

Stomatitis Materna.

[May

tion of so many American women losing their teeth, espe-
cially in the first lactation. This seems to me to be as much
entitled to a place in the category of blood diseases as
Stomatitis Materna. If the above described condition of
the stomach continues unabated, the decay of the teeth is
almost sure to occur, more sure than the disease under con-
sideration.

I am not alone in this mention of gastric derangement.
Dr. Dunglison, in his Practice, vol. 1, p. 31, says : " This
form is accompanied by great cephalic, gastric, and general
disturbance, and at times the eruption appears to extend to
the intestinal canal, giving rise to severe pain in the abdo-
men, diarrhoea, and typhoid symptoms, under which the
patient may sink."

Dr. J. H. Hollister says : "In a great number of instances,
the disease has made its appearance as the immediate se-
quence of constipated bowels, and was relieved almost as
soon as the proper correction was made." Vide Trans. 111.
Med. Society, 1859, page 47.

Dr. D. S. Brandon, after enumerating the mouth symp-
toms, says: "To these may be added, burning in the
stomach, with occasional vomiting, constipation, or diar-
rhoea, more or less obstinate." Southern Med. k Surgical
Journal, Jan. 1860, p. 4.

I am now in attendance on Mrs. R., who is seven months
in pregnancy. She complains of acidity of stomach, and
evidences of gastric derangements, and the urine is so in-
tensely acid as to produce severe inflammation and excoria-
tion of the external parts. She has had Stomatitis Materna
during previous lactations, both here and in Central New
York. I look for the same, sequence after her confinement,
unless that condition of the stomach is relieved, but not
otherwise. In one of the worst cases I ever saw, Mrs. II.,
it always accompanied acidity and was readily relieved by
tonics and antacids. I could point to case after case pre-
senting the same association of symptoms, readily relieved
by remedies addressed to the stomach, so that I am accus-
tomed to direct my attention to that organ, and am not in-
clined to look upon the disease as so uncontrollable and
unpromising as many writers.

Much of our knowledge of the <-L>/r"r/cr of disease is
derived from observance of the effects of remedies. An
important hint, as to the pathology of this disease, may be
obtained by reviewing the various remedies proposed In-
different writers. Dr. Backus may have been hypothetical

I860.] S natitis Materna.

in his opinion of this malady, bul he certainly indicated a
principle in its treatment, the wisdom of which is eviden
by its general adoption. His prescription is as folio
]{ Carb. Ferri. - slv.

Pulv. Rhei. -

Gum Alois. - aa lit.-.

Pulv. [pecac. -

Sapo. Elisp. - - - - aa grs. xij.

M. Ft, Pill NTo. 50. -Two of$hese pills should be I
twice or three times a day or often enough to keep
bowels Vi /// open,"

Dr. Eale rests the cure chiefly on '-tonics, such as lime
water and infusion of bark." Dr. Wood says "'the mosl
efficient remedies are said to be tonics, antacids and li
lives." Dr. D. S. Brandon, in a paper before referred ;<>,
lands turpentine, combined with castor oil or laudanum,
according to the state of the bowels; "say twelve drops
three or four times a day, on a little loaf sugar, and i;
instance that I know, or have heard of, has it failed."

Dr. Armor proposes the syrup of hypophosphites, com-
bined with Sinie's Elixir of Peruvian Dark. It may he
surmised that the Elixir has as much, to do with the cure as
the hypophosphites.

I am accustomed to use the two following prescriptions
with uniform success:

HMag. Calc. 5i.

Sapo. Ilisp. pulv. - grs. x.

Camphor " -

Sang. Can. " aa grs. v.

Mix. Dose from three to five grains, four times daily.
1} Cinch. Rub. - - 5ss.

Ferri. Carb. Prace.

Rad. Rhei. aaoij.

Port Wine. .---- Oj.
Ft. Mist. Dose, table-spoonful with each meal.
When there is loss of appetite, I direct the tonic to he
taken half an hour before eating, and the powder soon after,
otherwise both are to be taken soon after eating. Li many
cases where there is not much constitutional debility, and
in the earlier stages I find the first prescription amply e
cient to control the disease.

Many local applications have been proposed; among
them nitrate of silver has received its due amount of la u
tion. I have so' i his used repeatedly, often with no
benefit, and at m . affording but temporary relief. With

390 Stomatitis Materna. [May,

correct views of the pathology of the disease, such an event
might he anticipated. When I hear of a physician using
this treatment, I am constrained to think he does not know
what he is dealing with that his opinion of the disease
does not extend any further than he can sec.

Very man}' writers and practitioners recommend, in severe
cases, the weaning of the child. 3Lj experience and observation
is such as to lead me to hesitate to recommend any such procedure.
It may be conservative to the mother's health, hut there is
a tender offspring, who claims our sympathy and consid-
eration as well as the mother. The chances of rearing
children throughout our land are few enough at best
small, indeed, in our cities and fearful to the child that is
weaned in the first weeks of its existence. A recommen-
dation to wean the child in such cases in our city, is hut a
warning to prepare its shroud. I scarcely know an instance
in this city where a child has survived the first two or three
years of its perils, when weaned as a cure of stomatitis. I
have seen mother's turn away from such counsel, and avow
their resolve to suffer on rather than expose their offspring
to such fearful odds. There may he, and indeed are, severe
cases when this procedure seems imperative. I speak only
against the indiscriminate recommendation of some practi-
tioners, believing that, with proper treatment, a vast ma-
jority of mothers will survive and preserve their offspring.

With the above digression, I return to the consideration
of the pathology of the disease.

Post mortem examinations of the disease are not abundant.
A few have been made. I take from a valuable contribu-
tion to the literature of this disease, the following appear-
ances, as described by Dr. McLean :

"The stomach was almost completely denuded of its
mucous coat, with numerous patches of ulceration extend-
ing deep into its muscular tissue. A small patch around
the pyloric orifice of the stomach. Avas the only healthy
portion." Trans. Ind. Med. Society, 1856.

Many writers have asserted positively that the disease
occurs only in females, chiefly during gestation and lacta-
tion. Others, on the other hand, declare as assuredly that
it occurs also in men, boys and girls. I can only add to the
strength of the latter position. I am certain I have seen it
in that class of persons with characteristics as prominent
and unmistakable as in nursing women. Its only difference
seemed to consist in les^ persistency, owing to a more ready
removal of the causes. I had abundant opportunity to ex-

I860.] Stomatitis Materna. 891

amine a case of the kind occurring to a gentleman ab<
thirty years of age. In this case the stomatitis occurred
several times, immediately after eating blackberries pre-
served in tin cans a long time. Each attack was ushered
in b\- the scalding sensation in the mouth, so into rise as to
cause severe suffering for several days, by vesicles with
inflamed bases, by corrugation of the m neons membrane on
the side of the tongue, Slight swelling and ulceration of the
mucous membrane. In this instance the primary effed
was obviously on thestomach. The stomatitis not following
immediately, the cause was not discovered till alter eating
several times.

It may be true that we do not meet with it in so >cywc a
degree as in nursing women. Such might l>e anticipated.
All know that pregnancy and lactation exert a powerful ami
modifying influence on the stomach, both in health and dis-
ease. But I think that here the nervous system is more the
medium for communicating sympathetic influence than the
blood.

"Its attacks are not confined to any particular constitu-
tion or temperament, but are at times made on the most
robust, who always enjoyed good health." Bell & Stokes,
vol. 1, page 53.

This accords with my observation and experience, but is
hardly consistent with the exclusive anocmic hypothesis of
some writers.

It does not come within the scope of my object to give a
detailed account of the local, mouth symptoms of this mal-
ady. They have been already sufficiently indicated in the
foregoing. My object has been to indicate a few points in
the history and character of this malady. If the position
assumed is correct, the mouth symptoms become compara-
tively unimportant to the practitioner. His remedies must
be directed to the stomach. My aim has been to substan-
tiate the following positions :

First That the history of the disease extends too far back
to entitle it to the claim of a new disease.

Second. That so far as known it occurs in all localities,
and is not limited to malarial districts.

Third. That the primary seat of the malady is in the
stomach, modified in the female by gestation and lactation,
and followed by constitutional aberration as scq/u/ices.

This is sustained, 1st, by correlative symptoms; 2d, by
therapeutical amplications; 3rd, by postmortem examina-
tions.

302 Atropia in Incontinence of Urine. [May,

Fourth. That nursing women are the chief sufferers, but
that it occurs in other class* a pf persons. Chicago Med. Jour.

Atropia in Incontinence of Urine. By A. F. Pattee, M. D.,
of West Amesbury, Mass.

After observing the effects of belladonna in incontinence
of urine, so highly spoken of by many writers in different
medical journals, the writer was induced to try the alkaloid
principle, Atropia, knowing that the effects produced upon
the system are exactly bh >se of belladonna, only that they
are relatively more powerful, while the extract and tincture
often require a much increased dose, and often fail to pro-
duce the desired effect.

The dose can be more easily managed, and danger from
poison avoided. It can be given in solution, with but little
observable taste, which is of much advantage when given to
children.

Before giving the Atropia, attention should be given to
the alimentary canal correcting all irregularities, so far as
possible. \\r e often find some tenderness of the spinous
processes of the dorsal and lumbar vertebrae, which should
be rubbed twice daily with some stimulating liniment. The
diet should be plain and unstimulating ; water or slippery-
elm bark tea for drink.

I have prescribed the Atropia in thirty cases, four of which
were of long standing, and had been under treatment for a
long time, a diversity of remedies having been used. All
were completely cured, in a period of from six to fifty
days.

The one-fortieth of a grain was given, three times a day,
to adults, in solution, until the usual symptoms of bella-
donna is produced that is, dilatation of the pupils and
dryness of the fauces. The solution can be made as fol-
lows:

J J Atropia, - gr. i.

Aqua Destill., - - - - g v.

Acetic Acid, - U'tt. vi.

M.

Dose : one drachm, three times a day morning, noon
and night increasing or decreasing as occasion may rc-
quire. For children, the dose must be graduated in pro-
portion to their ages.

I860.] Editorial.

EDITORIAL AND MISCELLANEOUS.

Cnori' am) its Treatment with Antiperiodic Doses of Quinine.
By Henry F. Campbell.

We can listen witli more complacency to a minute recital of all tho
horrible circumstances of a child's death by any accident, whether blown
up with gun-powder or mangled l>v a train of cars, than we can hear
the simple announcement, "a child has died of Croup." In the one,
a momentary pang- has probably extinguished life and suffering
together in the other, hours, days, sometimes weeks of agony, both
bodily and mental, foreshadow a death fully as unavoidable and not less
horrible, either to the little sufferer or its attendants. Few who have
watched a case of croup from its hopeless stages to its termination in
death, will dissent from the horror we here express, or will object to a
review of any method of treatment which promises the remotest hope of
averting the painful scene of a child's death-bed where croup is the
dread destroyer. It is, par excellence, the opprobrium of our profes-
sion, and since cure is so uncertain, in its latter stages, let us consider,
with at least patience, whatever of prevention can be suggested in its
insidious beginning.

Croup, as it has occurred under our observation in the Southern
country, we arc persuaded, has an obvious and important relation to
Malarial Fever. It is nearly always at first, a neurosis, manifesting
itself in paroxysms, by a series of symptoms, either of a spasmodic or
inflammatory character, while frequently, these two classes of symptoms
are intimately blended. Any case of spasmodic croup is liable to be-
come true membranous laryngitis, but membranous laryngitis is not
always preceded by spasmodic symptoms. These last are not frequent,
except from the extension of Diphtheritic inflammation from the fauces
down into the larynx, there establishing what we consider the most fatal
of all the varieties of croupal disease, for, besides the mechanical obstruc-
tion to the air-passages, there is a constitutional asthenia, a combination
which often strikes a chill of despair into the heart of the medical atten-
dant, long before the more notable aspects of the case portend a fatal
termination. Of these cases, we will present our notes on a future
occasion.

394 Editorial [May,

In cases where spasmodic croup becomes transformed into the mem-
branous form, the process is not an evenly progressive one, but the
course towards this more serious variety, is interrupted by remissions,
and often by the most decided intermissions, the respite often occupying
from twelve to twenty-four hours. This is especially the case in the be-
ginning of the disease, and this is the true, and indeed, often the only,
period for efficient medicatiou. A child is attacked suddenly in the
middle of the night with all the urgent and apparently dangerous symp-
toms of what is ordinarily called Spasmodic Croup ; an emetic, a cold
wet bandage to the throat, or some other favorite efficient means promptly
relieves the urgency of the attack, the breathing becomes free, but is still
somewhat hoarse, the child sleeps well, and wakes in the morning appa-
rently as well as ever there may be some hoarseness towards evening
of the next day, but the attack is over and the child considered well. At
night again, perhaps, a few hours before the time of the previous attack,
all the symptoms return there may be fever, but generally as yet there
is none the same remedies are again applied perhaps more active
treatment is resorted to, and the child is again relieved perhaps per-
manently, as very often occurs, we are free to admit but again, ])cr1iaps
not, and this last possibility should give every case of spasmodic croup
all its importance in the eyes of every practitioner. If the case is not
one which is to take the favorable course, the child will be fuiind hoarser
after the second attack than after the first ; this hoarseness will greatly
increase towards night, when again there will occur a paroxysm more
violent than ever, more difficult to relieve, and on the subsidancc of the
spasmodic symptoms, there will be found still remaining a difficulty in
respiration a persistant distress, indicating either thickening of the mu-
cous membrane, or the effusion of the material for false membrane.
That which was dynamic has now become organic -functional occlusion
of the air-passage from muscular spasmodic action has now become a
mechanical obstruction from an encroachment on, and diminution of,
the calibre of the air-tube. The chances may be said even now to have
nearly passed, for a hopeful prognosis the treatment, after this, is ad-
mitted on all hands to be inefficient, and the result uncertain.

It is not of the cases when they have arrived at this stage, that we
wTish now to speak. It is our object here to urge what we consider
almost a specific treatment, which is particularly applicable in the early
part of the disease, but by no means unimportant even later. We refer
to the administration of Quinine in efficient doses during the inter-
missions and remissions characterizing the initial stages of the
disease.

I860.] Editoiial.

'I'lio treatment of croup, then, like that of Intermittent fever, the
great archetype of all paroxysmal diseases, may be divided into- -1st,
measures appropriate daring the attack : and 2nd, those appropriate
during the intermission or remission. We consider the division just as
important here as in cases of true paroxysmal fever.

During bhe attack, we regard emetics of the first importance ; effi-
cient doses of ipecac we prefer to all others, but lobelia is valuable, and
frequently used by many. We deprecate the common domestic practice
of giving castor oil or lain]) oil, as one of tie* first expedients in croup
for though these remedies often effect relief, still, when they fail, their
action on the bowels often renders all attempts at producing emesis en-
tirely nugatory. We prefer, therefore, the administration of emetics as
the very first movement towards treatment.

Cloths wrung out in cold water we have found one of the most valua-
ble means during the attack. It seems to act often, immediately, in
relieving the stridulous breathing and allaying the distress. Among our
notes is a remarkable case occurring in the practice of Dr. Robert Camp-
bell, wherein this application was the pi incipal remedy used, and to it
the fortunate result of the paroxysm, was entirely due. Large doses
of Quinine were used in the intermission. When the emetic has acted
efficiently, and the paroxysm is somewhat relieved, there remains great
Jwarse)icss and a tendency to a return of spasmodic constriction. There
is often great dryness in the laryngeal respiration At this stage we
have found Turpentine a most valuable remedy, administered in the
following manner :

Rj. of Spts. of Turpentine, ... 5j.

Brown Sugar, - ss.

Water (warm), ------ gyj.

Mix well. Dose, one teaspoonful every hour or half hour, till the hoarse-
ness subsides, when the time of administration may be prolonged. The
use of turpentine should not be too long continued, on account of the un-
pleasant effect often produced by this remedy upon the urinary organs of
children We have found this one of the most valuable remedies during
the paroxysm, after the free use of ipecac. We nearly always follow
any other treatment of the paroxysm, by the use of turpentine.

Our treatment during the intermission or remission, though by far
the most important part, may be given in but a few words, for it may be
summed up in these two : Give Quinine.

It is our constant, we may say invariable practice, to administer effi-
cient doses of quinine each day, for two days, after each paroxysm of
Spasmodic Croup, with the view of preventing its return, and we expect

39G Editorial. [May,

this effect to follow its administration with as much certainty as when the
drug is given in true paroxysmal fever. The time we have found best
for the administration of Quinine is to begin in the earlier part of the
day, and to continue it in such quantities as to keep the patient fully
under its influence until the period of the next paroxysm. The quantity
of quinine usually given in cases of croup, between each paroxysm, va-
ries from v. to xv. -rains, (in divided doses) in accordance with the age
of the child and the seriousness of the previous attack. Any remaining
hoarseness which may exist at the time of beginning the use of quinine,
usually subsides under the continuance of the doses. A good rule as to
the amount to be given is, to continue the doses till quininism is mani-
fested by the " ringing in the ears."

It will be observed that we recommend the giving of Quinine in the
intermissions for two days; the object of this is, that its administration
may be adjusted to both the quotidian and the tertian type of the eroupa]
paroxysms. It is by no means uncommon to find that this measure of
antiperiodic treatment may fail on account of a miscalculation as to the
period for the return of the paroxysm. It is therefore safer to give
quinine two days where the paroxysms had been at all violent.

We have thus hastily presented our views on the importance of
Quinine in the treatment of the early stages of Croup. We daily read
essays on the subject of this fearful disease, in which there seems to be
no systematic or rational plan of treatment. The paroxysmal feature of
the affection seems to be often entirely overlooked, and quinine is but
seldom mentioned with confidence, as a remedy.* Our confidence in the
above reported method of treatment, is the well-founded conviction of
experience. The record of a detail of cases would occupy much space,
and could add nothing to the confidence of the reader.

It is by no means uncommon for croup to prevail in certain localities,
with a frequency of cases, (especially where there is a diphtheric ten-
dency) to entitle the affection to the character of an epidemic in such
circumstances, we would say, in conclusion, that the free administration
of Quinine, in the earlier period of the disease, would doubtless prevent
the advance of the affection to the membranous and fatal stages ; and,
under all circumstances, Quinine, in these earlier stages, should never
be omitted.

* The present number of this Journal will be found to contain a valuable
selected article on page 3G5, entitled " The Croup Process, by M. Forges. "

I860.] Editorial. 897

Effect of Caffeine on the Musculah System. By II. I'. Campbi ll
[8ee Artk&t XI <_/ preicni Number.]

There is but a single additional remark which we would desire to
make on the effect of Caffeine, as observed in the foregoing case. Mul-
der, as we have Been, gave this alkaloid to rabbits, and the animals
aborted on the second day after its administration : Albers, in cur series
of experiments on frogs, administered the agenl by the stomach, and in

another, introduced it into the tis8Uea beneath the cutaneous Mirtace the

effect in both instances, was to produce a tetanic condition of the mus-
cular system. In our patient, the muscular relaxation was extreme;

his head would fall from side to side, his tongue hung out of his mouth,
in the prone position, and fell back into the fauces, in the recumbent
posture; not a fibre in his entire muscular system seeming to possess its
normal tonicity. And yet, in less than an hour after the administration
of a very large portion of Caffeine by the rectum, all this had suddenly
disappeared, and he was in the exercise of the most active muscularity ;
pulling away from his attendants, pushing them from his bed-side, jump-
ing out of bed, and performing every variety of movements in the most
energetic and well co-ordinated manner. From this simple collocation
of the experimental facts of Mulder and Albers, and of the observed
facts presented by our case, there certainly appears to be a relation
between the phenomena of the one and those of the other, which has a
bearing on the muscular system. Caffeine, it would appear, then,
somewhat in the same manner as strychnine, may be regarded as one of
our most efficient agents for restoring muscular contractility, and for
reviving the tonicity of the muscular fibre.

The principal object of the present report, however, is only to extend
the results of the above remarkable case, wherein the antinarcotic effect
of the drug had been very apparent; and we therefore desire to dwell
no longer on incidental physiological phenomena.

The Chemist and Druggist. We have received, through the U. S.
Agent, Mr. Henricks, of NewT York, a specimen of the above monthly
circular. Each number contains a variety of interesting and useful in-
formation, pertaining more particularly to Chemistry and Pharmacy,
and is published in London, England. As a Trade-Circular, we regard
it a highly valuable publication, and take pleasure in commending it to
those who wish to become conversant with Chemical and Pharmaceutical
affairs as conducted in England and other European countries.

Communications arc requested to be addressed to " Mr. Henricks, 150
Broadway, New York."

398 Miscellaneous. [May,

Fluid Extract of Chamomile. The use of chamomile, not
only as an agent to improve the digestive functions when
disordered by disease, as an antiperiodie, and as a general
tonic, hut as an agent for preventing suppurations in phleg-
monous erysipelas, in phthisis, and, in fact, every case in
which it is desired to prevent too abundant suppuration,
suggested a concentrated preparation of it, in the form of a
fluid extract.

Take of fresh chamomile flowers, - - - 1 pound.
Alcohol of sp. gr. 871, - - - q. s.
Moisten the chamomile, in coarse powder, with the alcohol,
then pack in a percolator, and cover with the alcohol; digest
six days, and draw off twelve ounces, which set aside. Con-
tinue the displacement with diluted alcohol, until it is freely
exhausted of its bitterness, which evaporate in a vacuum to
four fluid ounces. Mix and filter. One drachm of this
preparation represents sixty grains of chamomile flowers,
which is usually given in doses of twenty grains, as a tonic,
to one drachm, as an antiperiodie making the dose for
like cases from twenty minims to one fluid drachm.

SYRUP OF CHAMOMILE.

Take of fluid extract of chamomile, - - - 4 ounces.

Syrup, - 12 "

Mix, with syrup moderately warm, and strain through flan-
nel. The preparation is as clear as that made from the
flowers, with the convenience of being made at will. The
dose is one fourth that of the fluid extract, or from two to
four drachms.

Iodide of Ammonia in Syphilis. As the result of several
trials made by M. Gamberini, of Bologna, it is stated 1.
That it is suitable in all cases in which iodide of potassium
and sodium are employed. 2. It leads to a rapid cure. 3.
The quantity given daily may be carried as high as from
half drachm to half ounce, and intolerance is rarely exhib-
ited. 4. Emplo3'ed in friction with olive oil, it causes the
disappearance of nocturnal syphilitic pains. 5. The signs
of intolerance are a sense of burning in the throat and heat
of the stomach ; these rapidly disappearing on the suspen-
sion of the medicine for a couple of days. 6. Under the
internal use of this medicine indurations consecutive to hard
chancre disappear, as do also the indurated ganglionic
pleiades in the groin. 7. Arthralgia, rheumatoid affections,
periostitis, enlarged glands, and papulo-vesicular syphilide
of the back, are the forms of syphilis which have best
yielded to this drug. Bull, de Thcrap.

I860.] Miscellaneous* 899

American Medical Society of Paris. It appeal's, from the
correspondence of the New York Times, mat this Associa-
tion recently attracted the attention of the Police by neglect-
ing to give the requisite notice, on a change in its place of
meeting: "For several months the meetings were held in
the new place, when it became necessary, for some inci-
dental affair, to hold communication with the Prefect of
Police. New men in the meantime had been placed at the
heads of bureaux men who had never heard of such a
Bociety; and societies, ever since the dangerous clubs of
1S4S. are the particular horror of the Police. The conse-
quence was that there was a greal r<>w at the Prefecture
about that very innocent institution. The first thing was
to order the Society to cease its meetings. The next thing
was to call the Commissary of the new district to account
for permitting a society to go on unnoticed in his district,
for he knew absolutely nothing of it, and had made no
report on the subject, lie came near losing his place by
his neglect. The President of the Society was called twice
to the Prefecture, where he was obliged to enter into end-
less details on the nature of the Society, the character of its
members, and the limits of the debates.

"A domiciliary visit was also made by a secret agent to
all the members that is to say, to their concierges. The
President, in his capacity of chief conspirator, was honored
with two visits. Questions wTere asked as to what sort of
individual each was, when he went out and came in, what
sort of company he kept, whether there were ever many
persons at one time in his room, &c. When the Society
resumed its sittings, a policeman was sent to attend the two
first meetings, to be able to report from sight that the So-
ciety was really what it purported to be, and that no politi-
cal discussions took place. He did not understand English,
but he expressed himself satisfied all the same ; and, with
mutual expressions of regret at what had occurred, the
affair terminated.

"Evidently the Society was to blame in not fulfilling a
simple requirement ot the lav/ a requirement which seems
indeed very simple and very insignificant, but which hap-
pens to concern a system so delicate and so complicated in
its structure, that, like a watch, the least jar throws it into
a terrible confusion."

The annual meeting of the Illinois State Medical Society
will take place on the third Tuesday of May, 1860

400

JL'sr, Uaneous.

Treatment of Obesity. Mr. Duchesne Duparcreada short

paper on the use of fucus vesiculosus for the treatment of
obesity. Having tried this plant for the cure of inveterate
psoriasis, the author came to the conclusion that its reputa-
tion for the removal of that disease was much superior to
its real value; but that in another respect the drug pro-
duced an unexpected result, focus vesiculosus inducing
rapid loss of flesh, without discomfort or disturbance of the
digestive functions. Mr. Duchesne related several ca
whence it appeal's that in persons affected with premature
or excessive obesity, the weight of the body may be much
reduced by the use of the leaves and stems of fucus vesicu-
losus, in decoction, powder, or pills. Champ. J

A New 3f< thod of applying Chloridi of Zinc. The fol-
lowing formula is recommended by Dr. G. W. Spence, of
England, for a chloride of zinc paste. Dissolve fifty grains of
prepared chalk in two drachms (by measure) of commercial
muriatic acid ; dissolve one hundred and fifty grains of sul-
phate of zinc in two fluid drachms of boiling water. "W lien
required for use, mix the two solutions, and the result will be
a paste weighing near an ounce, and containing about one-
sixth of pure chloride of zinc. London Lancet.

Mr. S. T. Trowbridge, of Decatur, 111., has invented a
physician's cane. It consists of a hollow tube, closed at its
bottom, and having a semi-tube attached to the knob or
handle, and fitted within the cane, and allowed to move
freely in and out of it, and forming a receptacle for vials
containing medicines. The invention is designed to super-
cede, to some degree, at least, the use of the saddle-bags.

HwmboldVs Library. We see it stated that Humboldt's
library has been purchased for 40,000 thalers by Lord
Bloomfield, minister of England at Berlin. It had pre-
viously been announced that the library had been purchased
by Mr. "Wright, the American Minister at Berlin. Med. fi
Surg. Reporter.

Only thirty-six colored children were born in the city of
Providence, Rhode Island, during the year 1859 and in
the month of January, of the present year, twelve colored
persons died.

The American Medical Association meets in Xew Haven
in June next.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(HEW SERIES.)

Win Al'iiUSTA. CEOEIilA, JUNE, 1SG0. NO. 6

ORIGINAL AND ECLECTIC.

ARTICLE XV.

The Endermic use of Animal Fat in Typhoid Fever. By
Paul DbLacy Baker, M. D., of Eufaula, Alabama.

It is a true philosophy which teaches ua to take truth
wherever it may be found. It is a philosophy, the object
ami tendency of which, is to render common things exten-
sively useful, and useful things extensively common ; and
which teaches the medical man that instead of saying and
doing things to make people stare and wonder, he should
endeavor rather, to say and do those things that will here-
after prevent them from wondering and staring. It is a
philosophy, the results of which prove that, in proportion
as we approach to science, we shall attain to simplicity.

Actuated and encouraged, then, by the motto, "Jeprends
le lien on je le trouve," I have determined to offer to the
Profession some observations relative to the therapeutical
value of the endermic application of animal fat, or oil, in
fevers, especially those of the typhoid type.

Aware that the best way to secure for any remedy the
consideration and confidence claimed for it, is to determine
and explain its mode of action, my object will be to demon-
strate that the value of the one I now propose, is of a two-
fold nature. First, by acting, during its application, both
by reason of its specific property and the friction emploved.
26

402

Baker. The End, rmic use of

[June,

as a topical diaphoretic, softening and relaxing the skin,
exciting to action its secretory organs, and thereby restoring
its often greatly impeded, if not wholly suppressed, impor-
tant exhalent function. Secondly, having been absorbed
from the skin into the system, it goes directly to the nour-
ishment of the nervous tissue, and, also in a general way,
exerts an eutrophic effect during the progress of the fever, by
serving as fuel for its consuming fires, and thereby prevent-
ing the too rapid interstitial chemical change progressing
under such circumstances, so destroying the tissues, so
weakening and impoverishing the vital powers, that finally
the entire organism gradually fails, and at last succumbs,
an unresisting victim, to the incessant and insatiable rav-
ages of a continued fever.

The explorer in the field of pathology or therapeutics,
without the aid and guidance afforded by a knowledge of
physiology, is like the voyager at sea without the compass
to direct his way ; therefore, in the attempt to show the
importance of the indications claimed to be fulfilled by the
remedy which is proposed, and in the effort to prove its
modus operandi in meeting them, I will be compelled to draw
largely from the treasury of physiological knowledge, which,
at the present day, gives so much certainty, value and power
to the science of medicine.

It is claimed, first, that the endermic application of fat, or
animal oil, is beneficial in fever, by restoring the often
greatly interrupted and important function of the skin, and
keeping it in that soft, moist and pliant state peculiar to
health. Now, without supposing, by any means, that an
interruption of the transpiratory function of the skin is
often a cause of fever, and having, as a general thing, very
little faith in the efficacy of the ordinary diaphoretic agents
of the Materia Medica, it would, nevertheless, be absurd to
deny that, in the progress of fever, the function of the skin
is often greatly interrupted, if not occasionally, wholly ar-
rested, and that this consequent interruption often seriously
aggravates the disturbing cause and greatly embarrasses

I860.] Animal Fat in Typhoid Fever. 108

the treatment ; and that therefore a restoration of tins runc-
tion is often an important indication to be fulfilled.

In order to ascertain satisfactorily the desirables
preserving the function of the cutaneous Burface in the

treatment of disease, it will be necessary to inquire what
the objects of that function arc1, and the means by which
th->se objects are carried out With a view to this end, let
it be considered what an extensive excreting apparatus is

formed by the aggregation of the cutaneous glandulse.
According to Erasmus Wilson, each glandule is formed by

the convolutions of a single tube, which, when straightened
out, is about a quarter of an inch in length, the average
number of pores in each square inch throughout the body,
is about 2,800 the number of square inches of surface, in
a man of medium stature, is about 2,500 ; this gives seven
millions as the whole number of pores, and, therefore,
1,750,000 inches of perspiratory tubing, which is 145,833
feet, or 48,600 yards, or nearly 28 miles ! This extensive
system of glandulae subserves manifold and important pur-
poses. It helps to regulate the temperature of the animal
body; it acts vicariously with the urinary secretion when
that apparatus is at fault ; it assists in aerating the blood,
and at the same time, in eliminating from it carbonic acid;*
and, in addition, is also continually throwing off a large
amount of effete matter, and thus preventing an accumula-
tion of morbific materials in the blood. Hence, it is claimed

Experiments leave no doubt but that such a process is effected, to a certain
extent, through the medium of the cutaneous surface ; for example, when a limb
has been enclosed for some hours in an air-tight vessel containing atmospheric
air freed from carbonic acid, a sensible amount of that gas is found to have been
generated. Moreover, the livid hue of the surface resulting from asphixia, has
been observed to give place after death to the fresh color of health upon free
exposure of the body to the air, owing to the interchange of gases between the
air and the blood through the skin. It is. therefore, by no means improbable
that when, from any cause, the function of the lungs is impeded, the introduc-
tion of oxygen and the exhalation of carbonic acid through the skin undergoes
considerable increase. We therefore recognize the importance of such a vica-
rious action on the part of the skin in those diseases where there exists a rapid
circulation with imperfectly performed respiration, producing, of coarse, an
undue and injurious accumulation of carbonic acid within the system. Such a
condition is frequently observed in pneumonia, and in those cases of scarlet
fever in which, from the swelling of the cervical glands, respiration is greatly
obstructed.

[04

I ak j:i\. Thi Endem

[June,

that in the treatment of fevers, attention to the function of
the skin is a matter of great importance, for, in its healthy
action, we have a vast channel for the elimination from the
blood of the materies m"rh>. But, does experience and obser-
vation justify these views? The statement here of a few
well known facts will, it is thought, prove that they do. It
has been ascertained, by reliable and scientific observation,
that persons who have been constant!}-, day and night, ex-
posed to that morbific influence of the atmosphere existing
<luring an epidemic of yellow fever, but who have kept
their skins constantly bathed in perspiration by the employ-
ment of the most active and stimulating sudorifics, have
either entirely escaped the disease, or taken it at a late
period of the epidemic, in its mildest form.

In scarlet fever, a disease affecting at once the entire sur-
face of the skin, we have, in the anasarca, so frequently
occurring during the stage of desquamation, when the
function of the skin is most interfered with, strikingly man-
ifested the injurious consequences of such an interruption.

Again, in the operations of Nature, from the observation
of which so much may be learned, it is found that a copious
perspiration is frequently used for the purpose of removing
the cause of the malady from the blood, thereby becoming
the turning point or crisis of the disease. Thus, certain
forms of rheumatism are characterized by copious acid per-
spirations, and these should doubtless be encouraged as a
means of freeing from the blood the morbific matter, in the
form of an undue accumulation of lactic acid. Upon such
principles undoubtedly depends, to a great degree, the
benefit resulting from the employment of the wet sheet as
used by the Hydropathists, and which is one of the most
powerful of all diaphoretics. Finally, laying aside all these
facts, the vital importance of the cutaneous function is
proven conclusively by the fact that, if in health, the exha-
lent action of the skin be completely checked by the appli-
;i of an impermeable varnish, death ensues in a short

time.
I have been induced thus to dwell upon the philosophy

I860.] Animal Fat in Typhoid Fever, 105

of the cutaneous function, and the Importance of maintain-
ing it if possible, intact, in the treatment of febrile disea
from the fad that a late and standard writer upon thera
peutics, in his essay upon diaphoretics, lias, I think, much
underrated the importance of the function, the evil conse-
quences of its interruption, the necessity for its restoration,
and the value of the means employed for that purpose.

Having, I trust, succeeded by the collocation of the fore-
ffOinff tacts and circumstances, in showing that it is an im-
portant item in the treatment of disease, to keep in its
normal activity the eliminating function of the skin, and that
any therapeutical means capable of accomplishing this end,
is valuable, and entitled to confidence, I come again to
reiterate that T have uniformly found such a means in the
endermic application of animal fat.*

I have for the past five years employed it in all ca
where there existed a harsh and dry skin, with the unfail-
ing effect of rendering it soft and pliant, just as it would
an old piece of indurated leather. In scarlet fever, its ap-
plication is especially indicated, both during the height of
the fever, and in the subsequent stage of desquamation. I
have found nothing so beneficial in softening the skin and
soothing the irritation during the eruption ; and I have also
ascertained that its continued application during the period
of convalescence, combined with the occasional use of the
warm bath, tends, almost certainly, to prevent the subse-
quent and so much dreaded dropsical effusion.

* I will here state, that this method of softening the skin and restoring its
healthy function, was first suggested to me in 1854, then just entering the prac-
tice, by Dr. E. L. Antony, of Waynesboro', Ga. I was at the time suffering
from an attack of typhoid fever, with Dr. A- in attendance. He then declared
inunction to be the best, and most reliable of all diaphoretics, and during the
progress of the disease, had it practiced upon my skin to the extent of three
pints of olive oil. He, however, at the time expressed his preference for an ani-
mal fat in the shape of a "bacon rind," referring its more efficient action *
fact of its containing salt. I have though, since, by observation and experiment,
been taught that the bacon riud is preferable because it is an animal fat, and
that the great benefit derived from its endermic use is attributable but in a small
degree to its diaphoretic effects, compared with its vastly more important env
trophic property, and that the reason why, in this connection, animal fai
preferable to vegetable oils, is that the former are much more easily assimilated
to the wants of the system.

40(3 Baker. The Endermic use of [June,

In that dry, hot and husky condition of the skin so often
observed during the first two weeks of typhoid fever, when
the hand may be held in contact, for any length of time,
with the patient's skin, without producing the slightest
moisture, or changing in the least its dry and harsh state,
inunction produces the most happy effect; the hot, dry,
shriveled and harsh skin becoming cool, moist, smooth and
pliant.

I come now to my second proposition relative to the en-
dermic application of animal flit in fever, that which is by
far its most important effect, and which is, indeed, the
prime object of this communication, namely, that fat, or
animal oil, having been introduced into the system by
absorption from the skin, acts as a direct nourishment to
the nervous tissue, and also by supplying material for com-
bustion, prevents that destruction of tissues which other-
wise would of necessity result in the course of a continued
fever, or even, in health, without sufficient nourishment to
supply the constant waste going on in the animal economy.
I propose now to prove the practicability of the theory con-
tained in this proposition, both by the evidences of obser-
vation and experiment, and by the corroboration of many
well known facts and physiological truths.

To the satisfactory and successful accomplishment of this
end, it will be necessary, first, to inquire into the nature
and uses of the adipose tissue of the animal body, as well
as of the fatty matters found in the circulating current.
Physiology teaches that the adipose tissue is composed of
colls which possess the power of appropriating fatty matter
from the blood in the same manner in which the cells of
other secreting apparatuses appropriate the elements neces-
sary to the formation of the secretion they are destined to
elaborate, and that each fatty mass must be regarded in the
light of a gland, or, at least, an assemblage of secreting cells,
which, however, in consequence of certain provisions exist-
ing in the peculiarity of their structure, retain, under nor-
mal states of the system, their contents without the least

I860.] Animal Fat in lyphoid Fevet. 107

change or transudation for an unlimited period. We are
also taught, that ii is no1 requisite to suppose that animals

usually elaborate tatty matters from the elements of their
ordinary food, but that the formation of adipose tissue de-
pends directly upon the amount of fatty matter contained
in the ingesta. There is, however, evidence that when
there is an unusual deficiency of this material in their ali-
ment, animals may produce it, by a process of chemical
transformation, from the starch and sugar of their food ;
under these circumstances, however, the supply thus elabo-
rated from such substances does not go to the formation of
adipose tissue, since it exists only in such quantities that it
cannot be spared by the circulating fluid from the immediate
purposes to which it is to he applied. This unusual and
extraordinary capacity tends, in the most forcible manner,
to show of what vital importance is the existence of fatty
matter in the blood.

As to the uses of the adipose tissue in the body, physiol-
ogy teaches that it subserves several distinct purposes. In
this communication, however, it is only requisite to notice
its most important use, namely, of serving as a reservoir, if
not of nutritious material, at least of combustible matter, at
the expense of which, respiration and animal heat are
maintained; and all the vital functions of the body thereby
preserved and continued, when the ordinary materials sub-
serving these purposes are deficient, or altogether wanting.
In support of this view may be adduced many circumstances
and observations bearing directly upon it. For example,
in hybernating animals, we find that there takes place in
autumn a great accumulation of fat within their bodies, and
that from the consumption of this store of fat, the vital
properties of the tissues are maintained during the period
of inactivity, when the}' cease taking food. This is evident
from the fact, that when the season is over, they emerge
from their recesses healthy, and only exhibiting such a de-
gree of emaciation as shows that the supply of fat has been
consumed in the vital process. It is also a fact, that those
herbivorous animals, whose supply of food through the

408 Baker. The Bndermic use of [June,

winter is scant, manifest a strong tendency, in the latter
part of summer, to the accumulation of fat, Finally, all
circumstances being equal, it is a fact, that the length of
time which a warm-blooded animal can live without food,
depends upon the supply of fat laid up within its body.

The accomplishment of the vital purposes thus subserved
by the fat within animal bodies, is usually attributed,
mainly, if not solely, to the fact that it is, as it were, a
reservoir of combustible matter, supplying the carbon,
which by union with the oxygen, introduced by means of
respiration, evolves and maintains animal heat. There can
be no question but that this is one of the chief uses of the
fatty tissue, and that animal heat is evolved, in a great
measure, at its expense ; but, it is also highly probable, if
not equally certain, that it performs other vital offices
equally important. Mr. Carpenter, it is true, says: " There
is no sufficient reason to believe that iatty matter can be
converted, within the animal body, into a proteine com-
pound, which can serve for the nutrition of muscular or
other tissues." Now7, it may be probable that it never is
converted into a proteine compound, that is, an albuminous,
azotized material ; but, there are unmistakable evidences
that it is, nevertheless, an element of nutrition, and does go
to the sustenance, if not of muscular, at least, of other tis-
sues. Indeed, Mr. Carpenter, himself, acknowledges as
much; for, in speaking of the "Nature and objects of the
circulation of nutrient fluid," he says: "That it (the circu-
lation) furnishes all the tissues which are to derive nutri-
ment from the blood, with a constantly renewed supply of
the materials which they severally require ; * * * that
the different materials are drawn from the blood by the
several tissues it supplies. Thus the nutrition of muscle
requires fibrine, that of the nerve requires fatty matter"* &c.
Again, in speaking of the uses of the several constituents
of the blood, he says: "There is reason to believe that
oleaginous matter performs a most important part in the

* The italics my own.

I860.] AnimalFatin Tk/phoid Fcvqr. 109

incipient stages of animal nutrition, and that its presence ia
not loss essentia] to the formation of cells, than is that of
the albuminous matter which tonus their chief component,
ill nuclei being observed to include fatty particles;" Mr.
Carpenter does not say, however, why it may not be just as
important in the subsequent, as in the "incipient," Bta
of animal nutrition, thereby differing from all the other
components of the nutritive fluid.

Muller says " Fat may be regarded as a deposit of nutri-
kriment, which, during fasting and during wasting of the
body, enters the circulation, and is applied to the formation
of other organic compounds." One of the strongest evi-
dences that fat is necessary to the process of nutrition, is
its invariable presence in the chyle and blood. In addition
to this significant fact, it is found that the chyle, when ex-
amined near its entrance into the receptaculum chyli, pre-
sents very different characters, from that first absorbed by
the lacteals ; in the latter, the fluid contains albumen and
a large proportion of oily matter, without fibrinc ; while in
the former, fibrine begins to manifest itself in the coagula-
bility of the fluid, while the quantity of albumen and oil
globules is observed greatly to have diminished; proving,
very conclusively, that during the passage of the chyle in
the lacteals through the mesinteric glands, these substances
have in a great measure been consumed in the elaboration
of fibrine, the most vitalized material of the blood and the
most completely prepared for organization, supplying, as it
does, the larger portion of the solid tissues of the animal
body.

Many remarkable facts might be adduced to support the
belief that fatty matters are important to the assimilative
process. That it is in some way intimately connected with
that of nutrition, is evidenced by the following facts. It is
always present in considerable amount in newly formed
organized fabrics. It is a universal constituent of the nuclei
of cells, both animal and vegetable. It is always largely
present in embriotic structures. The plastic exudations of
blood contain more fat than the non-plastic. Farther proof

410 Baker. The JSndermic ttse of [Juno,

is afforded by the fact that the secretion of milk contains a
very large proportion of fatty matter, and that while the
fluid goes to the maintainance and development of the off-
spring, the mother, on the contrary, is observed to become

lean by reason of the consumption of the fat within her
body by the milk secreting process.

Besides these evidences of the important part subserved
by the fatty matters in the general nutritive process, there
exists strong reasons for supposing it especially and abso-
lutely requisite to the nutrition and maintenance of the
nervous tissue. Upon analysis, one-third of the solid portion
of this tissue is found to consist of fat, and while it is
ascertained that the walls of the nerve cells and nerve tubes
are composed chiefly of albuminous matter, the contents of
these cells and tubes consist entirely of the phosphorized
fats ; and Mr Carpenter says, that these are the active agents
in the operations of the nervous system. If, then, it be
true, that fat does go to the nutrition of the nervous tissue,
we see at once the imperative necessity o its constant sup-
ply, in the fact that it, more than any other tissue, is con-
stantly undergoing decay and renewal, because, being the
great superintending agent of all the operations of the
entire organism, its life must be one of unceasing activity ;
and it is known that the disintegration of all the tissues is in
direct proportion to the activity of their operations. If, then,
the waste of the nervous tissue is in proportion to its exer-
cise, its reparation must make a corresponding demand
upon the nutritive process in order to maintain the system
in a state capable of discharging its all-important function.

The uses of the fatty tissue having thus been considered,
it remains now to be ascertained whether it is practicable
to supply it to the wants of the system by inunction, when
there is a deficiency of it within the animal body. Here,
again, physiology teaches that the mucous membrane of the
alimentary canal is not the only channel through which
nutritive substances may be introduced into the circulating
current ; and though, in the higher animals, the cutaneous

I860.] Animal Fat in Typhoid Fever. II l

function must be regarded one, more of exhalation than ab-
sorption, yet, when the system has been drained by the
consumption of its store and a diminution of the regular
supply, the imbibition of nutritive fluids through the skin
occurs very vigorously. Many direct experiments have
ftnquestionably established the fad that nutritious materials
may be thus introduced into the circulation; and recently,
the experiments instituted both upon man and the lower
animals, with die endermic application of the different fish
and animal oils, leaves no soft of room Cor doubt; the
nutritive effects when used in this way, being identical with
those resulting from the internal administration of those
materials.

Here, the question might be asked, " how is it possible
that fat, alone, afforded to the system in any way, could
nourish the body while no aliment was being taken by the
stomach ?"

The subjoined extract from Carpenter's Physiology, tends
satisfactorily to answer this question by conclusively show-
ing, at least to a certain extent, whence originates the ben-
efit of the endermic application of fat when the required
amount of aliment is deficient from any cause. In his
chapter upon "Absorption from the body in general," in
speaking of the nature of lymph and the function of lym-
phatics, he says: "It seems not improbable that there may
he another source for the contents of the lymphatics. We
have already had to allude, on several occasions, to the dis-
integration which is Continually taking place within the
living body; whether as the result of the limited duration
of the life of its component parts, or as a consequence of
the decomposing action of oxygen. Now, the death of the
tissues, by no means, involves their immediate and com-
plete destruction; and there seems no more reason why an
animal should not derive support from its own dead parts
than from the dead body of another individual. Whilst,
therefore, the matters which have undergone too complete
a disintegration to be again employed as nutrient material,
is carried off by the excreting process, that portion which is

II- Baker. 7V,. Endermic use of [Juno,

capable of being again assimilated may be taken up by the
lymphatic system, [f this be the case, we may say, with

I))'. Prout, thai ka sort of digestion is carried on in all parts
of the body.' It may be stated, then, as a general proposi-
tion, that the function of the absorbent system is to take
up and convey into the circulating apparatus such sub-
stances as are capable of appropriation to the nutritive pro-
cess, whether these substances be directly furnished by the
external world, or be derived from the disintegration of the
organism itself."

Now, when it is remembered, that the chief difference
between lymph and chyle is the presence in the latter of a
considerable quantity of fatty matter, chemical analysis
showing that there is an almost entire absence of fat in the
former, we observe at once the necessity of supplying fatty
materials in the "sort of digestion" above alluded to,
when from any cause there is a deficiency of nutritive ab-
sorption by the lacteals from the alimentary canal.

We thus have seen how it is that an animal may Bub
for a limited period upon the disintegration of its own tis-
sues, and we also have seen how that period may be
lengthened out to the longest possible duration, by supply-
ing to this process of nutritive absorption the material which
alone it is deficient in, and which goes directly to the sus-
tenance of the nervous system, whose influence is, as it were,
the very steam which propels the wonderfully wrought
engine of animal life ; and when, from a deficiency of ma-
terial, its power ceases to be generated, the machinery of
that engine must stop, and life must pass away.

Thus it is, that, in the course of a long continued fever,
when the patient is taking no adequate amount of nourish-
ment, and when the supply of fat is being rapidly, if not
already completely, exhausted, the nervous system begins
manifestly to Hag. and its operations to be completely
deranged, tor the reason that the tissue is no longer sus-
tained in a condition requisite for the discharge of its super-
intending function.

18G0.] Animal Fat in Typhoid Fever. 418

WTiethcr the foregoing attempl to explain why the ender-
mic application of fat is beneficial in wasting of the body,
bo correct or not, docs not, in tho least, affect the existence

of the truth that it is advantageous. With me, the idea of

<

its pMcl effects did not originate in the theory of its action
herein set forth; on the contrary, tho facts long observed,

load mc to the investigation of why it was so.

The reason why I havq recommended animal fat in
typhoid fever, originates in no idea of its exclusive adapted-

ness to that disease. Its ^ood effects, when thus applied,
are equally manifest in many other wasting and long- con-
tinued diseases; and here, in passing, I will say, that it is
especially advantageous in the Tabes Mesenterica occurring
in the second year of infancy. In such eases, the endermic
application of cod-Jiver oil affords more promise of success
than all other medication combined. Indeed, what medical
practitioner in the Southern country lias not heard the old
nurses on plantations, boasting of the cures they have
worked by "washing" some little weak-necked, scrawny-
limbed, big-bellied infant in "pot-liquor!"

I have recommended the endermic supply of fat to the
wants of the system in typhoid fever from several consid-
erations. First, there is always little inclination, and often
great repugnance, on the part of the patient, to take any
nourishment at all. Secondly, the hurried respiration and
rapid circulation, in all fevers, too quickly consume the
store of fat previously laid up within the body, wasting that
portion which, under more normal states of the system
would, in time of need, have gone to the sustenance of those
parts, in the nutrition of which, fat is absolutely required.
Thirdly, besides this waste, common in all fevers, typhoid
fever is a long continued and exhausting disease, especially
affecting the nervous system, and that portion of it, too,
presiding over secretion and nutrition. The system, even
in health, is unceasingly active, and consequently, constantly
wasting, both of which processes are correspondingly in-
creased during the exaltation occurring in fever; therefore,

414 Baker. Animal Fat in Typhoid Fever. [June,

is its nourishment and maintenance continually and ur-
gently demanded. Fourthly, this urgent demand and
absolute necessity, is so often overlooked or neglected by
the patient;, his friends and physician, that I am firmly
persuaded that a vast per cent of fatal eases, occurring in
typhoid i'cvvr, results from actual starvation; OF course,
leaving out of the estimate, the victims of the medical treat-
ment of those who attempt to "break the fever," either
from ignorance of the nature of the disease, or from an
overweening confidence in themselves, associated with the
idea that it would be incompatible with a doctor's business
and intelligence not to be drugging his patient ; or, as is
often the case, from timidly yielding to the entreaties and
suggestions of friends "to do something;" through fear of
being considered nonplused, and discharged from the case,
or, at least, of having consultation advised. Fifthly, the
endermic application of fat is a more certain and speedy
way of introducing the material into the circulation, its
internal administration being often contraindicated by the
fastidiousness of the stomach and the impaired function of
.the intestinal canal. Sixthly, because, in the management
of a case of typhoid fever, it is our business to keep alive our
'patient and let him get well, and I know of no surer plan of
doing so, than by administering turpentine internally ; or,
what is better, combined with the fat or oil, and introduced
endermically. By liberally supplying, from the commence-
ment, to the demands of the body, the fat which the system
always requires, and also by the free allowance, from the
beginning, of good brandy. This last acting in concert with
the fat, and amply supplying the carbon in the excessive
combustion going on, and thereby allowing a certain pro-
portion of the fat, thus saved from the fire, to be assimilated
by the nutritive process. By these means, simple as they
seem, a vast majority of these cases may unfailingly be
conducted to a successful issue, without the internal use of
one drop of medicine. I, of course, speak of uncomplicated
eases.

In closing, I would remark that in selecting the fat to be

I860.] Proceedings of Medical Association of G 'a, 1 r>

employed, it is best to take those richesl in phosphorous,
as such ;ire the fats constituting a large portion of the uer-
rous tissue, such doubtless is the cause of the superioritj of

cod-liver oil to almost any other fat.

Finally, in making these endermic applications in the
latter stages of typhoid fever, extreme care should be used
not to fatigue the patient, by causing him to undergo any
physical exertion during the operation. The applications
should be made twice a day and continued as Long as the
skin will freely imbibe the fat. The best effects are observed
in children and negroes, because, in the one case, the appli-
cation can readily and thoroughly be made, and in the
other, the fastidiousness of the patient, if he has any, is not
regarded, and we may be sure of having- our directions
carried out to the letter, at least, with respect to the greasing.

Such is my faith ! May I be pardoned for saying, only
with that degree of confidence with which the (ruth should
be proclaimed, that I prove my faith by my works, in safely
conducting, with these means, many patients through attacks
of typhoid fever, and bringing them out in the end, ema-
ciated to no great degree, hut on the contrary, with such an
integrity of tissue, as ensures a much more speedy con-
valescence than takes place in ordinary recoveries.

ARTICLE XVI.

Report of th Proceedings of tlie.Medical Association of Georgia,

for I860.

The Medical Association of Georgia, assembled in the
City Hall in Rome, at eleven o'clock, April 11th, 18G0.

The House being called to order by the President, Dr. F.
S. Colley, the deliberations of the body were introduced
with prayer, by Rev. Mr. Jones, of Rome.

The roll being called, the following regular members
answered to their names :

J. G. Westmoreland, J. P. Logan, J. X. Simmons, J I ay-
den Coe, W. F. AVestmoreland, A. G. Thomas, IL \V.

416

Proceedings of Medical Association of Ga. [June,

Brown, of Atlanta; Kl.cn Billyer, R. C. Word, T. J.
Word, of Rome; DeSaussure Ford, Robert Southgate, o:
Augusta ; A. M. Boyd, W. A. Culbertson, of Cave Spring;
F. S. Colley, of Monroe; J. X. Coe, Flat Rock; S. W
Burney, of Forsyth; J. T. Banks, of Griffin; J. It. McAfee,
of Dalton; W. 0. Brandon, of McGuire's Store; W. P.
Bond, of Lithonia; and Johnson Matthews, of Yellow
River.

The minutes of the last meeting were then read and con-
firmed. Rules being, on motion, suspended, the following
candidates were, on written application, accompanied with
suitable vouchers, elected to membership in this Associa-
tion: J. B. Underwood, John M. Gregory, A. B. Gregory,
Wm. Terrell, J. King, J. B. W. Kowlin, J. C. Reese, T. F,

Jones, of Rome ; L. Price, D. F. Forman, Wall, Z. L.

Waters, of Calhoun ; B. B. Brown, J. A. Black, of Dalton
M. F. Crumley, Atlanta; V. M. Hodgson, Villa Rica ; E.
A. Ware, Floyd county; D. R. Richardson, Monroe, Wal-
ton Co.; N. C. Mason, Cass county; E. L. Connally, Fulton
county; G. M. McDowell, Pike county; J. X. Smith,
Tilton ; A. II. Shi, Newton Co.; M. R. Ballenger, Floyd
Springs.

Election of officers being in order, the President ordered
a ballot for President. Dr. Burney proposed the name o:
Dr. II. Coe, of Atlanta. Dr. T. J. Word proposed the
name of Dr. Robert Southgatc, of Augusta. Dr. South-
gate's name being withdrawn, Dr. II. Coe was, on ballot,
declared unanimously elected President for the current
year. Dr. Logan proposed the name of Dr. T. J. Word, o:
Rome, for first Vice-President. On ballot, Dr. Word was
declared unanimously elected 1st V. P. Dr. Hillyer pro-
posed the name of Dr. Robert Southgatc, of Augusta, foi
second Vice-] 'resident. On ballot, Dr. Southgatc was de-
clared unanimously elected 2d V. P. Dr. Banks proposec
the name of Dr. A. G. Thomas, of Atlanta, for Cor. anc
Rec. Secretary and Treasurer. On ballot, Dr. Thomas was
declared unanimously elected. \)v. Logan proposed the
name of Dr. S. W. Burney, of Forsyth, for Orator at the

_

I860.] Proceedings of Medical I ' if Ga. 417

next meeting. On ballot, Dr. Barney was found to be
unanimously elected next Orator. On ballot for Alternate

Orator, l>r. W. F. Westmoreland was declared unanimously
elected.

On motion, the President appointed as a committee, to
induct the President elect into the Chair, Drs. Banks, 1 1 i 1 1 -
yer and A. M. Boyd.

Dr. Colley, on retiring from tin* Presidency, delivered a
short, but beautiful and appropriate address very strikingly
marking some of the causes which tend to the Lowering of
the standard of the Medical Profession.

Dr. Coe was then inducted into the Chair, and assumed
the duties of the office, by making a few chaste and happy
remarks.

On motion, the Association adjourned till 3 o'clock, P. M.

Afternoon Session, 3 o'clock, P. M.

House was called to order by the President. The Presi-
dent called for the introduction of business requiring early
action. Dr. Logan moved that the Association appoint 7|
o'clock, P. M., as the hour for the delivery of the Annual
Oration carried. Dr. Boyd moved that the President ap-
point a committee of rive to nominate Delegates to the
American Medical Association motion carried. Commit-
tee, Drs. Colley. Logan, Burney, Southgate and Banks.

On motion of Dr. Colley. Association determined to send
two Delegates to the Convention for revision of Pharmaco-
peia, to assemhle in Washington, D. C, in May next. Dr.
Logan proposed the names of Prof. I. P. Garvin, of Geor-
gia Medical College, and Prof. J. G. "Westmoreland, of
Atlanta Medical College. On ballot, Drs. Garvin and
tmoreland were unanimously elected Delegates.

Dr. Burney offered the following resolution :

Resolved, That Dr. Colley be requested by this body, to
furnish a copy of his address delivered this day, on retiring
from the Presidency, to some one of the Medical Journals
of the State, for publication.

"Resolution unanimously adopted.

Reports of Auxiliary Societies being called for, no report
27

418 Proceedings of Medical Association of Ga. [June,

was offered. Rules being suspended, Dr. J. G. Westmore-
land moved that the Committee on Nomination of Dele-
gates to American Medical Association, be instructed to
select eighteen names. Dr. Banks offered as a substitute,
that as many be .selected as this body is entitled to. Sub-
stitute being put to vote, was carried.

Order being resumed, Written Communications were
called for no report.

On motion of the Secretary, Voluntary Written Commu-
nications were called for.

Dr. Boyd presented a report of a case of Ulceration of
Cervix Uteri.

Dr. Soutligate then presented a very interesting Essay,
entitled, The Tendency to Abandon the Practice of General
Blood-letting in the Treatment of Disease is it evidence of
an advance or retrograde movement in Therapeutics ?

On motion, Association adjourned till 9 o'clock, April
12th.

At 7 h P. M., Association listened to the very elegant
Annual Address by Dr. II. W. De Ford, of Augusta.

Second Day, 9 o'clock, A. M., April 12th.

Minutes of yesterday were read and confirmed.

Regular order being taken up, Dr. Burney presented a
case of Laceration of Uterus.

Dr. T. J. Word moved that the authors of the papers
presented to this meeting, be requested to furnish them for
publication in some of the Medical Journals of the State
carried. Dr. II. C. Word offered the following resolution :

Resolved, That members of this Association, having un-
finished Essays designed for this occasion, shall be allowed
to complete them and have them published by order of this
body.

Oral communications being called for, W. F. AVcstmore-
land, M. D., Professor of Surgery in Atlanta Medical Col-
lege, presented an instrument, of his own invention, for
making a section of small strictures of the urethra without
dilatation, with bad case successfully treated.

18G0.] Proceedings of Medical ' Hon of Gfa. 419

Prof. W. F. ^Vestmoreland presented a report of varii
experiments upon animals, a brief synopsis of which is here
introduced, with a view to determine the practicability
Ligating arteries with silver wire, and the closure of woui

of the external surface and internal organs, as intestines,
fee., with the silver suture

Experiment 1. Subject* :i pup five or six months old.
Lett carotid artery ligated. Result Death of the pup from
severing the artery by scratching. Exp. 2. Pup, six weeks
'old; right femoral artery ligated. Result successful, liga-
ture encysted. Exp. 3. Dog, two or three years old; right
femoral artery ligated. Result successful, artery obliterated;
ligature beautifully encysted. Exp. 4. Dog, two or three
years old; longitudinal incision in small intestine, two and
a half inches in length. Result Dog found dead in forty
hours after operation, bowels protruding through external
opening, wound united. Exp. 5. Dog, very old; right
femoral artery ligated. Result successful, artery obliterated,
ligature encysted. Exp. G. Dog, two or three years old ;
incision one and a half inches long in intestine. Result
successful, wound closed, suture encysted. Exp. 7. Dog,
two years old; right common iliac artery ligated. Result
Artery obliterated, ligature encysted. Exp. 8. Spaniel,
two or three years old; longitudinal incision, two inches,
made in small intestine. Result Bowel united, wire en-
cysted. Exp. 0. Dog, two years old; attempt to iigate
abdominal aorta. Result Rupture of aorta, ligated, lived
only a few hours. Exp. 10. Spaniel, young; abdominal
aorta ligated. Result successful; aorta obliterated, ligature
encysted. Exp. 11. Bitch, supposed five or six years old ;
section of small intestines, one and a half inches, removed.
Result Lived forty hours, wound united.

In some of these cases, Chloroform was admit nstered
in the others, Sulphuric Ether.

Dr. Dugas, through Dr. DeSaussure Ford, presented a
report of a case of Episiorraphy, and also a report of a case
of Staphylorraphy. Dr. Colley reported "an anomalous

420 Proceedings of Medical Association of Ga. [June,

case of delivery." Dr. W. F. Westmoreland reported suc-
cess in restoring respiration in animals, when chloroformi-
zation had been carried too far, by artificial respiration,
effected by the introduction into the trachea of a larsrc
clastic bougie through which air was forced by common
hand hellows.

Report of Committees appointed at last meeting to report
to this meeting, in order.

Report of Committee on revision of Constitution and By-
Laws, called for. Xo report.

Report of Committee on Medical Literature, called for.
Xo report.

On motion, both these Committees were continued, with
instructions to report at next meeting.

Report of Committee on nomination of Delegates to
American Meclical Association, called for. Committee re-
ported the following names : Drs. Southgate, T. B. Pliinizy,
L. J). Ford, II. II. Steiner, Augusta; Drs. J. P. Logan, II.
Coe, J. X. Simmons, Atlanta; Drs. J. T. Banks, E. F.
Knott, T. M. Darnall, Griffin; Drs. W. G. Bulloch, Juriah
Harris, Savannah; Drs. Robt. Battey, T. J. Word, Rome;
Drs. F. S. Colley, D. R. Richardson, Monroe; Dr. S. W.
Burney, Forsyth; Dr. W. W. Flewellyn, Columbus; Dr.
R, A. T. Ridley, LaGrange ; Dr. J. R.. McAfee, Dalton ;
Dr. G. L. McClesky, Athens; Dr. W. S. Meire, Madison;
Dr. E. 0. Ware, Cartersville ; Dr. Alex. Means, Oxford;
Dr. S. P. Lumpkin, Watkinsville.

On motion of Dr. Boyd, report was received and adopted.

Selection of place for next meeting being in order, Dr. J.
X. Coe, proposed Atlanta ; Dr. T. J. Word proposed Ma-
con. Dr. J, G. Westmoreland moved that a Committee be
appointed to report a place for next meeting. Dr. Hillyer
moved, as a substitute, that a vote on that question be taken
by ballot. Motion carried.

( )n ballot, Atlanta was declared the place chosen for hold-
ing next meeting of this Association.

On motion of Dr. Boyd, the Chair appointed a Commit-

I860.] Proceedings of Medical As* / Ga, \l\

tee of three to nominate Essayists for nexl me< ting. Com-
mittee \h->. Word, Logan and Southgate.

\)\\ T. J. Word offered the following resolution:

Resolved, That tlu* experiments of Trot*. VV. F. W<
moreland arc highly commendable, and it is hoped tl
will be continued, and result in greal good to the Pn
sion.

Dr. T. J. Word moved that sections 3rd and 4th, Art. 1 \t
Chap. 2, of the code of Medical Ethics, be published with
the minutes of this meeting. Carried.
Dr. W\ F. Westmoreland moved that the Secretary
instructed to have 500 copies of the Constitution and By-
Laws of tins organization, published, and distribute them
to its members.

Dr. Logan moved, as a substitute, that the Committee uu
Constitution and By-Laws be empowered to revise the same,
and publish 500 copies.

Dr. Brown moved to amend, bv adding that the Se< re-
tarv be required to distribute the copies so published to
members.

Dr. Colley moved to table the motion. Dr. Col lev's mo-
tion lost.

The original motion, as amended, was then put to vote,
when the vote resulted in a tie. The President voting in
favor of the motion, it was carried.

On motion, the Treasurer was ordered to draw on the
Treasury for funds to be furnished to Committee on Con-
stitution and By-Laws, to pay for 500 copies, to be pub-
lished as soon as practicable.

Dr. R. C. Word offered the following resolution :

Resolved, That notice be now given that at our next meet-
ing a vote shall be taken to determine a place for the }>w-
manent location of this Association.

Dr. Ford offered as a substitue :

Resolved, That notice be now given that at our next m<
ing, this Association determine whether or not this Asso-
ciation shall be permanently located, and if decided to
locate, the place shall be chosen.

The substitute being put to vote, was carried.

422 Proceedings of Medical Association of Ga. [June,

The Committee on Essayists reported the following list
of names :

King, Battey, Hilly or, T. J. Word, Rome ; W. F. West-
moreland, I). C. O'Tveefe, Atlanta; Doughty, Augusta; B.
B. Brown, Daltcra ; J. T. Banks, Griffin.

On motion, report was received and adopted.

Dr. Logan moved that the Committee on Constitution be
required to revise the list of names of members. Carried.

On motion of the Secretary, that part of the proceedings
continuing the Committee on Constitution was reconsidered.

On motion of the Secretary, the President was required
to appoint a new Committee of five to revise Constitution
and By-Laws.

Dr. Ford moved that the Committee be appointed from
one place. Motion lost.

The President appointed as that Committee, Drs. A. G.
Thomas, H. W. Brown, L. D. Ford, II. F. Campbell, J. T.
Banks.

On motion ot Dr. Boyd, the President appointed as the
Committee of Arrangements for next meeting, Drs. H. W.
Brown, J. G. Westmoreland, J. F.Alexander, D. C. O'Keefe,
J. X. Simmons.

Dr. W. F. Westmoreland moved that a Committee on
Finance be appointed to devise some means of raising funds
for the use of this Associations, and to report at next meet-
ing; carried. Committee W. F. Westmoreland, F. S.
Colley, R. C. Word.

Dr. R. C. Word offered the following Resolution :

Resolved, That the President appoint a Committee of live
to memorialize the Legislature of Georgia, at its next
session, to abolish the professional Tax upon Physicians,
and to urge the passage of an act requiring the Inferior
Court of each County to set apart such portion of the
County Tax as the Grand Jury shall recommend, to pur-
chase drugs for the benefit of the poor. Adopted.

Committee Drs. R. C. Word, B. B. Brown, J. G. West-
moreland, Burney, Southgatc.

Dr. Simmons offered the following Resolution :

I860.] Proceedings of Medical Association of (/". 123

Resolved^ That the thanks of this Association be tendered
to the city authorities of Rome for the4 use of their Hall, and
to the Physicians and citizens {){' the city, for their kind

attention to the members of this body during its present
session.

Resolution adopted.

On motion, the Association adjourned to meet in the city

of Atlanta, on the second Wednesday in April, 18(31.

From the Code of Medical .Ethics, Chapter Second

Section 3. It is derogatory to the dignity of the Profes-
sion to resort to public advertisements, or private cards, or
handbills, inviting the attention of individuals affected with
particular diseases publicly offering advice and medicine
to the poor, gratis ; or promising radical cures ; or to pub-
lish eases and operations in the daily prints, or to suffer
such publications to be made ; to invite laymen to be pre-
sent at operations to boast of cures and remedies to
adduce certificates of skill and success, or to perform any
other similar acts. These are the ordinary practices of
empirics, and are highly reprehensible in a regular
physician.

Section 4. Equally derogatory to professional character,
is it, for a physician to hold a patent for any surgical instru-
ment or medicine ; or to dispense a secret nostrum, whether
it be the composition or exclusive property of himself or of
others. For if such nostrum be of real efficacy, any con-
eealment regarding it is inconsistent with beneficence and
professional liberality ; and if mystery alone can give it
value and importance, such craft either implies disgraceful
ignorance or fraudulent avarice. It is also reprehensible
for physicians to give certificates attesting the efficacy of
patent or secret medicines, or in any way to promote the
use of them.

A. G. THOMAS, Sec. M. A. of Ga.

424 Ford. Annual Address. [June,

ARTICLE XVII.

The Annual Address Delivered before the Georgia Medical
Association, at their Meeting, held at Borne, April, 1860.
By DeSaussure Ford, M. 1)., Prosector to the Professor
of Surgery in the Medical College of Georgia,

Mr. President and Gentlemen of the Association :

As an earnest of gratification, and sincere thanks, that
you have appointed me orator, for this, our annual com-
munion, my thoughts have been busy in arranging them-
selves, with a view to scatter a few seed thoughts, which, if
they do not germinate and ripen into goodly fruit, may
invite others to elaborate them more ably, that they may be
amplified into the fulness of truth. Not long a member,
yet I feel a youthful, buoyant, enthusiasm, whenever
" leaden-footed, limping Time," seems to push forward,
more rapidly, the opportunity of a closer intercourse of the
members of our Association. Founded with a view to
solicit and advance investigations in the science of Medicine
tending to complete it as such ; to refine and make its
votaries more learned, more untiring, in scientific searches
after truth, it has progressed right onward, bravely adding
such truths ; wonderfully increasing in membership ; its
deliberations no longer confined to the larger cities, but
penetrating the less fortuned, until now we celebrate our
convocation, right up in the mountains, whose pure and
cxhilerating atmospheres are tinctured with a laudable love
for such beauties as are contained in, and burst, gushing
forth from, the full and maternal heart of our common
mother.

Beneath the sunny, and on the classic shores of Italy,
now stands but the shadow of the k4 Mispress of the
World"

': Sec the wide waste of all devouring years !
How Rome, her own sad sepulchre appears !
With nodding arches, broken temples, spread !
The ver}* tombs, now vanished like their dead !"'

Not such here, in your modern mistress of the mountains;
all is teeming with joyous hope and busy enterprise ; plenty

I860.] Proceedings of Medical Association of Ga. 125

seems "t<> leap to laughing Life"; beauty, in all tier fair
purity, lingers to gratify, and woman, typical ideal of thai
"sweel virgin type o\' Thought, pure, brave and high,"
appeal's before us, applauding with smiles her workings for
many of us, having " prevented the necessary sternness of
restraint, over sympathetic feeling, from falling into coarse-
ness of soul, or loss of true, natural feeling, by being the
witness to tenderness and sympathy." Magical the charms
which attract to the side of woman, and grateful the sphere
.of these our fair visitants, whose radiant smiles are evidence
of their tribute to our honored Association ! Feign would
we linger, to tell out our gratification, that you come to
listen to our abtuse talks on medicine; but oh may you
continue to charm and fascinate; go hand in hand with us
in our noble, charitable work, softening, ever refining, our
natures, and imparting a portion of that inviting tenderness,
whose ministration is first and last in the history of life !

The subject chosen is, Kxclusives, with the intention to
demonstrate that Rational Medicine is not to be placed in
the category, but lias as its motto, "Jeprend le bien ou je Ic
trouve"

Hasty conceptions, formed at the mind's lirst glance
in the first impetuosity of the judgment arc termed
opinions, conjectures, hypotheses ; whence come systems :
this, an idea emanating from the mind of a good and
noble philosopher, explains the origin of the legion-
numbered specialities, in all the sciences around us, each
exciting some notice, each imparting some additional
strength. A zealous devotee, grasping at such opinions,
conjectures, hypotheses with avidity digesting them his
system may be characterized, en masse, as containing only
errors, dilemmas, falsities; yet, the devotee of an opposite
system, untrammeled by bigoted prejudice, and petty
rivalry, will discover through the apparent hypothetical
jargon, such truths as labor always develops, thus crowning
him with jewels from his own laboratory, which will shine
with such brilliancy, as to demand the admiration, aye,

426

Ford. Annual A ddn ss.

[Juno,

adoption, of the scientific. Thus mind aids mind, system
system, until one sublime and fixed science is conceived
from the united and combined opinions and conjectures
given out from many pregnant sources : such " complimen-
tary duelism" is unceasing, multiplying the science into
various departments, each a promising child, growing to
gladdening manhood, supporting and adorning it as a beau*
tiful unity.

" The beginning of Philosophy is the study of differences,
but we climb to that beautiful Olympus, where simple and
essential truths reside the heaven of all the other spheres
of knowledge by comparing and deducing resemblances ;
just as we rise in moral and religious life, by seeking and
valuing Christianity above sectarianism." Imposing the
force of this truism, in canvassing and observing the many
and multiform subdivisions, which entice, so alluringly, the
faithful student of the science of Medicine ! Early in its
history, exposed to superstitious objections of the church,
the study of practical anatomy the chief corner-stone of
our temple was denied, under pain of banishment ; how-
ever, the massive intellect of the illustrious Galen was
enabled, by comparative anatomy, to compare and deduce
these resemblances; and, while aware of the insufficiency of
a knowledge of this comparison, to convey an adequate
idea of the delicate, exquisite, structure of the wonderful
and fearful organism of the human, "regarded comparative
anatomy merely an introduction to human dissection, with-
out which, the latter could not J)e studied with sufficient
advantages."

The study of differences could not be more potently illus-
trated than by Microscopical and Comparative Anatomy, a
study founded upon the great fact, that "animal life and
organization, throughout its prodigious varieties, is in imi-
tation of the human form the model form of all oreraniza-
tion each variety approaching as near that form as the
objects and purposes and conditions of its being will
possibly permit." What knew we of the tiniest of the

_

I860.] Proceedings of Medical Association of <!<>. 427

animal kingdom, their delicate structure, exquisite beauty,
potent analogy i^ ourselves ': Their generally nervous sen-
Bibility we saw, merely saw, bul no1 until men dissected and
appreciated the nice adaptation oi' means to ends, were we
cognizant oi' ganglia, filaments of nerves, organs, their
functions similar to man's; tentacles, vibrillae, so minute,
so perfect! Such inviting analogy, existing between man
and all these little, almost fabulous creatures, who will for
a moment doubt that the principles of human physiology
have been greatly extended and certified by pursuing the
study of organization along this descending gradation : and
while we contemplate this successful searcher after myste-
ries, the microscope, how can we pass, without acknowledg-
ing, with proud, delighted exultation, its development of
the cell growth, showing how such a "mere spark from the
anvil of the creator," kindles into warmth and lustre, the
brightest of his jewels, man!

Under the auspices of Iccus and Ilcrodicus four hun-
dred years before the Christian era as an improvement to
medical practice, the Gymnastic School of Medicine was
founded a system much respected, not only as remedial, for
many diseases of debility and irregularity, but as strength-
ening and forming the muscular, and manly frames of the
Greek youth. Surprising that until late ages, did a system
so universally practiced, and so extolled by the ancients
giving the world instances of magnificent bodily bravery,
whose heroes astonished the effeminacy of the world, with
their athletic arms disappear from notice! Ling, a Swe-
dish poet, a man of versatile genius, stern and inflexible
resolve, "read in the acient lore of his country, the record
of a mental and bodily prowess of uncommon virtue; the
doings of kings, jarls and vikings in the olden time;"
inspired by royal thoughts, he endeavored "to combine the
muscles of ancient heroism with the civilization of to-day,
and in the physical frames of the Swedes, to re-enact the
days of Snorro and Hakon-Jarl, in those of the 14th
Charles. In criticising him further, the writer quoted,

I2K Ford. Annual Address. [June,

says : " His verse breathes with a Homeric spirit of combat,
with a delight in the good science of the strokes, as well as
in the death of the foe : it has the harshness and boldness
of a mnscular rhyme.*'

Kinesipathy, or "the muscles of medicine,'' is a system
whose art consists in the external administration of forces:
posture, friction and numerous movements and modulations
of the "body and limbs, even organs, tending to counteract
the wastings of chronic diseases, byre-animating the atomic
feebleness of the functions. Graphically it is styled :
"admonition, contact, exercise, pursued into details, where-
by disease is literally handled." An enemy to acute dis-
ease, where motion would cruelly torture the pain into
damascene keenness, yet a precious friend to the weakness
and almost second babyhood of the muscular system, who,
by gentle exercise, well and judiciously directed, teaches
them anew their forgotten lessons.

Emphatically not medicinal, but hygienic, yet the follow-
ers of Preissnitz proclaim Hydropathy equal to, if not pre-
eminent over, all other remedial arts. The water cure
operates by alternately stimulating or depressing the natural
powers of the system, through the mediation, specially of
the universal skin system. If perspiration, a relaxant,
would be indicated, no plan of treatment would be so
rapidly and powerfully efficacious. If the economy, atonic
and feeble, needs tonicity and instaneous activity, the
douche, plunge bath or wet sheet, advocate with eloquence
their long acknowledged active power in producing such
results. If calmness and coolness, from febrile excitement,
is longed for, it is discovered in the refreshing quietude of
the sitz bath. Though not remedial, in the drug sense, yet
statistical and personal experience, compel the accceptance
of many cures effected, cither by the water, exercise or
regimen, which the proprietors of such establishments
rigidly enforce ; at the same time, however, many have
fallen victims to the continued inlluence of such rigorous
observances, when at the first resort, they were buo}*ed up

I860.] Proceedings of Medical Association of (>'<>. 129

with elastic health. In speaking of the continued resort to
waller cure establishments, an eminenl writer says: "Such
penances kepi up, they become Bevere mascerations ; the
faculties are not roused, but chilled, and the lain}) which
might have lasted for a quiet while, is beseiged by cold to
death." The therapeutic action of cold water, might be
styled "energizing," while that of warm "enervating." By
reaction the cold produces an excited glow and heat; the
sweat breaks out with drenching force. Packaman in the
wet sheet; at first the body is braced up, excited; soon lie
is soothed, goes to sleep, and when the reaction supervenes,
lie is taken out of his vapor bath vet and dripping, and as
red and ruddy as a lobster. The warm water, on the other
hand, depresses ; a sense of coldness results, and though the
sweats are slow and languid, they are still profuse and
exhausting.

To those loin.;- accustomed to press their beds of down:
long acquainted with indulgences which wealth and afflu-
ence unfortunately entail : suffering ennui from breaking
down of energy; too feeble and irresolute, physically and
mentally, to throw prostrate such pertinacious visitors to
such the water cure is invaluable. " They go, and the axe
is laid to their tree of evils," branch by branch cut away,
until, in a flood of fruition, the trunk puts forth new and
and healthful shoots: in the language of another, "their
-impossibilities are made possible for them, by the exacting
physician, who endures no remonstrances ; in an hour they
throw down the accumulated baggage of years early hours,
long walks, long forgotten beauties of nature, re-acquaint-
ance with the crystal springs, whose naiads had been
neglected for old Port, sweet sleep hours before midnight,
and the sense that they are clean human beings, or on the
way to such all these means carry health to the men who
are jaded with business or pleasure, but not yet struck for
death." It is the " central mortification of the flesh," and
much of its potency is owing to "the frigid morality which
it inculcates, and to the shock it gives to the dreaming man
and his lazv organs."

430 Ford. Annual Address. [June,

Antagonistic to the hippocratic aphorism: "contraries, or
opposites, are remedies for each other, the similia similibus
curaniur, of Hahnemann, has claimed much interest and
excitement. His wonderful genius and uninterrupted ex-
periments will ever be lauded with genuine admiration, yet
his whole system, although founded upon a few isolated
facts, furnished by some of the most learned and celebrated
practitioners, is o tinctured with a false medical philosophy,
that it can never stand the test of experience. Am English
physician, though scientific, and with large and cultivated
understanding, advocates Homeopathy so triumphantly, that
I quote from him: "Pact shows, that the attenuation of
medicines may go on to such a point, and yet, their curative
properties be preserved, nay heightened, that we are obliged
to desert the hypothesis of their material action, and to pre-
sume that they take rank as dynamical tilings." " A drop
of aconite may be put into a glass of spirit, a drop of this
latter into another glass of spirit, and so on to the hundredth
or the thousandth time, and still the aconite property shall
be available for cure." "Here, then," he continues, "we
enter another field, and deal with the spirits of things, which
are their potential forms, gradually refining massy drugs,
until they are likened to those sightless agents, which we
know to be the roots of nature, and feel as the most power-
ful in ourselves." A spiritualistic sort of pathological ana-
tomical knowledge, then, must be absolutely necessary for
the successful Homeopath, and these attenuated millionths,
mysteriously permeate through the materialistic morbid
phenomena, compelling the spirit to put on a spiritual
disease, similar to the original one, thus seeming to be the
great remedial agent, for that part of the economy known
as the spiritual body, and excluding the idea of the material
body being siek, unless the mind, or soul, or " sightless
agent" invites or rather poisons it. Often, I believe, Cimens
sana in corporc sane" is true, but not universally; hence we
are tempted, when it is so, to prescribe colored inert water
to quench the imaginative morbid thirst, sternly "insisting

I860.] Proceedings of Medical Association of Ga* 481

they must avoid that noxious article, camphor, the antidotal
ordium of the pharmaceutical vineyard '." Supremely
ridiculous and unphilosophical, such a proposition as this
that the utmosl triturating refinement, kepi ap until dooms-
day, to destroy the material, in order to arrive the spiritual
essences of their medicines, even supposing the absurdity of
such independent existence. Wei] might they put a drop
of aconite at the source of the Savannah river, then take a
drop ^i the water at its mouth, and put this in the Atlantic
ocean, and w-still the aconite property be available for cure,"
since they add more importance to divisibility, carried ad
infinitum, than to the drug in its natural state.

Hahnemann's disciples soon involved him in their exag-
gerations, and shrouded in the German mysticism, the
homeopathic therapeutics numbered many admiring parti-
Bans ; for, it is said, "no idea in medicine, however absurd,
but will find advocates, both among physicians and pa-
tients." Like all sudden innovations, its meteoric lights
shown forth brilliantly, dazzling, however, even the worthy
innovator, blinding him from appreciating long established
facts, hut imparting a kind of spiritual sight for the myste-
rious, infinitessimal and heterogeneous farrago of useless
simples, which so characterize his system. Indeed, meteoric-
like, it has passed rapidly through the spheres of critical
analytics, not dropping the philosopher's stone, but possibly
a few pebbles, which may adorn the cabinet of ^rationalistic
practice ! Hahnemann's Organon that regulating governor
of his triturating machinery reminds me of the "Embre,"
the text book of the ancients, who felt certain of impunity,
whatever might be the result, so long as they scrupulously
adhered to its prescriptions; "thinking it better ninety and
nine should fall victims to an erroneous practice, than that
the validity of the precepts, delivered by the mighty
Thouth, should be called in question, or one heretical
patient recover in contradiction to them." Homeopathy
had its day in the world, but the infatuation and therapeutic
reveries have been dissipated, and dispersed by the com-

432 Ford. Annual Address. [June,

bined influences of ridicule and want of success ; and now,
the successors and worshippers of Hahnemann, like the
prophets of Baal, in their extremity, cry from morning even
until noon, 0, Baal, hear us! Bat there is no voice, nor
any that answer. Elijah-like, we mock them, saying, cry
aloud, for he is a god; either he is talking, or lie is pursu-
ing, or he is in a journey, or, peradventurc, he sleepeth, and
must be awaked. And they cry aloud, and have "blown
their own trumpets, abused their neighbors, and entreated
belief in monstrous and unproven assertions, until even that
exceeding personal impudence, essential to a successful
homeopath nil conscire sun, nulla pallescere culpa avails no
longer."

So perfectly and supremely ridiculous the torn foolery of
Thomsonianism, and so futile except as murdering whole-
sale that, with Dr. Smith, of Macon, Ga., we dignify it by
this notice: it is von gran wmbug*

Though termed the " chaotic mother of children fairer
than itself," and condemned as "cumbering the earth with
its age and infirmities," yet we laud and celebrate, aye.
magnify the Allopathic School of Medicine, not merely as
its disciples, but because it is founded upon a scientific
inductive philosophy, having considered particulars,
and individual cases, and employed them for generals,
which are intimately related to such particulars.
From the days when an appetite for knowledge was first
evinced, the minds of an illustrious galaxy of brilliant men
have searched after certain and evident facts, collecting
them from numerous quarters, and reducing them to a
certain degree of order, which systematic order manifests
itself through the practice of an intelligent and devoted
Allopath. Our system imbibes all the sciences wherewith
Nature has inspired and assisted the human intellect ; pene-
trates the universal and beautiful arcana of the animal,
vegetable and mineral kingdom each containing wonderful
truths, and giving some support and, by an empirical
experimental synthesis, intimately joined with the experi-

I860.] Proceedings of Medical Association of Ga< 488

ences of many, has contributed remedies for nearly every
malady by which we an- visited. Accused, by the strictly
routinish systems o\ experimenting with the valuable lives
of humanity, we might be expected to blush, timidly, for
our system ; no1 so, but, in the language of another, we
"glorj in the thought, that time honored Allopathy has
been founded on empirical philosophy " If our usual
remedies fail, in obstinate cases, and we have been imbued
with a thorough knowledge of the fundamental principles or
medicine, it would be culpable if we did not resort to ex-
perimentation, on such scientific inductions as our educated
minds could dictate ; thus unlike the Homeopath, who,
when his remedies fail, is compelled to fall hack upon
chaotic allopaths to shield him from the anathemas his
wanton ignorance so justly merits.

Anatomical knowledge a study of the human economy ;
in health, the relation of organ to organ, artery to artery ?
and so on : Pathological Anatomy the genius of our sys-
tem a study of morbid phenomena ; Chemistry, the science
of qualities, with a stud} of the material bodies and gases of
the universe, and the knowledge that certain medicines pro-
duce certain effects, acting through different media some
upon the nervous tissue exclusively, some upon the blood
some upon the absorbents, some upon the secretory system -
all these facts form a nucleus, from whence our knowledge
of physical and material laws, and their intimate relation,
and mutual dependence, are derived, and from whence have
been established all those first principles, which are now
arranged and classitied so systematically, and which ever
guide safely the intelligent Allopath.

Hating insulation, the Allopathic school we proclaim as
being founded upon the philosophic idea of eclecticism,
which very eclecticism lias developed it into the proportions
of colossal beauty, force and grace. Nothing can he more
naturally true and scientific, that in order to strengthen any
particular or individual thing, we must, like the industrious
bee, fly from place to place, beauty to beauty, extracting
28

\.\\

d. Annual Aa\

[June,

only the good and pure from the mass, in order to erect a
complete and perfect fabric. Thus we arc benefitted by,
and borrow from, the Kinesipath, in old paralitic ci

where the nervous derangement is merely functional, their
Bystem of friction, exercise, &c., soon teaching the feeble
muscles to grow strong, and, in the language of another,
" the mind and will which had alienated themselves, are
coaxed back into the arms and legs." A case treated in the
hospital at Augusta, where the patient had been bed-ridden
for months with rheumatism the disease itself cured, but
the patient too timid to use his emaciated limbs was ma-
terially benefitted by friction and gradual exercise, and the
importunate necessity of action, that in two weeks time he
acknowledged the beneiit as almost miraculous. Even we
experience happy results by this handling, in diseases of the
organs themselves ; e. g. the secretions of the liver may be
excited by frequent nudgings, and exercise of the abdomen,
immediately oVer the organ. On this principle, too, the
dyspeptic is often relieved, manifestly, by horseback exer-
cise. YV^ith these few facts before us, we commend this
system to the investigations and practice of the scientific, as
precluding the necessity oftentimes of crowding their
patients with tonics, and as a luxuriant field which will
yield a healthful harvest

Hydropathy we practice in the warm and cold baths, aye,
even wet sheets, and considering the one instance of the
parching fevers of our Southern districts, how can we ap-
plaud too loudly the llydropathist, in that he has taught us,
by his special observation and study, the soothing and cool-
ing effects of effusions of water, when, not long ago, our
patients writhed with restless agony, and yielding to natu-
ral instincts, cried for a single drop to wash their seething
tongues ; yet it was denied, thus subjected to the tortures of
Tantalus. Now, our chills arc cut short by large and copious
draughts of warm, while fevers are cooled down, if not in
many instances terminated, by cold water. In violent
inflammations of the brain, who has not witnessed the

L

18G0.] Proceedings of Medical Association of Ga, 185

quietude following the douche of cold water to the head !
( )n the principles inculcated by this system, we substantiate
the advice of change of climate, feeling that, independent of
variety of scenery, which of itself is remedial in mauj
instances, patients are benefitted by breathing more dry, or
more moist atmospheres, or the bodies exposed to colder or
warmer blasts.

Through the dark cloud hanging about their exclusive-
ness, we perceive many philosophical ideas, which we
eagerly appropriate for our already brilliant coronet, and
only pity those proprietors of water-cure establishments
who, having the opportunity, do not practice, as an adjuvant
to their system, the Allopathic teachings.

An Allopath may deplore "that the human intellect
should ever fall from its high estate, to fatuitously play
with straws, and herd with fool, and idiot, like the poor
broken-minded Lear," yet, be is indebted to Homoeopathy
for a low move rational ideas than his system inculcated
before its advent. The more careful investigation of the
natural history of diseases, it lias truly incited : diminished,
silently, the amount of massy drugs, and, mayhap, was the
channel through which the inordinate use of the lancet was
drifted far away. Scarlatina and the other exanthemata,
pneumonia and delirium tremens, diseases which homoeo-
paths harp about as being more successfully treated by
them. The traditional treatment of these has been greatly
modified, and now the intelligent Allopath is obliged to
acknowledge the expectant plan the rational one, cheerfully
according to the Homoeopath the credit of directing his
mind to more careful study. Even if, on the other band,
the Homoeopath will allow a malignant paroxismal fever to
terminate fatally, in ignorantly waiting to treat symptoms
as they arise, while we would jugulate the disease, by our
empirical specific, yet, we must give him some credit for
his reasonable, exclusive expectancy, since many affections,
under his notice, recover from his infinitessimal nothings
Dame Xature, in other words all of which facts impel us>

4-3t> Metallic Ligature*. [June,

:. scientific men, to scrutinize more closely, and study more
critically the natural history of all diseases.

You pnveive, Mr. President and gentlemen, that I am
governed by the saying

'! Take the truth wherever it is found,
Whether on native or foreign ground "

and, unlike many critics before me, while considering ex-
clusive systems, have discovered some merit, even though
it may be obscured by the most gross and unscientific tenets,

which they claim as fundamental principles. Careful and
unbiased scrutiny of their practice, however, though unphi-
losophical, as explained by them, recommends itself to us,
and has undoubtedly assisted in instilling that love of more
careful and patient investigation, which so characterizes all
our excellent and eminent searchers after truth, of this
century. Yielding to honest convictions, not allowing the
possibility of the orthodox voting me heretic, to have any
influence, I have endeavored to award "honor to whom
honor is clue." I cannot close, however, before recom-
mending the exalted position of Allopathy to public criti-
cism from time immemorial respected by sages; practiced
by the learned; sung of in the thrilling ecstacies of poesy ;
and " surviving all heretical opposition, it stands, to-day,
as a mountain rearing its majestic summit through the
pestiferous fogs, and petty isms, far into the ethereal regions
of truth." Aye, indeed, we are wedded to it this, our
united band, an evidence ; this, our meeting, a touching
thank-offering and we view it as a luxuriant field, where
our sickles -may reap an abundant harvest : a table, where we
may enjoy the most sumptuous banquets !

Metallic Ligatures.

On the 21s1 of March, 1829, Mr. Henry S. Levert, of
Alabama, now Dr. Levert, of Mobile, in the same State,
graduated in medicine in the University of Pennsylvania,
having presented a thesis entitled "Experiments on the use
'a' Metallic Ligatures as applied to arteries" This paper was

I860.] Metallic Ligatures. \r,

published as the leading article <>f The Aynerican Journal of
the Medical Sciences for May, L829, tlie experimental portion
of which will be found below. This paper, simple, unprc
tending, and conclusive in its experimental character, and
significant in its physiological and surgical import, wa
altogether demonstrative, so Par as the analogical evidence
derived from surgical operations upon dogs is applicable to
man. These experiments excited much attention, bu1 made
no converts. Surgeons, biased in favor of silk and similar
ligatures, did not choose those of metal, but soughl for
arguments which east doubts upon the superiority <>t* the
latter. If they tailed to verify the new experiments, they
did not tail in defending themselves against even an appear-
ance of favoring an innovation, which virtually proved thai
an important branch of operative surgery was not practiced
in the best manner. Each defended himself, as far as was
prudent, until, at length, the subjeel was almost wholly
forgotten.

Let us look at a lew text-hooks the first which come to
hand in order to ascertain what was said, for nothing was
done, in relation to Dr. Levert's experimental investiga-
tions :

In his Principles of Surgery, Prof. Miller says, nature
regards metallic, as well as other forms of ligature, as
" toreign substances to be extruded by suppuration."

Prof Fergusson, in his Practical Surgery, says : "The
ligature which I generally make use of is small, smooth,
and well-spun twine. * * * Some practical surgeons
have been far too nice regarding the size and material of
ligatures," etc.

M. Velpeau sums up the various kinds of ligatures, inclu-
ding those of Dr. JJevert, in the following words: "From
these inquiries it results, as I conceive, that the nature and
the form of ligatures in the treatment of aneurisms, are not
so important as they have been generally thought," etc.
< Operative Surgery,)

In the 11th vol. of the Dirt, de Mai. ct de Chir., M. Begin
(art ligature) notices Dr. Levert's experiments upon animals
with metallic ligatures. But M. Begin throws into his
appreciation doubt and dissent, thinking that man and ani-
mals differ, and that metallic ligatures are not bo good as
some other kinds, especially those of animal substances.

In his Surgical Dictionary, S. Cooper, art. ligature, no
mention is made of Dr. Levert's experiments, or of metallic
ligatures. Prof. Henry H. Smith, of Philadelphia, in his

438 Metallic Ligatures. [June,

treatise on Practical Surgery (1856), says : Vk Experience has
shown that any Ligature that is strong enough, and that is
properly applied, answers equally well."

Lisfranc, a great, though somewhat eccentric surgeon, in
the second volume of his surgery (Medecine Operatoire,
Paris: 1846), after giving a summary of \)v. Levert's experi-
ments with ligatures of lead, gold, platina, and silver, vir-
tually rejects them, because he had neither seen metallic
ligatures employed, nor did he know that they had ever
been applied directly upon the human subject. ("Je iai
pas vie employer ces ligatures ; je ne sache meme pas qu'on les ait
appliquees sur Vhomme" 805.)

Tacitus lias somewhere said, that if the reward of inves-
tigation be taken away, study will be neglected: " Sublatis
studiorum pretiis, etiam studia peritura." Now, without having
either a personal acquaintance with Dr. Levert, or any in-
formation as to his own attitude in regard to his claims, it
is reasonable to assume that he expected his experiments
should be tested, and if found to be a great step towards
the advancement of surgery, that he should have the satis-
faction of a just recognition in the Republic of science, and
the more so, because, at the present moment, the silver
suture which lie had so fully tested as being upon an experi-
mental basis "free from danger, and productive of peculiar
advantages," is proclaimed and otherwise appropriated, as
the greatest discovery of the nineteenth century. This is
what has been called playing Hamlet with the part of
Hamlet left out altogether. If even the half of the merits
now claimed for the silver suture be conceded, Dr. Levert
did not Write in the sands; nor will the waves of the third
of a century wash out his record. Documents and dates,
thanks to the art of printing, are more powerful than the
Roman Lictors, who, bearing fasces and axes, marched
before Kings and Consuls, enforcing respect and punishing
the refractory. It is the pen of history "which is mightier
than the sword" or the Lictor's axe.

Without affirming that the suture of silver, or other
metal, is what its advocates have recently claimed for it,
the greatest discovery of this century, there seems to be
already extant considerable evidence, which daily increases,
in favor of its superiority over those ligatures which have
been, and are still usually employed. Hence, whatever
merit the former may possess attaches itself chiefly to the
experimental investigations of Dr. Levert, as the following
document will show. B. Dowler.

30.] Metallic Ligatures. I '''

Experiment /.On the Kith of May, 1828, I laid bare the
righl carotid artery of a dog, and after separating it care
fully from its accompanying nerve and vein, I passed under
it a load wire, and tied it [irmly. Both ends of the wire
were then cul off with a pair of scissors, and the sharp
points benl down with a common dissecting forceps. The
wound was now drawn together with a few stitches of the
interrupted suture, and over these were laid some adhesive
strips. This animal was not confined, but suffered to run
at large: when I examined him several days after, I found
the stitches ulcerated out, and the wound open; it had
filled up from the bottom with granulations, but the edges
of the skin were separated to a considerable distance ; with
light dressings it healed entirely by the 5tli of June.

Jim 2Stk. I killed this animal and dissected with care
the neck. A small cicatrix existed in the skin; the lend
was found in the situation in which I had placed it, by the
side of the vein and nerve, perfectly encysted; the artery
at this place had been removed entirely, for the space of
hall' an inch.

Both ends of the vessel, caused by this removal of its
central portion, adhered by loose cellular substance to the
surrounding parts, which appeared to be in a perfectly nat-
ural state. The end towards the heart was not at all
increased or diminished in size ; it was sealed up for three-
eighths of an inch in extent, by an organized substance,
resembling a coagulum of blood in color, but not in con-
sistence, it being much firmer. The end towards the head
resembled the one just described, in all particulars: the
substance, however, which idled its extremity, was of
greater extent, and occupied the whole space up to the next
branch, which was rather more than half an inch.

Not the slightest trace of inflammation existed in the
neighboring parts; on the contrary, they appeared perfectly
natural. The lead itself was enclosed in a dense cellular
substance, which formed for it a complete cyst.

Experiment II. The right carotid artery of another dog
was separated from its contiguous parts on the 17th of May,
and a lead wire placed around it, as in Experiment 1. The
lips of the wound were kept in contact with sutures and
adhesive strips. I examined it three days after, and found
that it had united by the first intention, in the whole of its
course, except in those points included by the stitches;
these I cut loose and dressed it simply with adhesive strips.
When I looked at this dog again, I found that from the

440 Metallic Ligatures. [June.

itching of the wound the animal had scratched off the
dressings, and broken up the new adhesions ; I washed it
carefully to remove the dirt, and dressed it with simple
dressings. It healed kindly, and was entirely well on the
6th of June, at which time I killed the dog, and made a
careful dissection of the parts. The cellular substance here
was much thickened and indurated, forming a strong bond
of union between the nerve, vein, and artery. The two
former were in their natural condition; the artery was per-
vious its whole extent, to within three-eights of an inch of
the wire; at this place the calibre was entirely obliterated;
a firm substance, resembling bruised muscle, filled its
cavity: between the ligature and the head the artery was
impervious, and much diminished in size, having the
appearance ^ a mere cord, not exceeding one-fourth the
original dimensions of the vessel. The lead preserved its
situation around the artery: it had become entirely en-
ted, and not the slightest remains o\' inflammation
existed.

Experiment III. 1 cut down on the left carotid of a third
dog, on the 29th of May. and proceeded as in Experiments
I. and II.. differing in no respect, except in dressing the
wound: I used no stitches, but mreely adhesive plasters.

June 1st. I examined the wound, and found that it had
united through its whole extent ; but as I supposed the
union not to be very firm, the strips were re-applied, and
suffered to remain on until the 5th, when they were
removed altogether.

June 27th, The animal was killed, and a minute exam-
ination made. The lead wire was found around the vessel.
which was impervious for an inch or more, as in the former
experiments. The surrounding parts healthy.

Experiment TV. Jum 9//-. The dog which was the sub-
ject of the last experiment, having entirely recovered from
the first operation, now became the subject o{ a second,
which was performed on the carotid o\' the opposite side.
This was conducted exactly ;is the preceding: the wound
united by the first intention without the least difficulty: no
constitutional symptoms manifested themselves. On the
27th. at which time this dog was killed, an examination
was likewise made of this side of the neck: the appearances
corresponded exactly with those oi' the preceding experi-
ments.

Experiment V. August bth. 1 performed a similar exper-
iment on the carotid of another dog. I killed him on the

I860.] Metallic Ligatu 441

.;.] of September, and found thai the appearances differed
in no respect from the foregoing.

The lead having answered my expectations so well in
these cases, I felt a great inclination to ascertain whether
that substance alone possessed the property of remaining in
contact with the living tissues, without exciting irritation
or any unpleasant consequences, ^v whether similar results
might not be obtained by using other metals. I accord-
ingly continued the subject, using gold, silver, and platinum,
instead of lead.

Experiment VI. August 12th. The right carotid of a dog
was separated neatly from its surrounding parts, and tied
firmly with a small gold wire; the wound was kept closed
with adhesive strips, and by the third day had united firmly.
September 2d. The do<j; was killed, and I examined his
neck; I could perceive no difference in the appearances
exhibited here from those produced by the lead.

Experiment VII. Octobi r 13th. I exposed the left femoral
artery of a <\o<j;, ami placed around it a gold wire. 15th. I
examined this doy;, and found that from his restlessness he
had removed the dressings, and had torn open the wound;
I replaced them, and lie recovered in a short time. October
30th. L examined the subject of this experiment, and found
that the results corresponded in every particular with those
above related.

Experiment Vlfl. October 16th The above experiment
was repeated on this dog; the wound healed very kindly
by the first intention, etc. Oct. 30th. I found the result
to coincide with the last in all particulars; there was a
slight appearance of ecchymosis around this ligature, which,
no doubt, would have heen removed in a few days more,
only fourteen days having elapsed between the operation
and the examination of the result.

Experiment IX. October 5th. I passed around the carotid
of a dog a piece i>\' silver wire, and united the wound by
the first intention, which had taken place on. the 9th, at
Which time I examined it. Oct 30th. I found that the
silver had become encysted, and had left no remains of irri-
tation.

Experiment X. October 5th. The same experiment on
another dog. 30th. The result- the same.

Experiment XI. October 13th. I passed a silver wire
around the right femoral artery of a dog. 15th. Wound
healed. 30//'. Wire encysted. Xo traces of inflammation
remaining.

442 h 'attic Ltigabi [Jane]

Experiment XIL August 29th. I cut down on the le
carotid of a flog, and passed around it a platinum win
This animal made his escape, and I did not see him agaiij
until the 16th of October, when I examined Li.- nock; the
wound had united so nicely that its former situation could
s.-an-clv be recognised; the cellular substance ben<
slightly thickened and indurated; the artery was obliterate J
for an inch and a half or two inches ; the middle portion
resembled a small cord, around the center of which I found
the platinum wire enclosed in a mass of condensed cellular
substance, which formed for it a cyst; the inside of this.
cyst was smooth, and adhered closely to the platinum ; no
traces of inflammation remained.

Experiment XIII. October Ibth. Another dog was sub-
jected to an experiment resembling the above in all partic-
ulars. Oct 30//?. I killed him. and found no other differ]
ence in the appearances than that the cyst which enclosed
the platinum was not so perfectly formed ; it however
existed.

Experiment XIV. October 16th This experiment was
conducted precisely as the two last; the appearances upon
examination were the same. This dog was the subject of
Experiment VII, and was examined on the 30th of October.

Experiment XV. June 15th. I enclosed the humeral
artery of a dog in a ligature made of a single stran of silk,
previously waxed. In applying the ligature I drew it barely
tight enough to place the opposite sides of the vessel in
contact, without dividing the internal and middle coats.
Both ends were then cut off, and the lips of the wound
placed in apposition; it did not unite, however, by the first
intention, the dressings having been removed by the ani-
mal ; it was now dressed in the usual way, and soon healed
perfectly by granulations. On the fourteenth day after the
operation I made a dissection of the parts ; the artery was
filled with a firm coagulum, both above and below the place
of the ligature, which prevented the possibility of haemor-
rhage, so firmly did these coagula adhere to the parietes of
the vessel.

The ligature was found in the center of a small abscess,
loose and detached from the surrounding parts; the artery
was ulcerated through, the ends being separated a short
distance.

Experiment A' VI. August loth. I repeated this experi-
ment on the femoral artery of another dog ; the wound was
united by the first intention. Sept. 2<f. Upon dissection,

I860.] Metallic Ligatures. W3

an abscess as large as a pea was discovered immediately
under the skin and above the artery ; the loop of silk waa
found in its center, and offered no resistance when 1
attempted to remove it.

Experiment XVII. I passed under the femoral artery of
a dog a piece of gum-elastic, previously stretched and rolled
to render it oi a proper size, and tied it with a single knot.
This operation was performed on the 15th of August ; the
wound united by the firsl intention. Sept %d. An exami-
nation was made of the result ^i' this experiment. The
ligature was found encysted; the inner side of the cyst was
uneven, and not inclose contacl with the gum-elastic; from
its appearance I thought that pus had existed, but was now
absorbed; the artery was obliterated to the next branch,
both above and below.

Experiment XVIII August 20th. The same experiment
repeated on the right carotid of another dog. 2Sd. Per-
fectly united by the first intention. Sept. 2d. The gum-
elastic was found contained in an abscess as large as half a
nutmeg; the artery was impervious both above and below
the ligature, and ulcerated through at the place of its ap-
plication.

Experiment XI X. September 1st. The experiment with
gum-elastic was repeated on the femoral artery of another
dog, and the wound united in the usual manner. This dog
was the subject of Experiment XII; consequently I had
not an opportunity of examining him until the 16th of
October, when he was again caught. The cicatrix in the
skin was to be seen plainly. On making an incision at this
place, I perceived a small lump about the size of a pea,
immediately under the skin, and at the lower angle of the
wound. I opened this, and found it to contain the gum-
elastic ligature, surrounded by a small quantity of yellowish
looking pus ; the vessel was removed for the space of an
inch and a half, both ends obliterated. Just above the
place of the ligature, several small arteries, not distinguish-
able in the healthy condition of these parts, were observa-
ble, and appeared to be spent upon the contiguous muscles.

Experiment XX. August 25th. I cut down on the left
femoral artery of it dog, and tied it firmly with a grass liga-
ture, such as is used for fishing-lines. 21th. It had healed
by the first intention. Sept. 2<l. The grass was found en-
cysted, but the inner side of the cyst was moist and uneven,
and did not appear to embrace the ligature closely ; no ap-
pearance of inflammation.

444 Electricity in tin Treatment of thx [June,

Experiment XXI. August 25th. The same operation per-
formed on another dog. Sept 3d. It was examined, and
found to correspond with the twentieth in every particular.

From the experiments now detailed, we may, I think,
conclude that the plan of tying arteries with lead and the
other metals is free from danger, and may be productive 01
some jfeculiar advantages; more experience and a greater
number of experiments are necessary to establish this point
thoroughly, and it is to be hoped that some one fully com-
petent to the task will prosecute the subject.

Electricity in the Treatment of tJie Diseases of th< Ear. By

De Courcillox, M. I).

Of all the local agents employed in the treatment of the
diseases of the ear, electricity is, undoubtedly, the least effi-
cacious, although, perhaps, the most praised, not only by
physicians, but by patients who seem to expect every thing
from it. Of course, charlatanism takes advantage of the
popular credulity upon that point as upon every other, and
electric batteries are busy working, if not the cure, at least
the money out of too plethorous pockets.

(Treat things, it is true, may be expected of electricity for
the relief of deafness ; still, I am afraid our knowledge of
its therapeutic application and effects upon the organ of
hearing is so limited, that it must take some time before it
be made to work the wonderful cures so much wished for.

They, have endeavored to establish an analogy between
the electric fluid and the nervous influx, and hence, the
therapeutic effects of this powerful remedy have been praised'
without measure. The Abbe Xollet (1) struggled against
such an unfounded induction, and the propagators of the
contrary opinion, Bertholen, {'2) Manduyt, (3) Comus, (4)
Ponia and Brainard, (5) could not countenance their asser-
tions with good substantiating reasons. Relatively to deaf-
ness, it cannot be denied that electricity has a very marked
action upon the acoustic nerve, ft has been inferred that
it ought to contribute to restore the sensibilitv of the ear,

1. Encycl. art. Electricit., 1755.

2. Pe le elect, du corp? humain.

:>. Mem- de la Societe Koyale de Med., 1

I. Journ. de Phisique, 1775.

5. Journ. de Med., November, 1787.

I860.] Diaeasi s of the Ear. 1 1".

and it has particularly been used in cases of nervous deaf
less.

Manduyl (6) treated ten deaf patients with this means,
considered heroic, and only one seems to have been slightly
benefitted. Cavallo (V) asserts thai electricity cures everj
kind of deafness, but he gives rib proof for his assertion.
Lebourier Desmoutiers (8) says thai by this means he ha
restored the hearing to a deaf and dumb girl, bul a shorl
time after the cure the child was in as bad a condition as
before the treatment. Hufeland (9) published in his Journal
a great number of cures of deafness, bu1 most oi them could
not stand a minute and severe criticism ; for with some the
deafness was but intermittent, and with the others the dis
ease was but recent. Busch, of Marbourg, (lo) has treated
with electricity a man sixty years old, and after ten sittil
the disease appeared to be destroyed. It is very probable
that in that ease there was but a simple obstruction of the
Eustachian tube. There remains to be known how far the
electric fluid can liquify the mucosity accumulated in that
passage. So far, nothing proves that it does. Lentin
speaks of the advantages which can be derived from elec
tricity combined with stimulating injections, but he confesses
to his not having had the opportunity to make the necessary
experiments.

The French aurists of our times have taken but very lit-
tle notice of these fine promises. Saissy (11) thinks that
this therapeutic means is applicable but in cases of deafness
from partial palsy. Itard (12) says that electricity is not of
the least \\>^. in the diseases of the ear, and Deleau is of the
same opinion.

Most of the aurists who believe in the efficacy of elec-
tricity against deafness, agree in saving: that this agent
ought particularly to be employed against the form known
as "torpid," that is, from want of nervous action. But
this species of deafness is rare, for Kramer during his long
career reports only four or five such, of a hundred cases.
The result of it is, that in the greater number of cases
treated by electricity, the disease ought to he increased in

(>. Diet, des So. Med. art. Electricite.

7. A Complete Treatise on Elect., Vol. 9-

8. Consid. surles sourds limits de naissance.

9. Journal vii.

10. Aseitrage /air ausibenden Arznerwispenschaft.

1 1. Essai, etc., p. 272.

12. Traite, etc., b. y.

I Hi Di of th Ear. [June,

the ratio of the violence of the excitement produced by that
fluid upon an already over excited system. Kramer lias
constated the insufficiency of such a treatment upon two
hundred and two patients affected with nervous deal!.

and he adds, " 1 do not advise anybody to try that remedy."

Considering electricity, galvanism and animal magnetism
as emanations of the same power, it has been tried to render
useful the properties of these different agents to ameliorate
deafness. It lias even been thought that mineral magnetism
could be advantageous in such cases, hut no fact justifies such
an opinion. The introduction of a magnet in the meatus, or
its application concentrated upon the pavilion, do not act
otherwise than by the sensation of the metallic cold it imparts
to the parts, and this can prove injurious.

As to galvanism and magnetism, they are very active
agents, which have of late l)ecn of great repute in Europe.
Magnetism and electricity have particularly been praised be-
yond measure. Here are the results constated by Kramer's
experiments :

Generally the deafness to be attended was " nervous with
noises." In such cases electro-magnetism has a very active,
very irritating action upon the acoustic nerves. These effects
arc still more marked when the current is directed from the
Eustachian tube to the meatus externus. The immediate effect
of such a current is to produce acute pains in the ear, convul-
sive motions in the surrounding parts, and an increase of the
faculty of hearing ; but such a happy change lasts but a few
moments. If the same experiments are continued for a while,
there is almost invariably increase of the noise and augmen-
tation of the disease. It is plain to every careful observer
that electro-magnetism does not act as a tonic, but as an irri-
tant; the acoustic nerves are violently over excited, and one
can readily understand the result of such a medication. It is,
then, of the utmost importance to use but sparingly and cau-
tiously of sucli a therapeutic agent.

Mineral magnetism has been considered as a powerful
means of cure of the deaf and dumb, whether their affection
was congenital or acquired. Doctor Barrils, of Hamburg,
who has experimented upon the deaf and dumb of the Berlin
Institute, had signalled fourteen cures of fifty-eight patients,
but I was enabled to constate (it is Kramer who speaks) that
my watch was not at all heard, even applying it upon the ear
of the two children which were reported as the brightest ex-
amples of such an astonishing success; and, however, my
watch is heard from a distance of thirty feet by people enjoy-

L

I860.] Do Bad Smells Can D l IT

Lig ;i healthy hearing, Baldinger, (1 ) A.udrej , | _'i and Tliourct,
have published nothing authentic on the Biibjoct. Becker,
Bnlmering, Schmidt, and Bahrdt, have experimented \\ iili the
Bamc moans, 1 > 1 1 1 with the most complete failure.

Magondie, J * >l>vrt do Lamballe, Mesniere, have often em
ployed electro-magnetism in certain forms of nervous deatni
but they nevor derived any good advantage from it. M.
Dnpotet, a celebrated magnetizer, was allowed t<> experiment
upon tlie subjects of the Royal institute of the deaf and dumb
in Paris, and the report of iMagendie before the Academy <>!'
Sciences demonstrated the uselessness of the efforts of thai
individual.

Galvanism has been prized with enthusiasm by a certain
number of learned men, who mosl of them have acted under
the influence of a momentary impulse, without knowing what
kind oi' deafness they intended to cure. Of course, their
assertions do not deserve the least confidence. It is true that
galvanism produces upon the acoustic nerves a very active
stimulation, and Schubert explains thus the case with which
certain patients perceive a few sounds to them new. Bui
such an improvement docs not sustain itself; besides, it often
happens that such a shock, repeated, aggravates the disease
very rapidly. Itard speaks in about the same way upon that
subject. Hence, it is safe to conclude that galvanism has
never been of any authentic service in the treatment of the
affections of the car, while it is beyond doubt that it has fre-
quently proved very injurious to the patients subjected to its
influence.

Since practicing in San Francisco, we have collected a cer-
tain number of facts illustrating the ideas as advanced in the
above paper. At the next opportunity we will publish them,
and thus show the ill results of the abuse of electricity, etc.,
in California.

Do Bad Smells Ctfusi Disease ?

The tendency of the human mind to rest satisfied with any
belief that is authoritatively asserted, is too well known t<>
require any comment. Philosophers (-fall kinds are n<> more
exempt than other people from this easy style of dealing with
difficult problems. Medicine is, wre think especially charge-
able with cherishing pet answers to questions that force

J . Opusc. Medic-

2. Beobachtungen and Untersuchungcn uber den Gibranch des Magnet?, etc

448 Do Had Smells Cause Disease ? [June,

themselves unkindly on her; and we think that the way in
which she has made up her mind as to the causes of various
kinds of levers, is an example of tin's stylo of cutting the
Gordian knot.

Of late years, it must have struck all our readers that pig-
styes, dirty pools of water, open privies, ash heaps, etc., have
been declared highly criminal, and on all occasions even ad-
judged guilty of producing any kind of fever or bowel com-
plaint that may have broken out in the neighborhood. If a
child happen to .-ulW'v typhus in a farmhouse, it is the mi.xen
at the end of the barton that caused it. If an epidemic of
English cholera befal a village, it is traced to the duck-pond
by the road-side. If in a wealthy household the inmates are
stricken with diptheria, some open sewer, close at hand, has,
as a matter of course, been the cause. So accustomed are we
to hear this sort, of reasoning resorted to on all occasions, that
one feels a little difficulty in expressing doubts as to the cer-
tainty with which the effect is unhesitatingly traced to its
cause. Nevertheless, we think there is at least sufficient evi
dence to cause reflecting minds to pause ere they give in their
adhesion to the general opinion, and thus shut their eyes to
further research and inquiry. Dr. Watson has, we know, stated
it as his distinct opinion, " that neither animal nor vegetable
decomjiosition is sufficient to generate fever of any kind ;"
and the researches of Dr. Gu}r, and other observers, have cer-
tainly gone some way to support that opinion.

Dr. Guy, in his very interesting contribution to the Journal
of the Statistical Society, on the health of Nightmcn, Scaven-
gers and Dustmen, gives us a mass of statistical facts, which,
it must be confessed, run counter to the generally received
opinion, that foul animal or vegetable emanations are the
fruitful source of disease. This class of men, without doubt,
spend their days in the very midst of filth of all kinds. Pie
says :

"In most of the lay-stalls or dustmen's yards, every species
of refuse matter is collected and deposited night-soil, the
decomposing refuse of markets, the sweepings of narrow
streets and courts, the sour-smelling grains from breweries, the
surface soil of the thoroughfares, and the ashes from the
houses."

This heterogeneous mass the scavengers or ''hill'1 people
have to sort or to pass through sieves, so that the emanations
arising therefrom must be brought into intimate relation with
their lungs and skin'. If fever and diarrhoea are so clearly
traceable to the vicinity of these so-called noxious materials,
surely the scavengers ought to be a poor, fever-stricken race.

18G0.] Do Bad Smells Causi Diseasi . 449

A medical examination, however, of this class of workmen as
compared with brickmakers and bricklayers5 laborers, proves
that the scavenger is comparatively exempt from disease.
Thus, among a number of men examined in each of the three
classes, it appeared that the numbers attacked by fever were,
among the scavengers, 8 per cent.; among the bricklayers'
laborers, 35.5 per cent.; and among brickmakers, 21.5 per
cent.

This result seems extraordinary enough ; but it may be
argued that these men do not live in the laystalls or dustyards,
and therefore that their exemption from lever may be attribu-
table to this; but what can be said if the master dustmen and
their families, who live all their lives in the midst of these
heaps of so-called fever-nests, are healthy. Dr. Guy says :

"I do not think that, whether in town or country, such an-
other body of men (as master dustmen) could be brought
together, except by selection ; and it is not going too far to
assert of them, that, if the comparisons were limited to the
inhabitants of London, or our large towns, no score of selected
tradesmen could be found to match the same number of
scavengers brought casually together.''

Unless we suppose that the scavengers get used to this so-
called miasmatic atmosphere, or that after a time it no longer
alfects them, we cannot see how the foul emanation theory
can hold water. Nature cannot work in one place differently
from another. Night-soil must be just as deadly in an open
yard in London as in the country. But here we have the ex-
periment tried on a larger scale, of a whole class of men sub-
jected to foul emanations, and yet they are far from being an
unhealthy race, and are not nearly so prone to fever or bowel
disease as the bricklayers' laborers.

We are far from wishing it to be understood, however, that
we do not consider foul emanations as dangerous or baneful
under any circumstances. In our opinion, they become
noxious when much concentrated. Our houses, for instance,
arc built on the principle of a bell-glass ; and our drains and
privies, and all other impurities, if allowed to give off a dele-
terious miasma, most certainly do become most virulent
sources of disease. But, in the open air, we think it mty
doubtful whether these emanations are ever the cause of in-
jury to man.

Let us watch with Dr. McWilliam a still more gigantic
experiment on the health of the Thames waterside people,
which has been going on for years, and is still proceeding.
The whole sewerage of two and a halt millions of people, has,
within the last ten years, been turned into the metropolitan
29 '

450

Do Bod Smells Cause Disease '.-

[June,

stream. Year by year its waters have become more contami-
nated, and its smell more disgusting. It should follow that
the health of the waterside community is proportionally de]
creasing; that febrile complaints, cholera and diarrhoea are
alarmingly on the advance. But what is the real state of the
ease \ l)r. McWilliam in his Report for the year 1858, on the
health of the Water Guard and Waterside Officers of her
Majesty's Customs, says :

"As respects bowel affections, to which I include diarrhoea,
choleraic diarrhoea, dysentery, etc., the types of those forms
of disease, which, in this country, noxious exhalations arc
commonly supposed to originate, we find the additions during
the four hot months of the past year from this class of com-
plaints *20.3 below the average of the corresponding period of
the three previous years, and 73 less than those of 1857.

The quantity of putrescent animal and vegetable matter in
the Thames has been going on increasing; but the illness-
generally attributed to the emanations arising therefrom has
been decreasing ! We know that many will urge that all the
combustibles (if we may use the term) being thus accumula-
ted, it only requires the match to be applied, to find epidemics
raging like wildh're. But the year before last, cholera did
break out on the banks of the Lea, and there died out, appar-
ently from want of sustenance. This year, according to the
Lancet, cholera,, veritable Asiatic cholera, has been on board
the Dreadnaught ; yet it has not spread, and there seems nd
likelihood of its doing so, for this season at least. As Dr.
McWilliam truly says, " It is nowhere sustained by evidence,
that the stench from the river or docks, however noisome, was
in any Way productive of disease.'' It is true that one water-
man, in June last, was said to have died of Asiatic cholera,
and that his death was ascribed to river poison ; but, as the
eminent observer, whom we have just quoted, correctly re-
marks, "it is opposed to all analogy, and to the usual order of
nature, and therefore unphilosophical, to suppose that a cause
so extensively diffused should have been so singularly limited
in its effect."

Greatly doubting, as we do, the alleged ill effects of foul
emanations in the open air upon human life, we nevertheless
do not think that the crusade against filth should for one mo-
ment be relaxed. A bad smell may be no more unhealthy
than a bad taste, but we should, if possible, avoid the one as
much as the other. What we should, above all things avoid,
however, is the falling into the error of supposing that bad
smells are the indubitable sources of many puzzling diseases,
and of thus hardening our minds against investigations of the

I860.] Treatment of Dyspepsia. 461

kind which wore instituted a year or two ago by Dr. Barker,
and which, when completely carried out, will enable na to
decide what the noxious principles are which make all the
difference between an unpleasanl and a malarious odor.

Treatment of Dyspepsia. By M. Beau, Hospital of La
Charite.

The disturbances of digestion comprised under the appella-
tion of dyspepsia constitute a morbid state extremely various
in its forms. However these may be. two indications only
require to be satisfied, namely, to contend with the cause of
the disease, and to check the latter by the course of treatment
most appropriate to its leading symptoms.

When, as ir frequently happens, dyspepsia is connected
with the persisting agency of some mental cause, it is difficult
to find any remedy but diversion of the mind. Dyspepsia is,
however, sometimes expressive of a foul condition of the
primse vise, in which case M. Beau prescribes:

R. Pulv. ipecac. - - 15 gi\

Antimon. potassia-tartratis - - '2 gr.

Aquae. - - - - - 5 oz.

To be taken in two doses, at an interval often minutes. This
practitioner even usually begins the treatment of dyspepsia in
general by the exhibition of the above emetic mixture. It is
his touchstone for the discrimination of o-astric derangement
from certain forms of dyspepsia which closely resemble that
indisposition. If gastric derangement be really present, it
promptly yields to the remedy, and. in the contrary case, no
more severe symptom is induced than nausea and slight vom-
iting. In a young girl, under Mr. .Beau's care, dyspepsia was
due to the presence of tape-worm, which, being expelled by a
single dose of kousso, the derangement of the digestive organs
was at once relieved. If the malady is referable to the abuse
of tobacco, tea, coffee, fermented fluids, etc., a cure can be
looked forward to only from abandonment of the injurious
habits. When the difficulty of digestion is under the influence
of some internal disease, it is towards this the practitioner's
attention should first be directed.

As to the special treatment of dyspepsia, Mr. Bean begins
by banishing from it, almost altogether, narcotics which, ac-
cording to Mr. Pidoux's graphic expression, are the knout of
pain.

Opium and belladonna silence pain, it is true, but they fre-
quently mask its cause, and have, in dyspepsia, the further

Treatment of Dyspepz [Juno,

disadvantage of destroying the appetite, and interfering with
the digestive functions. Mr. Beau likewise denounces absti-
nence from food and repose in Led as highly improper, and is

even more stringent in his interdiction of blood-letting which
may induce anemia. The patient should eat despite the pain
which must follow, abstinence being in dyspepsia more dan-
gerous than excessive feeding. lie must also take exercise.
M:-. Bean, on one occasion, attended a patient who, believing
himself to be Buffering from disease of the liver, kept his bed,
and, lA' course, digested his food with much difficulty. The
professor ascertained that the supposed hepatic affection con-
sisted merely in intercostal neuralgia, which is so common in
dyspepsia, lie obliged the patient to get up and take exer-
cise ; on the very next day digestion was attended with less
pain, and a complete cure was effected in a fortnight. In
-hurt, it is necessary that dyspeptic subjects should not lead
an eccentric life.

In dyspepsia each case stands alone, and, therefore, the
practitioner has to deal with individual predispositions ; hence
a necessity for feeling his way, in order to discover the really
effective treatment. Among the remedies which are daily
prescribed in Mr. Beau's wards for the primary symptoms of
dyspepsia, none, in our opinion, are so useful as cool sulphur
baths. In summer, and during the warm season, cold river-
baths or cold water affusions, repeated twice or thrice in the
day, are also a powerful medication. Next in order of utility,
we may mention a succession of as many as seven or eight
blisters applied to the epigastric region. As to internal med-
icine, trinitrate of bismuth (half a drachm daily.) magnesia,
tonics, bitters, such as wild endive, or camomile, pepsine, or
Belloc?s charcoal, arc also found advantageous. The latter
preparation consists of charred poplar wood, and is taken at
the dose of one table spoonful after each meal ; it is more
successful with men than with women, without any assignable
cause.

It will be readily conceived that a properly regulated diet
promotes the efficacy of these various remedies. Mr. Beau's
patients make three or four meals daily, consisting in soups,
meat, vegetables, raw and very ripe fruit. Wine and water
is allowed to some, to others, beer, cider, or even water, ac-
cording to the effects of cither upon the digestive functions.
Mr. Bean has observed that, more especially in women, wine
and water often keeps up dyspepsia, and that many persons
suffer merely from the very copious drink they indulge in.
Whatever beverage be adopted, it should be taken sparingly.
.Mental diversion, when possible, is often of the greatest assist-

I860.] Treatment of Dyspepsia. 158

ance in the treatment : for instance, it is not unusual to find
that persons, who digest with difficulty their meals at home,
will dine out and eat with appetite and perfect impunity all
sorts of dishes. Gymnastics, walking, riding or carriage* sor
cise, constitute hygienic adjuvants of unquestionable value in
the treatment of this disease.

Turning to Borne of the Leading Bymptoms of dyspepi ia, we
find that 1>>s <>i appetite, gastralgia, intercostal neuralgia,
flatulency, constipation, vomiting, are these which more i
dally claim attention.

For loss of appetite, Mr. Beau prescribes bittei
water, spices, iced drinks, and to convalescents lie even
times permits anchovies, oysters, salad, fruit, and these arti-
cles of food are digested without difficulty. Gastralgic pains
are removed by blistera and ice internally; both these reme
dies are likewise applicable to obstinate vomiting. In certain
cases, however, vomiting is induced by abstinence, in others,
it depends upon the capriciousness of the stomach, and yii
when the food is changed. Some two years ago, a patient a!
the hospital Cochin every day vomited his broth and soup;
Mr. Beau altered this for a more nutritious diet of meat and
bread, and the vomiting ceased at once. The same resull \va
obtained in the case of a young man whose stomach, in
of the use of narcotics, rejected every thing, even ice ; his food
was modified, and the very next day convalescence set in. As
to flatulency, it may be removed by charcoal, or calcined n
nesia; constipation, by aloetic pills or cool enemas; warm
injections should by no means be resorted to, inasmuch as they
relax the intestinal fibres, and, therefore, operate in a manner
exactly opposite to the required object.

Besides the above, which Mr. Beau designates as the usual
remedies, there are others of a more or less expensive descrip-
tion, such as traveling, hydropathy and mineral waters ; these
are attainable by privileged patients only, and their efficacy
cannot be disputed. Mere change of place, irrespective i >f
consideration of the nature of the air, is a most useful resource
in dyspepsia. Traveling breaks the habits of life, alters
mental pre-occupations of the patient, and exerci the

digestive powers a still greater influence ; sea-voyages pres
over land-journeys, the advantage of meeting the double indi-
cation of inducing vomiting and submitting the subject to the
tonic inhalation of sea air.

It is highly probable that the mere change of place hi
considerable sh.are in the effects attributed to mineral waters.
Those of Vichy and Plombieres, however, taken on the spot,
seem, in many instances, beneficial, but they enjoy no cxclu

454 Treatment of Dyspepsia. [June,

si\ e Influence, and Mr. Beau considers it a very difficult matter
to point out the peculiar spa which will cure the patient. The
water-cure is another valuable mode of treatment, particularly
for persons in easy circumstances, avIio eat too much and exer-
cise too little. It is not so useful for the poor, and it operates
much in the same manner as bracing mountain air, by stimu-
lating the appetite and reviving the digestive powers.

Forcible ingestion of food is a singular medication, which
worked wonders in Paris in the hands of Benech. Instead of
the gum-water, broth or milk, recommended by Broussais,
Benech suddenly prescribed beefsteaks, slices of sausage
highly flavored with garlic, strong soups and claret. The
patients were, of course, terrified by this complete subversion
of all their previous diet regulations, but it must be acknowl-
edged that many derived much advantage from this new
system.

So much for the main features of dyspepsia. We now turn
to the secondary symptoms, the first of which requiring the
practitioner's attention is anemia from destruction of the
blood-corpuscles. Iron is the classical remedy with which
this symptom is usually met, but it succeeds less frequently
than is generally supposed. The ingredients of the blood are
best restored by healthy digestion. This should, if possible,
be re-established by bitters, tonics, exercise, change of air, and
the desired object is thus attained with far more certainty
than by the exhibition of metallic iron. Scorbutic anemia
yields to vegetable acids, water-cresses, and horse-radish ; and
deficiency of albumen in the blood will be remedied by dras-
tics and hydragogne aperients.

The nervous element of the disease, the nervosism of dys-
pepsia, should also be taken into account. This condition
bei lg one which sorely tries the powers of endurance of both
a ient md physician ; the medical attendant often endeavors
> e nervous irritation by e her drops, orange flower
water, infusion of lime flowers, and sometimes even with
opium or belladonna ; but, as we have stated above, these are
but palliatives, from which none but temporary relief can be
expected. It is not the branches, says Mr. Beau, but the tree
that must be felled. In such cases, therefore, cold affusions,
tonic diet, and exercise should be resorted to, and the method
instituted a hundred years ago by Tronchin may again be
be adopted with advantage. From the habits of luxurious
idleness indulged in, at that time, all ladies complained of
vapors; Tronchin ordered them to make their own bed and
sweep out their own rooms ; being a fashionable practitioner
he was listened to, and the success of his prescriptions was
such as ultimately to lead to his fortune.

I860.] Valerianate of Strychnia.

Valerinate of Strychnia. By R. Wysong, M. D., of Char-
lotte, x.V.

The above compound, bo far as my knowledge goes, has
never been introduced into the pharmacopoeias, either of
this country or of Europe; I feel, therefore, some delicacy
in bringing it before the profession ; but believing, as 1 do.
thai it will pro\c an acquisition to the already long list of
medical preparations, and trusting to the liberality of the
members of the profession for a lair trial of this new prepa-
ration before they condemn it, I will give my limited expe-
rience with it.

* I have been using the Val. Strych. some ten months, and
find that it is more particularly adapted to those cases where
there is general debility, accompanied with nervous excita-
bility, loss of appetite, indigestion, constipation, depression
of spirits, and all the symptoms following more or less on
the want of tone in the nervous system. Heretofore, in
manv of such cases, I have used strychnia, and although
they generally improved under this treatment, yet I never
met with as complete success with it as I have in similar
cases with the val. strych.; hence I am led to believe that,
in all such cases as above mentioned, we have in this prep-
aration a very reliable and useful remedy.

The preparation I have been using is prepared by dis-
solving snip, strych. in valerianic acid. So simple a prepa-
ration can be put up by any physician or druggist. I have
been using it in the following proportions:

Snip, strych. - ^v. viij :

Val. acid. - - - - % i ;

but this quantity may be altered to suit particular cases.

The following are some of the cases in which, among
others, I have used it with entire satisfaction :

May, 1859. Mr. E., aged 45 has Buffered with asthma
for fourteen years ; has tried various remedies without the
least benefit. The paroxysms came on about once a week,
he never passing two consecutive Aveeks without having
one; is very nervous, and suffers from general debility.

.A///. 19th, '59. Prescribed

! Of Sulphate <A' strychnia. - gl\ i :

" Pure water. - - - ."> i :

" Acetic acid, suf. quail.

Directed ten drops, three times per day, to be increased one
drop per day until the dose reached thirty drops. Kept

456 VaterimL of Strychnia. [June,

him on this prescription one month without any apparent
benefit.

Feb. 20<A. Prescribed

R Of Val. stfych. - - - - 5 i ;

" Water. - - 5 i.

Directed ten drops, three times per day, to be increased as
above. Has never had but one paroxysm since lie com-
menced with this prescription, and is now, to all appear-
ances, in good health. The medicine was kept up about
one month.

Sept. '20fli. Has continued free from asthma; occasion-
ally, daring damp or rainy weather, experiences slight
hoarseness, with disposition to clear the throat; this is gen-
erally relieved by a few doses of the sol. val. strych.

May, 1859. Mr. R., aged GO has had asthma since July,
1858, the paroxysms increasing in frequency each week.
He now has one nearly every day. and sometimes two per
day. In conjunction with asthma, he has bronchitis, also
indigestion, torpor of the liver, as indicated by decided yel-
low hue- of the skin, constipation, and ashy stools, he never
having an evacuation without taking some purgative ; at
times there is decided stranguary ; this seems to be super-
induced by constipation, as it is always relieved by free
action of the bowels. Pulse over 100, small, and at times
can scarce be counted ; great general debility spends
more than half the day in bed ; very nervous, so much so,
that by reading the least exciting newspaper article, or even
conversing with a friend, will at times bring on a paroxysm.
Cannot sleep in the recumbent posture, but is compelled to
be propped up nearly straight in bed. The paroxysms
come on generally about 3 Jr. M., but may be brought on
any hour, by the least excitement. Has been in the habit
of taking nauseants when he feels an attack coming on,
which, after several hours, relieves him for the time.

May 1 Wi . Prescribed

Ij_Of Val. strych. - - - - 5 i ;
" Water. - - - - Si.

Directed to commence with live drops, three times per day
to be increased three drops per day until the dose reached
thirty drops. For several weeks had no sensible effect,
owing to the dose being too small, and very irregularly
taken ; in fact, he seemed to be growing worse.

I860.] Valerinate of Strychnia.

May 81st. Prescribed

\{ Of Acetate of squills. - - r> i ;

11 Tar. ant. - - gr. ij.

Directed to begin one hour before tin* usual time for attack,
teaspoonful every fifteen minutes until nausea was pro-
duced; at the same time prescribed

ItOf Yai. strych. - - - 5 ij;

" Water. r, i.

Directed fifteen drops, three times per day, to be increased
.one drop per day, as above. After the fourth day, as there
had been no paroxysm, directed tbe nauseous mixture to
be left off.

June 11th. Has had no return of paroxysm; no sign of
bronchitis; bowels regular; skin greatly cleared up; pulse
TO, rather full and strong ; general health improved in
every respect, so much so, that he drives out several miles
every clear day, and sleeps without inconvenience in a
recumbent posture. Continued the valerian, thirty drops
three times per day.

July 1st. Xo return of asthma ; health very much im-
proved; seems quite free from nervous excitability. Con-
tinued the val. strych., as before.

Sept. 20th. Continued free from asthma up to the latter
part of August ; had not been taking the medicine regu-
larly for some weeks. About this time, during a very damp
day, drove several miles to see a neighbor; upon reaching
there, sat down in a draft until completely chilled, which
brought on his asthma. Since that time has had one
paroxysm. Saw him September 8th; prescribed val. strych.
as before. lie is now enjoying his usual health.

I have given the above case at some length, in order to
showr more fully what I conceived to be the effect of the
medicine. I doubt very much whether the case will ever
be permanently cured, but by the use of the above prepara-
tion the disease has evidently been kept at bay, and the
patient's general health very much improved; and by long
continued use of the remedy, he may possibly break up all
tendency to asthma.

I have used val. strych. with very great success in the
treatment of females. One case of inflammation of the
ovarian gland followed by suppuration, in leucorrhoca ; of
course, in such cases, I also applied local means.

158 Vegetable Parasites of th Human Skin. [June,

" The Vi '/< table VarasiU s of the Human Skin" by Jabt : Hogg.*
By V. Translated by O. I). Palmek, Zelienople, Pa.

The first researches on Vegetable Parasites, in general,
are dne to Bassi, of Milan. He discovered, some twenty
years sincej the vegetable character of a disease that pro-
duced great ravages among the silkworms. About the
same time, Schonlein discovered vegetables of the class
( h/ptogamia, order Fungi ; the appearance and development
of which accompanied certain diseases of the skin. Since
that time, the observations Of Schonlein have been repeated
and extended by a great number of authors, such as Messrs.
Kemak, Gruby, Lagenbeck, Robin, Hughs, Bennett, Ku-
chenmeister, Bazin, Jenner, Gall and many others.

Do tlic cryptogamic productions of the skin play the part
of determining cause, or are they not merely accidental epi-
phenomena of the affections denominated parasitic '." This
is the question propounded by Jabez Hogg, and which lie
seeks to investigate. Each 'side of the question has grave
authority to sustain it. Dr. Bennett maintains that these
vegetable formations are secondary, and are only found on
animals previously diseased. Drs. Kobin,. Gali, .Tenner,
Bazin, and others, on the other side, affirm that the parasite
is the sole cause of the disease. Dr. Jabez Hogg inclines
io the opinion of Bennett ; and here follows an epitome oY
the arguments on which he is supported :

1st. The vegetables of the order Fungus invariably derive
their nutritive elements from matter, the vitality of which
is diminished, and in the way of being decomposed, or
already partly decomposed.

2d. These vegetables have nothing characteristic, for they
have been observed in almost every species of chronic dis-
ease of tlie skin. Thus, in twenty cases of Leprosy and
Psoriasis, evident traces of vegetables were found in ten.
The same production was noticed, in two out of three cases
of Lichin, four times out of six cases of Eczema, in one
rase of Ichthyosis, and in one of Spilus. None of these
cases passed for being caused by fungi, according to Jabez
Hogg.

3d. Other observers have not been able to lind fungi in
the diseases that have been, attributed to their develop-
ment; and Dr. Hogg cites in support of this allegation,
and as competent authority, Malherle, Cazenane and
AV^ilson.
3

*From Gazette Hcbdomadaivc dc Medicine et dc Chtrurgie. July, 1859.

I860.] V rites of the Human Skin.

A.mong the disease passed in review by Dr. Hot
is found in the first rank : I m t the singularity of the matter
is, that in a goodly number of cutaneous affections, he has
encountered uol one single case of this disease; which, it is
fcrue is very rare in England.

The preceding considerations induce the author to con-
clude thai there doc- not exist parasites characteristic of
such and such diseases, and constituting their determining
cause, He adds to the proofs he has given, thai the inocu-
lation tried by Remak and others, repeatedly, od sound in-
dividuals, always tailed, and that cutaneous diseases arc
rarely, if they are ever, cured by the destruction <>!' the
parasites; whilst they may he remedied by tie- suitable
administration of alteratives ami tonics, such as are suscep-
tible of correcting the dycrasia of the blood, the true source
of the disease.

The memoir of Dr. Hogg, of which we have given but
a very concise summary is quite extended. It has required
very considerable research, and therefore deserves to beheld
in consideration. Notwithstanding it is very easy to be
convinced, in reading it, that the author is not perfectly
posted in the science appertaining to this subject. Many of
the arguments employed by him are valueless.

It were necessary, in order that we should eomprehend
the result at which lie arrives, by an examination of many
cutaneous affections, that he should have specified well,
Lichen^ Eczema, etc., instead of assuming, as Dr. Bazin lias
done, that certain varieties of these eruptions ought to enter
into the group of parasitic affections.

No one will dispute hut there may be conditions of the
Boil that favor the development of the cryptogamia. With-
out this, it would be very difficult to explain why the
.A<-arion Schoneinu, or Fungus of (he favus, vegitates, in pre-
ference, on the hairy scalp of infants : why the Trwophyton
tonsurans should occupy, by predilection, the same seat in
children, and the parte of the face covered by the beard in
man (Mentagra.) .But avc must not attribute to these con-
ditions of the soil more importance than they deserve,
whilst they exert only a pre-disposing influence.

Dr. Hogg still invokes, in favor of his opinion, facts that
can lend him no aid. He cites the experiments of Remak,
and says the inoculations tried by him did not succeed.
Now, the inoculation, or rather transplantation, practiced
by Remak on himself did succeed perfectly. Bazin, more-
over, has been successful not only in inoculating the favus,
but also the Tricophyton tonsurans.

L60 Vegetable Parasites of Ifo Human Skin. [Juno,

Finally, Dr. Hogg contends that the destruction of the
parasite but rarely cures the cutaneous affections called
parasitic, if indeed it ever cures them. And further, ac-
cording to him, these affectioes may be cured, by a system
of medication, directed solely against the dycrasia that
causes the disease.

In order to express as exactly as possible, the truth on
these two points, we must take the counterpart of Dr.
Hogg's proposition. The beautiful experiments of Dr.
Bazin have established irrefutably and this is one of the
greatest progresses in pathology in modern times that the
radical destruction of parasites, such as is made by epila-
tion, is the sole efficacious means of treating parasitic affec-
tions, having a vegetable cause.

Of all the arguments of Dr. Hogg, there remains only
one sole assertion L e. That fungi have been found in
many diseases, not hitherto ascribed to cryptogamic pro-
ductions as a cause. We have already made reservations
in regard to certain facts. As to others, what do they
prove ? We should not, in any manner, be surprised, if
there should be found spores, after an assiduous search, in
the products of various eruptions. But how can any com-
parison be established between these cases and those where
the spores, either alone, or accompanied by sporuUes and by
mycelium, are in considerable quantity, and have penetrated
to the midst of all the elements they enter. It is enough
to examine, by the aid of a microscope, a small portion of
a cell in ffltrus, a hair torn from a part affected with Men-
tagra, a parcel of the scales in Pityriasis versicolor, to be con-
vinced of the importance exerted by the Gryptogamia in these
affections importance demonstrated in a manner altogether
peremptory, by the effects of the parasiticide treatment.

This new war, very benign to be sure, against the con-
quests of the microscope, in the field of cutaneous patholo-
gy, will have no better success than the others. Whatever
may be said to the contrary, the microscope, in all these af-
fectious, has rendered an immense service. It has thrown
light upon these affections, previously so little understood.
It has led Dr. Bazin to establish a rational and methodical
treatment for them, and to substitute for the secret remedies
vaunted by the successors of the Mahans, a more simple
and efficacious medication. The aigumcnt appearing most
in fashion at present, consists in saying that the parasitic
diseases were cured before these new researches were
made. We will say nothing of the Itch, but as regards the

L860.-] Cold I on in Narcotic Poisoning, 161

cutaneous affections produced by the cryptoqamia, they were

not cured certainly but in a very small minority of C8

This is proved by the physicians sending their patients to
the brothers Mahan, in despair of healing them by their

own moans ; proclaiming thereby their proper inability. I.
speak here of the Plica only. The Mentagra may righfully
pass, in certain cases as altogether incurable; and the Itch
itself, although the method of general friction had been
employed, we were so little instructed in its effects previous
to the investigations of Dr. Bazin, that we daily resorted to
some new mode of medication, either externally or inter-
nally. Now, it is the microscope that has brought us to
understand the utility of general frictions ; and since that
time this method is nearly the only one put in requisition.
It is to the microscope that we are indebted for the disem-
barrassment of that incessant and deplorable hatching -oat,
still-born therapeutic means of cure. This most precious
instrument has taught us why the epilation and the parasti-
cide lotions, general frictions, and parasite-destroying unc-
tions, heal the cutaneous eruptions caused by parasites.

If we call medicine an Art, it is a Science also. To know
how to cure a disease is evidently the supreme aim of the
Art. To know the wfo refore of the curing of this disease is
almost the last words of Science.

On Cold Affusion in Narcotic Poisoning. By Dr. Reeves
Jackson/

"Under the impression," says the author, that the value
of cold allusion as a convenient and most effectual remedy
in cases of narcotic poisoning, is not so highly appreciated
by the-Profession as it should be, I am induced to relate the
following cases : Every Practitioner who has had experi-
ence in such cases, must have been painfully sensible of the
impotency and impracticability of many of the ordinary
means. When the degree of narcotism is very great,
emetics cannot be swallowed, the stomach-pump is frequent-
ly not at hand, and galvanism, although a remedy of un-
doubted power, usually cannot be resorted to from want of
the necessary apparatus. In view of the difficulties which
surround the treatment of these cases, it is fortunate that
there is a remedy ahvays at hand, and one that in nearly
every case in which recovery is possible by any means, is
promptly effectual."

462

Cold Affusion in Narcotic Poisoning.

[June,

Three cases are related in exemplification of these obser-
vations. The first was a child eight months old, to which

a large dose of Godfrey's cordial had been given five hours
before the author saw it. Intense stupor and rapid sinking
were present, and the case seemed hopeless. The head
being turned downwards, a steady stream of cold water was
poured from a coffee-pot over the occiput. When two or
three gallons had thus been poured, the child made a long
gasping inspiration, and opened its eyes. They were soon
closed again, hut after the affusion had been continued
awhile longer, the breathing became more distinct, and the
child uttered a feeble cry. Suspension of the affusion was
attended with complete reproduction of the sopor, which,
however, soon yielded on its resumption, and after awhile
the child having been got to cry lustily, vomiting was pro-
duced by means of an emetic and tickling the fauces. In
two or three days the child had regained its usual health.
2. A lad, aged 19, suffering from facial neuralgia, drank a
large tablespoonful of laudanum. The author was called to
him seven hours after, and found him under the full pois-
onous effects of opium ; the surface cold and clammy :
the breathing irregular, slow and stertorous ; the respira-
tions eight in the minute ; the pulse full, slow and very
irregular, the pupils very contracted and insensible to light,
the countenance calm and pale. Various means of arousing
and exciting him were tried in vain, when cold water was
poured upon the head from a large pitcher, held at a height
of about eighteen inches. The effect was almost magical in
arousing his sensibility; and, after awhile, violent vomiting
ensued, all symptoms of drowsiness disappearing afterwards,
under the use of a cup of strong coffee. 3. This was an
example of poisoning by belladonna, occurring in a lady, to
whom it had been administered in an enema for the relief
of neuralgia of the rectum. She was found by the author
completely insensible, with a swollen, flushed face, slow,
unstertorous breathing, and a small, hard (180) pulse. Va-
rious means were employed to arouse her without any
effect A large enema of thin gruel was first administered
in order to clear out any of the poison that might remain in
the bowel; and a steady stream of water was then poured
upon the back of the head and neck. In about five minutes
she made an attempt to articulate ; and the use of the affu-
sion was suspended, as the patient was cold. Placed in
bed, and lightly covered, in ten or fifteen minutes her fact-
became flushed, and she again fell into a deep sleep. The

I860.] itment of Corns. 163

cold affusion was re-applied, and she soon regained con-
sciousness. Although she continued drowsy for some
hours, she recovered without the use of any other remedy,
her vision remaining dim and confused for aboul three
weeks.

Dr. Jackson observes thai although the efficacy of cold
affusion in opium-poisoning has been proved before, I
not aware ol*"its employment in the case of belladonna.
"Toxicologists agree in stating that where an overdose of
belladonna basbeen taken, the stomach and intestines are
peculiarly insensible to impressions; and, in fact, the whole
nervous system is temporarily paralysed. This fact, of
course, detracts very much from the amount of dependence
to be placed on emetics and purgatives, even when they can
swallowed, and obviously enhances the value of a remedy
so simple and convenient, and which promises to be so use-
ful, as cold affusion to the head. Evacuants, even admitting
that they produce their full therapeutic action, can do little
more than rid the system of that portion of the poisonous
substance, which is still unabsolved, and although highly
useful for this purpose, and not to be neglected, yet, as
remedies to relieve the narcotism already produced, and
which forms the real source of danger, they are compara-
tively worthless. Hence the necessity of a remedy which
has the power to stimulate the nervous system to a sufficient
degree of action to maintain the vital functions, while
labouring under the prostrating influence of a narcotic
poison." American Journal of Medical Science, 7i%,'p. TT.

On the Treatment of Corns on the Sole of the Foot. By
Holmes Coote, Esq., F. E. C. S., Assistant Surgeon to
St. Bartholomew's and to the Royal Orthopaedic Hospitals.

I have lately had under my care some cases illustrating the
nature of this painful affection and its treatment. It may be
necessary to remark that corns are technically termed "clavi,"
from a fancied resemblance to the head of a nail ; but most
persons know that they consist of thickened epithelium or
cuticle," and that a small bursa is sometimes found between
them and the subjacent parts. They proceed entirely from
undue pressure ; hence they appear on whatever parts of the
feet a pair of badly titting boots or shoes press unequally and
unpleasantly. The remedy is simple, and consists in the per-
son so affected wearing boots with a sole as wide as the sole of

4G4 Treatment of Corns. [June,

the foot, of ample length, square at the toes, and with the
upper leather soft and moderately loose. But this advice is
rarely followed, fashion exerting a more powerful influence
than common sense."

There is however a form of corn which is found on the sole
of the foot, the pain attending which is so great that patients
are at times unable either to walk or stand. Mr. Erichscn
notices it in his work on Surgery. "It is usually of small
size and round in shape, the neighboring cuticle being always
greatly thickened and hardened. It is extremely sensitive to
the touch, the patient shrinking when it is pressed upon, as if
an exposed nerve had been injured. On slicing it down with
a scalpel, it will be found to be composed of soft, tough and
white epidermis, arranged in tufts or small columns, in the
centre of each of which a minute black dot is perceptible.
Each tuft appears to be an elongated and thickened papilla,
and the black speck is a small point of coagulated blood which
has been effused into it. Around the depressions in which
each of these corns is settled, the hardened cuticle forms a kind
of wall." p, 439.

I have known ulceration to occur in this morbid structure,
when a deep and foul sore, exceedingly sensitive, is formed.
It may be healed by rest, but it recurs when the patient
resumes the usual habits.

Now the cause of these corns will generally be found to
proceed from a tense condition of some of the important ten-
dons, that most frequently affected being the tcndo-Achillis.
AVhen it is so contracted the foot cannot be raised beyond a right
angle, and itfollows that the weight of the body is unduly thrown
on the fore part of the sole of the foot, where the corn speedily
forms. The contraction of the tendon may be so slight as to
need careful examination for its detection ; but so long as it
exists, the cause of the corn remains, and it will be found that
any other measure less than the division of the tendon, will
be only palliative. The subcutaneous division of the tendon,
its elongation, and the restoration of the foot to its normal
bearings, must be conducted on the usual principles of ortho-
paedic surgery. The practice has been adopted many years
at the Orthopedic Hospital ; but it is not so generally known
as, in my opinion, is desirable.

The number of physicians in the State of Virginia,
according to the census of 1859, is 2,072.

I860.] Pulmonary Phthisis. 165

On the Curability and the Treatmentof Pulmonary Phthisisand

Tubercle.

At ii meeting of the Emperial Academy of Medicine,
Oct. 15, M. Piorry commenced the reading of a memoir
'On the Curability and the Treatment of Pulmonary
Phthisis and Tubercle." He did not, however, finish.

-Is the symptomatic collection to which authors give the
name of pulmonary phthisis susceptible of cure ? This ques-
tion must be answered affirmatively. But in our day it is
not a question of stating whether phthisis, considered as a
-disease, may be cured, but of determining if tubercles,
having their seat in the lungs, arc susceptible of being re-
moved, or at least of becoming inoffensive ; it is in this
point of view that T shall consider the question. For a
long time tubercles have been considered incurable. It is
our illustrious Laennec who first established the possibility
of their cure. I have published numerous observations
which put this opinion beyond a doubt. Besides, Ave have
every day examples of cure of certain organs attacked with
tubercles, (lymphatic ganglions, vertebra, articulations, tes-
ticles, etc.)"

After having established the curability of tubercles, M.
Piorry examined the series of means of treatment which
rational medicine must oppose to the accidents united un-
der the name of pulmonary phthisis.

"Before all," said he, "the regimen must be regarded as
the preservative, palliative and curative means par excellence.
The first indication, in order to combat the tuberculous
state, is to nourish the patients. The alimentation ought
to be rich and abundant so long as the ingested articles do
not produce diarrhoea, which may weaken more than the
food can repair. In order to reconstitute the blood, to
remedy its discoloration or loss of globules, the least irrita-
ting ferruginous preparations must be given as, for exam-
ple, the iron by hydrogen save in cases of haemorrhage or
mucous diarrhoea. The second indication is to evacuate
the fluids which may obliterate the bronchia?. For this
purpose we administer tartar emetic and syrup ipecac.
There are still two simple means which have been of ex-
treme utility for several of my patients : the first is the in-
halation of the vapor of the infusion of the elder tree, or
the flowers of mallow ; the other consists in provoking slow-
ly a very profound or deep inspiration, which is to be followed
by o ftr>/ quick, energetic expiration. This should be so man-
aged by tlie patient, that the air passing* out should carry
30

40b' Pulmonary Phih [June,

before it the liquids contained in the air passages. The
first of these means moistens and softens the too thick spu-
ta, and the second provokes its expulsion. Another press-
ing indication is to prevent the putrefaction of the secre-
tions in the tuberculous cavities, and to prevent the absorp-
tion of the pus or pyoid matter which accumulates in them.
It is these matters which, penetrating the circulation, pro-
duce hectic fever, night sweats and the rapid weakening of
the patient. It is to prevent these accidents that it is
necessary to make the patient expectorate, as has been al-
ready said. To prevent the putrefaction of the secretions,
the inhaling of the vapors of alcohol are agents of the first
order. The putrefied secretions, not only in relation to
their absorption, bnt numerous facts have led me to believe
that they produce, by their presence on the gastrointesti-
nal membrane, diarrhoea, softening, and even ulcerations ;
it is then extremely useful, in order to avoid tubercular in-
flammations, that the secretions should be expectorated and
by no means swallowed. I have seen diarrhoea arrested
wben they have avoided the deglutition of expectorated tu-
berculous matter. It is of the greatest importance to ar-
rest the evacuations from the bowels and skin, which so
much weaken consumptives; but there are extreme difficul-
ties in fulfilling this indication. The only means truly effi-
cacious are, the washing out the large intestine with water
by the aid of the irrigator of Equisier; of preventing, as
has been already said, the deglutition of the expectorated
matter; of preventing the altered pus from remaining in
the cavities and thus causing pyemia, which is soon follow-
ed by diarrhoea ; of giving but small quantity of drinks,
and of choosing among the aliments those which as albu-
men, etc. do not cause, in general, very liquid stools.
Milk for consumptives is an excellent article of food. It
does not cause diarrhoea, if care is taken to reduce it one-
fourth by prolonged boiling. As to the sweats, the best
means of lessening or combatting them is to see that the
patient is not covered with heavy clothes, and that he
breathes a pure air, frequently renewed and properly warm-
ed. Is there any medication which can act usefully on the
indurated masses in the divers degrees which surround or
repair tubercles ? Some thousands of facts collected in the
wards of La Pitie and Charite permit me to solve this ques-
tion. It is no longer doubtful that the preparations of
iodine, administered in fumigations, potions or frictions,
etc., do modify very advantageously the destructive pro*

l 860. ] Treatment of AscaricU ?. 167

of tuberculization. Under the influence of the iodine medi-
cation, combined with profound and reiterated inspirations,
I have seen tuberculous indurations diminish in extent, the
symptoms of the disease amend very sensibly, the app< tite
return, the action of the heart increase in force, and the
adipose tissue increase. I have seen this relict' persisl for
months and years in certain eases. Bui it must be avowed
thai the number of radical cures is yery small, and I can
only recall a dozen o\' veritable solid cures. Some persons
have opposed the iodine medication in the treatment of
phthisis; this is evidently owing to the fact that this pre-
cious remedy lias not been employed by them in the most
advantageous manner. Some have attributed to iodine the
production of inflammation of the mucous membrane of
the nares, pharyngitis, etc., softening of the tubercles, and
the hastening o{ the fatal end; analogues to those of phthi-
sis, which cease if we stop the remedy. I fear that some
may have confounded, from an incomplete diagnosis, the
effects of some accidental or secondary complication such
as a pleuritis with the jmenomena the results of the em-
ployment of iodine. I have followed my patients with
great attention ; they have been numerous, and I have never
witnessed any such results."

Treatment of Ascarides.

Sir I have already called the attention of your readers
to this subject ; and I trust you will allow me to do so again.
1 think we are disposed to under-estimate the importance of
the malady in question ; for, to judge from my own expe-
perience, I should say that there are a very great number of
individuals who are tormented b}T these animals. One can-
not help thinking, that if only one tithe of the high scien-
tific powers which are daily exercised in the investigation
of all sorts of incurable diseases, were exerted upon this,
that a discovery of real value to humanity would almost
infallibly result. Here is a complaint, which a priori, we
have a right to conjecture is a curable complaint ; and yet
it is one which numbers of individuals are subjected to from
infancy to old age. I must say that I have really been sur-
prised, since looking into the matter, to find how many per-
sons are infested and tormented by these wretched crea-
tures. It is curious that the greatest authority on this
subject, Kuchenmeister, appears to have been all his life

468 Treatment of Ascarides. [June,

troubled with the animals in question a fact which
may lead people to the idea that their eradication is impos-
sible. Now it seems to me to be very evident, that if ever
we are to arrive at their complete removal, two facts in the
history of these animals must be ascertained; and these
two facts I can nowhere find satisfactorily told. I therefore
conclude that they should he the special objects of study
with those who desire to investigate this subject. The
first is, What is the actual seat of the ascarides how high
up in the intestines do they live and breed? It is truly
surprising to find how little really is known upon this point,
though on consideration of the fact, that in post mortem
examinations the investigation of the subject is usually
altogether neglected, we have a ready explanation of the
ehvumstancc. We want to know, then, first ? Do these
animals live and breed higher up in the intestine than our
injections, etc., per anum, can reach ? Are the ova depos-
ited high up, and the animals developed as they pass down,
making their presence known only in the rectum ? Or,
again, do they live and breed and are developed only in
the rectum'.'' If these animals' ova are deposited high up
in the intestine, then we may conclude that remedies ap-
plied per anum can only give temporary relief by removing
those oi^ the animals which are present in the rectum. But
if it he shown, on close study of their natural history, that
they live and breed only in the rectum, then we have to in-
vestigate why it is that remedies are in so many cases, inef-
ficacious for the cure. We want also to have a remedy
shown which, while it is destructive to the ascarides, is at
the same time harmless as regards the intestinal walls.
These are all points which scientific investigation has yet to
make dear, but which are yet clearly points about which it
may be exercised, with every prospect of yielding, a most
happy harvest of facts. Does the thick mucus, which ;
readily thrown out by the irritated mucous membrane of
the rectum, form a cover or nidus for the ova, protecting
them against the destructive influence of injections ? Or,
again, may not the ova of the animals (if their actual and
only habitat be the rectum) be deposited beneath those large
folds of mucous membrane which encircle the lower portion
of it in particular, and so in great part escape altogether the
action of injections, unless when large quantities are thrown
into the gut. so as to distend it completely '.' Every day we
see in the scientific journals accounts of a certain cure for
ascarides ; hut the tact, which I started off with, viz., that

L860.] ,J"" of the Vagina, 169

numbers of individuals nave been all their life the subject -
of these worms, and cannot gel rid of them, proves that the
rignl cure has yel to be found. I think I bave above pro?
posed two questions, which if answered, will mosl assu-
redly either giveus a certain cure in all eases, if a cure i
attainable by injections, or will show us what is now-a-da)
denied thai we must try to attack the animals by remedies
administered throueh the mouth.

Occlusion of th Vagina Operation Recovery, Communi-
cated tor the Boston \iedical ami Surgical Journal.

Mrs. M. M., thr Bubjecl of this notice, was -- years of
age; rather below the middle size, weighing about 110
pounds ; of dark complexion, with dark-blue eyes, and of
bilio-sanguineous temperament. Had been married -\\
years: had never menstruated, so far as she knew, and bad
never had connection with her husband. The breasts and
external organs of generation were fully developed, and in
good proportion.

We were called to see Mi's. M. Sept. 19th, 1859. Found
her suffering severely from retention of urine having
passed very little water for the previous twenty-four hours.
On attempting to introduce a catheter, we found a large
tumor round, hard, and resembling in its appearance, ;i
child's head pressing upon the vulva, and entirely obscur-
ing the urethra.

Did not succeed in introducing the catheter. A saline
cathartic and diuretics were ordered.

Sept. 20th. Saw our patient in the morning, and as<
tained the following facts. She had observed swelling of
the lower extremities from four to six years anterior to our
to our seeing her; otherwise had enjoyed good health, until
about six months before our first visit, since which time she
had suffered with pain in the back, and had noticed a tumor
in the lower part of the abdomen. Had never suffered on
account of her water until about a week before she called
upon us; nor had she at any time suspended her usual do-
mestic avocations until the last mentioned date.

Upon examination, we found everything normal except
the vagina. That organ, entirely occluded, with its walls
a quarter of an inch in thickness, having the appearance of
a hard, round substance, was pressed down upon the exter-
nal labia, so as to separate those parts to a considerable ex-
tent, and terminated in a perfect cul de sac.

470

'Epidemic Whooping- Cough.

[June,

Slight fluctuation was observed in the tumor, which led
to the conclusion that it contained a fluid, and that that fluid
was the menstrual discharge, which had been regularly
secreted, and deposited in the occluded vagina, since her
womanly development

A trocar was now thrust into the sac, and three quarts of
a thick, black, inodorous fluid, closely resembling tar in
color and consistence, were drawn oh". The opening was
then freely enlarged, and the parts kept seperated with
tents, and thus a very convenient, artificial opening and
entrance into the vagina was made. Our patient has
enjoyed good health since the operation, menstruating
regularly, until she became eneiente, which is her condition
at this time.

That the vagina should be perfectly occluded, while all
the other parts were in a state of entire development, is no
more singular than many other aberrations of nature of
almost daily occurrence, yet there are some inquiries perti-
nent to this case :

1st. Did this patient come to maturity as early as other
healthy females ?

2d. If she menstruated as freely as ordinary females,
ought not the quantity of this fluid to have been greater?

3d. How could this mass of excreted matter have remain-
ed for so long a period of time, in that pent-up condition,
and vet without offence ?

Treatment of Epidemic ^Vhoopiivj-Cov.rjh oy Vaccination.

According to the statement of Dr. Otsolig, the above named
treatment, recommended by French physicians, was repeat-
edly tried in the hospitals des Kownoschen Gotwernments^

with the following results : 1st, the vaccination passed through
its regular stages during this disease : 2d, it had in some cases
an obviously favorable result upon the issue of the cough, cut-
ting short its duration, and modifying the violence of its
attacks: 3d, in many cases no perceptible impression was
made upon the disease. In some cases the internal use of
tannin, (gr. vi., in broken doses every twenty-four hours.) in
connection with an infusion of senna-leaves, proved to be of
great value, six days' continuance often being sufficient to
cure the disease. GruvacVs Not

I860.] Strychnin* in II 171

Lactagogiu Effects of ih\ Leaves of (/>< Castor Oil Plant

\\ the meeting of the Medical Society of London, on the
12th nit, Dr. Ronth exhibited three preparations of the leaves
of the castor oil plant, a tincture and Liquor, (doses of each
one drachm,) and an extract, (dose, live grains.) The leaves
were obtained from Australia, and the drugs prepared by Mr.
Greenish, of London. The Society would remember that Dr.
Ronth had read a paper on the subject of the lactagogue
effects of this plant, the leaves of which, applied to the
breasts as poultices, and as fomentations to the vulva, f<>r
three days at intervals, were used, in Bonavista, to induce
milk in the breasts of women within catamenial ages, but par-
ticularly in those women who had borne children. The milk,
once produced, could be perpetuated by the simple irritation
effected at the nipple by the suction of a child. These facts,
related by Dr. M William, had been continued in part by Dr.
Tyler Smith. Dr. Ronth had published his experience on the
subject also, in a series of papers. To lying-in women, with a
deficiency of milk. Dr. Routh had given the infusion, in com-
bination with conger-eel soup, and the effect in determining
a copious flow of milk had been remarkable. He had admin
istered the extract to unmarried women within catamenial
ages, and the effect had been to produce intense pain in the
breasts; but as lie could not find anybody in that case who
would try the effects on a child, he had not yet induced milk
in the breasts of such. After three or four days, the symp-
toms were relieved by a copious leucorrhcea. As it was pos-
sible that a larger experience of this remedy might enable u
to convert some married women, within catamenial ages, into
wet nurses, and as it undoubtedly acted as a powerful lacta-
gogue in suckling women, he was desirous that others also
should experiment on the subject, and therefore to direct them
where it could be procured. Lancet.

Strychnine in Ileus.

Junhauser, of Vienna, cured chronic ileus of a lady, sixty
years of age, who suffered frequently from colic and torpidity
of fecal discharges. After five days of costiveness, violent
diarrhoea supervened, which defied all remedial agents. This
condition was finally relieved by strychnine. In giving it, he
proceeded upon the theory that the cramp occurring in the
dysenteric process, and the attending blood stasis, was of a

472

An rosed Bone.

[June,

reflex nature, and caused by a disturbed innervation of the

nervous centres presiding over the intestinal canal. Junhauser
prescribed one-sixth oi a grain of strychnine dissolved in fyj.
of distilled water, and gave one teaspooni'ul every two hours.
As. soon as about two hours after the first dose was taken, all
emesis and strangury subsided. Borborygmi came on, at-
tended with the passage of a large amount of gas, with violent
noise. After a few hours, quite a quantity of feces, in the
form of SCybala, then a second, which Avas quite thin, when
the lady, much exhausted, fell into a deep sleep, with copious
perspiration. Until noon there were frequent large discharges
of feces and gas, thin and very fetid, which passed off with
colic pains. The urinary secretion, which had been very
sparing, became abundant. Under the use of a strictly regu-
lated diet and proper regimen, the patient rapidly recovered
from a state of extreme emaciation. Wien ZeiUchr.

Necrosed Bone.

Dr. Jas. R. Wood presented a specimen of necrosed bone,
which was taken from a man, who, four months before, suf-
fered amputation of the thigh, for compound fracture of the
leg. The wound healed soon after. The amputation was
performed below the junction of the middle and lower thirds
of the thigh. Shortly after it had closed over, dead bone be-
gan to show itself; and it was found that the whole of the
circumference of the lower portion of the femur, was in a
necrosed condition ; which gradually extended, the separation
of rhe periosteum being encouraged by the frequent introduc-
tion of probes, &c., between it and the bone. Very soon,
new bone began to be deposited from this periosteum, which
has increased until the present, when about four and a half
inches of the distal extremity of the bone was removed with a
pair of duck-bill forceps. The new deposit is enormous, being
about four times the natural size of the bone.

In connection with this specimen, he stated that Dr. Markoe
looked upon the cause of necrosis in that locality, as owing to
a want of nutrition of the bone, the supply of blood from the
medullary artery having been cut off; and referred to a very
clever paper, by that gentleman (Dr. M.), which was published
in a recent number of the N. Y. Journal of Medicine.

The Purity of Glycerine may be tested by dropping into
a glass oi' it a few drops of nitrate of silver. If, as is often
the case, the glycerine contains any chlorides, there will
immediately take place a cheesy precipitate. Bull, Thcr.

I860.] Editorial. 178

EDITORIAL AND MISCELLANEOUS.

American Contributions to Medical Knowledge. We Are much
gratified to find thai the valuable idea of otir able colleague, Professor L-
A. Dugas, recently presented in I hose pages, 1ms met the general appro-
bation of the profession. The following is from the May number of the
St. Louis Medical Sf Surgical Journal. We sincerely hope it will
not be long ere " American Contributions to Medical Knowledge "
will find an embodiment, and command the consideration they so richly
merit.

Professor Dugas, of Georgia, in an article in the Southern Medical
i\- Surgical .Journal, addressed to the American Medical Association,
(after pointing out the disadvantages under which the profession in this
country labor in not having the numerous and valuable contributions to
practical medicine and medical literature, which are constantly made in
our domestic journals, collected and preserved in a condensed and per-
manent form for reference,) suggests the practicability and desirability of
a republication similar to Braithwaite's Retrospect or Banking's Abstract.
He says :

" Let a semi-annual work be published by subscription, bearing the
title of ' American Contributions to Medical Knowledge,' or any other
similar import. Let it consist : 1st, of a reprint, partial or complete, of
all such papers contained in the 'original department' of American Med-
ical Journals as may be deemed worthy of permanent record ; 2d, of
Reviews of American books on medicine and its collateral branches ; 3d,
of abstracts from the original matter of our journals that may not appear
under the first head ; 4th, of medical intelligence, biographical notices,
&c.; and lastly, of a complete list or index of the original articles of every
American medical journal issued during the preceding six months. To
this might be added, whenever convenient, general indexes of the whole
series of the various American medical periodicals. The lack of a gen-
eral index to our journals makes the labor of consulting them exceed-
ingly onerous, and doubtless constitutes one of the greatest impediments
to the diffusion of American views in systematic works."

His idea is, that this work should be published under the auspices of
the American Medical Association. We like the main suggestion, but

474 Editorial [June,

arc of the opinion that it would be far better done a.s a private enterprise
than if it were undertaken by the Association.

There is no doubt of the fact that foreign medical writers, and medical
journalists, both British and Continental, do habitually and systematically

cither ignore altogether American contributions or else discredit the
veracity of American reports. They are not willing to admit that we
have any medical literature of our own, or that we are entitled to be
smized as fellow-citizens of the republic of medicine. This, it is true,
is the result of ignorance and prejudice, which is worthy only of con-
tempt. Still, the time has arrived when we should set up for ourselves,
and at least do justice to our own writers. In our opinion, the profession
in this country is not one whit behind that of any other country under
heaven, and self-respect requires that we should teach the world that
there is an American profession as well as an American nation. But, in
order to do this, we must first learn to respect ourselves, and American
periodicals must learn properly to appreciate the labors and contributions
of their own countrymen. This, we boldly assert, has not heretofore been
done. Take up almost any of our domestic journals, and three-fourths
of all the extracts will be found to be from foreign sources, to the almost
entire neglect of matter equally as meritorious of home production. We
do not desire to be invidious, but, by way of illustration, take the oldest,
the largest, and we presume the best sustained journal in the United
States, " The American Journal of the Medical Sciences " and what
do we find scores of closely printed pages devoted to extracts from for-
eign journals, with here and there a page or two gleaned from the forty
or fifty periodicals published in this country. Indeed, so struck have we
been with this remarkable feature, that we have often thought that the
title of this ponderous quarterly was a misnomer ; and that it might more
properly be styled the American Journal of Foreign Medical Sciences.
In justice, however, to several of our leading periodicals it should be
stated, that they have recently commenced to publish a resume from our
home journals, and thereby added no little to the interest of their pages.
Still, as a general thing, the facts are as we have stated; and while it is
so, we should not complain that our national medical literature is not
recognized and appreciated abroad, when in point of fact we set the ex-
ample by discrediting it ourselves. Whilst, therefore, we heartily second
Dr. Dugas' move, and hope soon to see his suggestion carried out, we at
the same time call upon our own countrymen to be more liberal, more
just, more appreciative of their confreres at home. Then, and not until
then, can we hope to have our national literature respected and honored
by the rest of the world.

I860.] Editorial. 175

A-Nimal Oils in Fever. hi the present number will 1"- found a
valuable article on the use of external inunction with animal t-ii in
Fevers. Wc regret that an almost morbid repugnance to occupying
apace, has prevented Dr. Baker from giving the details of many of his
interesting cases. We have, upon his suggestion, used this method in
Typhoid Fever for several years, and can fully vouch for his high opinion
of the treatment from personal observation. The firet case of Typhoid
Fever in whioh inunction was used in our practice, was visited with as
by Dr. Baker. At his suggestion, the patient was rubbed over with lard
twice a day. The improvement was rapid, and the convalescence pro-
ceeded to entire recovery in a very short time. We have frequently
>inee used the application both in Scarlatina and Typhoid Fever, and
can report the most satisfactory results* n. F. C.

The Diseases of the Ear; Their Nature, Diagnosis and Treat-
ment. By Joseph Toynbee, P. R. 8., etc., &c., with one hundred
engravings on wood. pp. 440. Philadelphia : Blanchard <fc Lea. 1860.

The mere title of the above work would almost secure for it a place
in the library of every practising physician. No class of diseases can be
contemplated with so little satisfaction by the general practitioner, as
those which relate to the apparatus of audition remotely and obscurely
situated in its petrous bony capsule, the auditory apparatus is but little
understood by the generality of practitioners cither in its anatomy, its
physiology, or its pathology. It is seldom subjected to inspection and
study in the dissecting room, on account of the difficulty attending the
display of its several parts, and the delicate manipulation necessary for
its thorough investigation consequently most physicians enter upon the
exercise of their profession writh but very imperfect ideas in regard to
the organ of hearing, and in a few years are willing, of necessity, to re-
sign all interest in that department of practice which relates to it. The
result of this neglect, on the part of the profession, has been to place
nearly all cases of aural disease in the hands of professing specialists who
are, nine eases out of ten, the most consummate quacks. The honest
physician, with mortification and regret, will acknowledge his incompe-
tency, and refuse to take charge of these cases, while the impudent char-
latan, knowing far less, but wholly unscrupulous, will proclaim the most
accurate knowledge and boast of the most invariable and triumphant
success.

* See letter on Typhoid Fever, by Robert Campbell, M. D-, in former volume
of S. M. fy Surg. Journal.

476 Editorial. [Juno,

[Judex these circumstances, then, the truly .scientific and experienced
aurist who has written out both principles and practice to guide the pro-
fession in this department, has performed a real service, the value of
which cannot be too highly estimated. Every practitioner has it within
his power to become thoroughly acquainted with the science of the sub-
ject, and when applied to, can at least examine and converse about any
variety of the cases intelligently and confidently. Instead of pulling up
the external car and looking into it, introducing a speculum, (if he knows
there is such a thing in existence) and saying he " can see nothing out
of the way," he can now go, systematically, into an examination of the
case he can classify the symptoms and educe an interpretation from
them which will point to the true character and locality of the affection
and present him the indications for a rational, and in many cases, hope-
ful treatment. The patient will not be forced to leave him filled with a
well-deserved contempt for both the practitioner and his art.

None could have been found more competent to prepare a treatise on
the subject of Diseases of the Ear than Mr. Toynbee ; engaged, for more
than twenty years, in this as a special department, he has collected a
vast amount of experimental facts and observations, which render his
work one of the highest value his subjects are discussed with a clear-
ness and precision which cannnot fail to enlighten and to impart accurate
information to his readers. Starting with the undeniable assumption
that no true knowledge of any disease can be derived without a direct
inspection of the affected part, our author has made at least two thousand
dissections of the ear in order to determine the condition of the several
tissues in its various diseases. His pathology is therefore based upon
ocular inspection, and his pathologic and therapeutic inductions are
hence entitled to a degree of confidence which few teachers, at the
present day, can justly command. His style is very agreeable he
makes but few references, seeming to rely principally upon his own ob-
servations and reflections, though by no means distrustful of the reports
of others. There is a didactic assurance about all his teaching, which
imparts the idea to his readers that they arc receiving the instructions of
one who is a master.

For convenience, the work has been divided naturally into several
heads. Thus, 1st. Introduction, wherein the subject is considered gen-
erally, and methods of investigation and modes of dissection given. 2d.
The External Ear. :3rd, 4th, 5th, 6th and 7th relate to the External
Meatus. 8th, 9th and 10th, are upon the structure, functions and dis-
eases of the Membrana Tympani. 11th. The Eustachian Tube. 12th

I860.] Miscellaneous. 177

and loth. The Cavity of the Tympanum. 14th. The Mastoid Cells.
1 5th and 16th. The Diseases of the Nervous Apparatus of the Ear, pro-
ducing what is usually called " Nervous Deafness." 17th. Malignant
Diseases of the Ear. 18th. On the Deaf and Dumb. 19th. Bar-
Trumpets and their use.

The Appendix consists of a list of published papers on the subject of
Aural Medicine, and is valuable as a reference.

We have seldom met with a work which has gained so entirely our
unreserved approbation, and which we can so confidently recommend to
the careful study of the profession.

The above work is for sale by Messrs. Thomas Richards & Son, of
this city.

Glueosurkx in Paludal Fever. Burdel, of Vierzon, has
addressed a paper on this subject to the French Academy
of Sciences. The results of his researches are thus stated:

1. In paludal fevers there exists a true diabetes or gluco-
suria.

2. This glucosuria is only ephemeral ; that is to say, be-
ing the indication of derangements in the organism, it ap-
pears with the fever, persists during its continuance, and
disappears with it.

3. Glucosuria in paludal fevers shows clearly the exis-
tence of a special agency destroying the equiKbrim existing
between the cercbro-spinal and sympathetic systems. .

4. Tli is explanation of Claude Bernard is confirmed by
the following facts : The more violent the access, the more
intense the chill, the larger, also, is the quantity of sugar
in the urine on the contrary, when the attacks have been
frequent and have lost their force, and, in. a word, the more
a cachexy is established, the less sugar is produced. Ga-
zette des Hospitaux.

" Such is Homoeopathy. It is not a system, and hardly
an it be called a method. It is really nothing but a com-
bination of hypotheses borrowed from different systems, an
attempted innovation, in which the influence of metaphysics
and mystic spiritualism is mingled; the marvellous plays a
part in it, ami a large part also belongs to the supernatural,
to the invisible, to the mysterious to all those things which
can seduce feeble or ill-enlightened minds.*' lu rm des <f< ux
Mondes.

478 Miscellaneous. [.June,

Memorial to Jolm Hunter, We beg leave most cordially
to recommend to the profession of the State the communi-
cation in this number of the Journal on the above subject,
from a Committee appointed by the Councillors of the Mas-
sachusetts Medical Society at their last meeting. In order
to a more full understanding of the topie, aw Btate the fol-
lowing tacts.

About a year since, an order in council was passed by the
British Government to "close up the vaults and catacombs
under the Church of St. Martin's-in-the-Fields." For-
tunately for the memory of Mr. Hunter, Mr. Frank T.
Buckland remembered that the body of John Hunter had
been laid therein. Accordingly, on February 22d, 1859, be
sought for it and found the coffin "in excellent preserva-
tion," with a brass plate upon it,* bearing Mr. Hunter's
arms and the following inscription :

JOHK HUNTER,

ESQ.

Died 16th Oct'r,

1 7 9 3 .

A.ied 04 Years.

This discovery excited great interest in the minds of the
medical profession of England, and it was finally decided
by the Royal College of Surgeons to obtain liberty to re-in-
ter the remains in Westminster Abbey, among the great
and good, if that could be done."

The Dean and Chapter of "Westminster cordially acceded
to the request in a reply couched in language like the fol-
lowing : " We shall be proud to be the guardians there of
the ashes of so great a man."

Under these propitious circumstances, the body was re-
moved to the Abbey, March 26th, in the presence of the
Medical Profession of London and the adjacent country : it
was placed, with appropriate services, in a spot near "rare
Ben Jonson's" grave. We have understood, from a physi-
cian who was present at the time of the funeral, that the
anthem chosen for the evening service was peculiarly grand
and impressive, as its sounds re-echoed from aisle to aisle
of that noble old cathedral, " When the earth heard him it
bore witness to him." The remains were lowered into their
final resting-place "while the pealing organ poured forth

*A "rubbing" of this plate was presented, not long since, to the Boston So-
ciety for Medical Improvement.

I860.] Miscellaneous. I7:

Handel's grand and sublime chorus, well suited to the
memorable occasion,

' His body is buried iii peace, bul bis name, it liveth evermore.' "

Those events naturally suggested the erection of a monu-
ment to the memory of John Hunter. The profession
throughout England have cordially taken up the subject.
The question now is, whether the profession of Aimerica
will aid in this pious work. It is proposed, as will be seen
by the programme of the Committee, to appeal to the phy-
sicians o[' Massachusetts. Very appropriately, we think,
they suggesl a very small sum ($1.00) for each person. We
sincerely hope for their success, and that the name of every
regularly educated physician will be placed on the sub-
scription list, which it appears is finally to be deposited in
the library of the College of Surgeons, near the museum
founded by the great man, whose name every physician of
the Anglo-Saxon race must ever delight to honor.

The Antiseptic Properties of Iodine. French Academy of
Sciences, (from the Amer. .Med. Monthly,) The true anti-
septic is that which prevents putridity, destroys it when
already existing, and prevents its re-appearance. Such an
antiseptic is iodine. l)r. Marchal employs it in the form of
solution, in an aqueous solution of an iodide. The aqueous
solution appears to he more efficacious than the alcoholic,
since there is produced with the use of the latter a constric-
tion of the tissues, which only admit of slight penetration
of the liquid charged with the antiseptic. The alcohol also
coagulates albumen, which would likewise retard the
absorption.

The iodide solution can be injected into sinous portions
of sanious and foetid ulcers, which cannot be done with a
pulverulent or semi-solid substance. It is only necessary to
moisten the dressing from time to time, without the necessity
of uncovering the ulcer several times a day an advantage
which will be properly appreciated by surgeons. In hospi-
tals, the iodine escaping from the apparatus, saturated with
its solutions, will serve to purify the air of the wards. Dr.
M. thinks there is no condition so favorable for the sick and
wounded, under ordinary circumstance.-, ov in times of
epidemics especially those of a typhoid or typhus charac-
ter as a continuance in an atmosphere suitably iodized.
The miasm arising from crowded quarters, more fatal to
armies than lire or sword, most probably has its antidote in
iodine.

480 Miscellaneous.

Habits of Physicians in 163r Sydenham, in the last
treatise which he wrote, gives fife following- account of his
manner of living : k* In the morning when I rise, I drink a
dish or two of tea, and then ride in my coach till noon;
when I return, I moderately refresh myself with any sort of
meat of easy digestion that I like, (for moderation is neces-
sary above all things); I drink somewhat more than a quar-
ter of a pint of Canary wine immediately after dinner every
day, to promote the digestion of food in my stomach, and
to drive the gout from my bowels. When I have dined, I
betake myself to my coach again, and when my business
will permit, I ride into the country two or three miles for
good air. A draught of small beer is to me instead of a
supper, and I take another draught when I am in bed, and
about to compose myself to sleep/'

Another Sovereign Remedy for Ascarides The Amer. Med.
Monthly says Dr. Compenat has got a cure for ascarides,
which has never failed in his hands. It is a simple injec-
tion of water, containing five, ten, fifteen or twenty drops
of sulphuric ether, according to the age of the individual,
and repeated more or less frequently, according to the
number of the animals present. This agent, he says, has a
double advantage; by its subtility it readily enters into and
destroys the larva?: and, by its antispasmodic powers, it
allays the spasmodic and the nervous symptoms produced
by the animals.

Abortive Treatment of Paronychia. Dr. Van Archen, in
an article in the Medical Monthly, on diseases of the tropics,

-ays: " If called to a case of whitlow which frequently
occurs during convalescence from typhoid fever while
still in its beginning, I order two ounces of saleratus, or
crude carbonate of soda, to be dissolved in about four ounces
of boiling water; in this the finger should be held until the
solution cools, which should then again be warmed, and
kept applied for three or lour hours. In nearly all the
eases this abortive treatment is sufficient to effect a cure.
In more advanced cases the whole finger should first be
wetted and then rubbed with a solid piece of nitrate i^
silver until the skin becomes discolored: the finger must
then be kept in an emollient poultice, until, at the end o\'
thirty-six hours, the whole of the cuticle peels oil" and the
cure is complete. But if suppuration takes place, which is
marked by lancinating pain and throbbing, free incision is
the remedy."

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(new series.)

Vol. XVI. AUGUSTA, GEORGIA, JULY, 1S60. NO. i

ORIGINAL AND ECLECTIC.

ARTICLE XVIII.

Case of Ovarian Disease, complicated with Pregnancy and im-
mense Secretion of Liquor Amnii Delivery of Twins at 5J
months Beeovcry. By E. M. Pexdletox, M. D., of
Sparta, Ga.

Some four years since, Mrs. C , (a lady of small

stature and delicate constitution), was delivered of her third
child. Her recovery was somewhat tedious, involving-
symptoms of engorgement of the womb with partial
paralysis. In fact, she laever finally recovered her usual
health, there being more or less disturbance of the uterine
functions, until August, 1858, when she was taken down
with irritative fever, during which time we discovered a
tumor in the left side, which we immediately pronounced
ovarian. She was put on a gently alterative treatment, her
health gradually improved, and the tumor disappeared in a
lew months, so far as it could be detected by the hand. It
is proper to state, that at one time we referred it to the
spleen, from its position being rather higher than that gen-
erally occupied by ovarian tumors. But her barrenness for
four years, and the subsequent history of the case, con-
firmed us in our first opinion.

During the past year her health Avas good, her uterine
functions natural, catamenia regular up to the 7th October,
31

482 Pendleton. Case of Ovarian Disease. [July,

when she became enciente. The usual signs of pregnancy
supervened, and nothing unusual occurred until ahout the
fourth month, when she began to swell so rapidly that in
one month's time she presented the appearance of full term,
and was so distended as to sutler much pain and inconve-
nience. At this juncture, March 21st. we were called in,
and found her in this condition. The enlargement seemed
to he regular as -in ascites the pain, however, was referred
to her left side, the seat of the old tumor, with a similar
soreness. We could not distinguish fluctuation, and the
tenseness was so great as to excite our fears as to the result.
We put her on diuretics and hydragogues of a drastic
character, such as jalap and cream tartar, hut found no
effect produced on the tumor by the medicine. There was
and had been for some time quite a paucity of urine, hut
no cedema of the extremities or bloating of the face. Wfl
continued our treatment for ten days, with no relief ; on
the contrary, the abdominal enlargement became more
tense, the pain more severe, particularly in the region of
the old tumor, the patient feebler, with inability to w^alk or
even sit up only for a short time, owing to the weight of
the tumor. We determined upon a consultation, and as
we felt the need of a surgical adviser and operator, we sent
for Dr. II. F. Campbell, of Augusta, who came with his
usual promptness.

There were several very difficult problems for us to solve,
upon the right solution of which might hang the fate of
both mother and child. 1st. Was she really pregnant, or
was this ovarian dropsy ? All the symptoms of pregnancy
were present, and we could not doubt, though now (April
2d) quickening had ceased for two days, giving us hope
that, we would not have to destroy fetal life in our efforts
to relieve the mother. 2d. "With what was the pregnancy
complicated ascites, ovarian dropsy, or some other impro-
bable and undehnable cause? Without being able to deter-
mine clearly and satisfactorily what the complication might
be, our course was very apparent, viz: to puncture the
membranes and produce miscarriage, particularly, now that

I860.] Case of Ovarian Disea . L88

we had every reason to believe thai fetal life had ceased.
Accordingly, Dr. Campbell proceeded to puncture the
membranes, which he found very difficuH to accomplish.
It was found, soon, that premonitory Bymptoms of labor
were coming on with a gradual dilatation of the os tinea, ami
we thought best not to interfere too much with the uterus,
that we might produce lesions of its internal structure, as ii
was too high to reach except By an instrument. In conjunc-
tion with these manipulations, we separated the membranes
ami gave wine of ergot freely, and had the gratification of
finding, after a night's rest, that our patient was in actual
labor the next morning (Tuesday, April 3d.)

By 10 o'clock a fetus was expelled, which gave evidence
of having been dead several days. But a new mystery
appeared. No water came with it, the abdomen remained
as much distended as ever, and on introducing our lingers
as high up as possible in ulcro, we discovered a fluctuating
sac of water, which we punctured with the stilct, when a
stream issued forth that deluged the patient's bed from
head to toe, and relieved her almost instantly of the abdom-
inal tension with which she had suffered so much. Another
fetus came down and was soon delivered, which was found
to have been dead but a short time, to all appearances.

Our patient recovered rapidly, and without any untoward
result. Xo tumor is discoverable in the left side, and the
pain and soreness are entirely gone. We suppose that all the
morbid symptoms in the case originated in ovaritis, which
at first was disposed to take on the form of chronic enlarge-
ment, but yielding to the alterative treatment, or the vis
mcdicatri.r nature subsided, until the gravid uterus rose
above the pelvis, and mechanical pressure wis made upon
the ovaries, the irritation and pain returned, which resulted
in effusion and all the other train of symptoms presented in
this remarkable case.

The books throw but very little light on such cases ;
indeed, Drs. Churchill and Ashwell seem to be the only
authors in our reading who have detailed cases of the same
character. The only one which seems to have fallen under

484 Southgate. Essay on Blood-let tin'). [July,

the notice of Dr. Ashwell, was so near like ours in every
important particular, that after reading it we felt well
pleased at the course we had marked out in the treatment,
and the general pathological views we had taken of the case.

A similar case occurred in this county some 3-ears since,
in the family of Dr. Green, only the woman (a negi
carried hers to a successful delivery, though every one was
astonished at her undue size previous to her accouchment.
The Doctor informed us that gallons of amniotic fluid
passed from her as in the case of Mrs. C .

As Dr. Camphell was with us, and took great interest in
the case, we hope he will add to our imperfect report any-
thing which may have escaped us, and particularly such
cases from other authors as he may find, in his researches
in this heretofore almost untrodden path of pathological
science.

[We are so well pleased with Dr. Pendleton's excellent
report of the above case, that we have concluded not to add
here a single remark, even at his own suirixestion thus
kindly made. 11. f. c]

article XIX.

An Essay on Bloodletting, read before the Medical Association
of the Stede of Georgia, at their Annual Meeting, laid at
Borne, April 11th, 1860. By Robert Southgate, A. M.,
M. D., of Augusta, Ga.*

Motto. Nil remedium, nisi tempesHvo usu sit.

Mr. Presidext axd Gextlemex T invite your attention
to a brief examination of the following question:

The tendency to abandon the practice of general blood-
letting, in the treatment of disease : Is it evidence of an
advance or retrograde movement in Therapeutics ?
This is a question of much interest, and worthy of the

thoughtful consideration of every member of the profession.
That medical opinion strongly inclines to give up what

* See also pamphlet published by the author.

I860.] Tra M Hon of Ga. [65

has long been regarded as one of our most reliable m<
f cure, will hardly be questioned ; for no very extended
observation will convince us, that general bleeding has
l)ocn abandoned almost, if not altogether, by many practi-
tioners; that by a large majority it lb resorted to with great
reserve; and that by a very few is it still recognized, as a
safe ami reliable agent in the treatment of disease.

What lias led to this great change of opinion ': Is it duo
to conviction, forced upon us by observation of injurious
results from the practice, or are we merely following in the
wake o\' a few leaders, to whose "ex cathedra" decisions
the general medical mind is blindly submitting its faith ':
On so vital a point as the one before us, it is alike due to
self-respect, and the interests of humanity, that every med-
ical man should calmly examine the grounds of his belief;
for it is a fact, not very ereditablc to us, that we are under
the influence of a strong tendency to adopt views of impor-
tant points of doctrine and practice, that may he entertained
and published by some leading member of the profession,
without submitting them to the critical test of reason, or
entertaining the question May not such views, and the
practice based upon them, be the convictions of a single
mind, swayed by influences, and placed in circumstances
far different from those under which we may be called to
act ?

The history of blood-letting, from the earliest record we
have of it to the present time, would be a curious, although
not very profitable, subject of study. Its origin may be
traced back to a very high antiquity ; for the earliest physi-
cians, whose names have come down to us, practiced the
operation. Setting aside the fabulous notion recorded by
Pliny, that the idea of it was conceived from observing the
habits of the hippopotamus, we will not be very far from
the truth in supposing, that the benefit following the loss of
blood from accidental wounds in persons laboring under
internal disease, ;i- well as the salutary effects of nasal,
hemorrhoidal and other hemorrhages in certain malad
arretted the attention of observers, and led to an imitation

486 Southgate. E BloodAetting. [July,

of nature. It may be fairly presumed that, when first insti-
tuted, the practice was productive of good; otherwise, it
would have fallen into disrepute; for the instinct of self-
preservation is bo strong, that it would have recoiled from a
proceeding manifestly detrimental. A\re find, indeed, that
blood-letting, in its various forms, was practiced in all a.
and in all countries; that in the earliest times it had its
advocates, and numbered its opponents ; that Hippocrates,
and the greater part of his disciples, espoused its cause ;
that Chrysippus and Erasistratus denounced it as injurious;
that Celsus, (Yelius Aurelianus, and Areteusof Cappadocia,
were its determined friends; that Galen was its advocate,
and that in his footsteps followed Paul of Egina, Alexander
of Tralles, and Avicenna. Then arose the chemical school,
with Van Hclmont at its head, who denounced it as inju-
rious; and from the date of the ascendancy of the chemical
doctrines to the present time, the record is any thing else
but gratifying to a just professional pride.

Personal animosities were engendered and mingled in a
contest, which should have been decided by an appeal to
the tribunals of experience and reason. AVe are told that
Bosquillon, a Parisian physician of distinction, was so vexed
at physicians, in his day, giving up blood-letting, that he
practised it largely in almost all diseases, and with a pro-
fuseness shocking alike to reason and humanity; that Guy
Patin (out of spite, I suppose,) caused his son to be bled
twenty-four times during the course of a single pleurisy ;
and that Hecquet, a physician of eminence, fell a victim to
copious and repeated venesections overwhelming evidence,
certainly, of the strength of his faith, as well as of the weak-
ness of his intellect. Such is the humiliating record of the
past ! We could smile at the lolly of those who have pre-
ceded us, if the visions of the murdered did not rise up to
rebuke any other feelings than those of sorrow and regret.

We cannot doubt that, in contrast with those who held
these extreme views, there have been in all times and in all
ages, physicians who discerned the golden mean, and
steadily adhered to the practice of blood-letting, as an

18t)0.] Iranaacttims Medical Association of Ga, iv7

institute of uature, whose precepts they dared nol despise.

Descending from those periods, the annals of which are a
heterogeneous compound of truth and fable, to more mod-
ern times, we have, in the i;-oo<l old common sense school
of English medicine, the names of Sydenham, Baillio,
Pringle, Ferriar, Heberden, and a host of others, associated
with the practice of blood-letting. In our own day, ii has
the consistent advocacy <>{' the sterling good Bense of Wat-
son and BiHing, o\' London; ^{' Graves and Stokes, of the
eminently practical Dublin School of Medicine: <A' the
sagacious Trousseau, of France, whoso admirable work on
Therapeutics seems to be a digest of all the learning of the
Past, illumined by all the lighl ^\' the Present Hueffland,
the Nestor of German medicine, after an experience of fifty
years, spoke warmly in its praise; and in our own country,
we have the testimony of one who, after a long* life of unex-
ampled success in the practice of medieine and surgery,
bore the strongest testimony to the safety, value and efficacy
of the practice. "It may be," said the distinguished man
whose words I quote, "that in some few instances, 1 have
had occasion to think I have earned the use of the lancet
too far, but I have to lament very numerous instances in
which my timidity has prevented me from using it with
sufficient boldness to save my patient from death.'7 Such
was the testimony of Philip Syng Physick. CAarum ct
venerabile nomen.

Until within a few years past, the medical mind seemed
enjoying repose in the belief that, in general blood-letting.
we possessed a reliable means of cure; when, all of a sud-
den, its equilibrium was disturbed by the startling an-
nouncement, that blood-letting was not only not useful, but
positively injurious in the treatment of Pneumonia ; the
announcement being followed by a formidable array i>\' sta-
tistics, which, it was confidently asserted, proved that the
percentage of deaths when general blood-letting had been
practiced, was largely above that under a purely expectant
system of treatment. Xow, this announcement must have
been sufficiently startling to those who blindly accepted

488 Southgate. Essay on 'Blood -letting. [July

such statistics, as a foundation upon which could be reared
the solid and well-proportioned structure of truth ; but I
question whether it seriously disturbed the equanimity of
any one who had learned to appreciate the full and practi-
cal bearing of the simple truth, that every case of disease
should, in a practical point of view, be regarded as an indi-
vidual sid generis, to be dealt with, not in obedience to the
terms of any pre-established formula, but as common sense
should prescribe, after a full, calm, and deliberate estimate
of all the relations and bearings that should rightfully
influence and determine our mode of procedure. Let us
suppose that one hundred cases of Pneumonia were sub-
mitted to treatment. Fifty, under the purely expectant
system, embracing the withdrawal of all hurtful influences,
and the placing of the patients under conditions favorable
to recovery; the remaining fifty being indiscriminately
subjected to general bleeding, or some method of active
medication ; might we not very safely predict, that the per-
centage of recoveries would be in favor of the expectant
system ? Let us look at this for a few moments, and see if
some good reason may not be assigned for the anticipation
of such a result. If there is a principle, occupying a more
prominent position than any other, in the minds of expe-
rienced men of the present day, it is this that the human
system, when attacked by acute disease, institutes a move-
ment in the direction of its own relief; and that the duty of
the physician principally consists in watching the move-
ment, aiding and co-operating with it; with this reserva-
tion that as this movement is sometimes boisterous and
turbulent, and likely, by its violence, to defeat its end, it
requires to be moderated and controlled, whilst at other
times, it is so crippled and oppressed, that it demands the
interposition of art for its relief.

The general principle is, however, what I have stated it
to be. ISTow, the practice of general bleeding, in each and
every case of Pneumonia, seems to be in direct contraven-
tion of this principle ; and when so indiscriminately em-
ployed, must lead to disastrous results, especially in such

I860.] Transactions "Medical Association of Gfa. 489

cases as are treated in Large hospitals, and upon which the
statistics arc based. Would it not be reasonable to fear,
that in nianv of the cases, the recuperative energies might

be lowered to a point at which disease would gain the mas-
tery, and, finally, achieve the victory. We know, more-
over, that after a while, points of stagnation take place in
the inflamed tissues, and that these points must, by simple
mechanical force, load to the formation of others; and it is
more than probable, that general bleeding employed on the
eve of the subsidence of the general excitement would pro-
mote their formation; and that cupping and blistering
would then be adapted to check the progress of the more
strictly localized disease. But many cases do recover after
general bleeding, even in hospital practice, and some die
under the expectant system; unless, therefore, we bad all
the data that the inductive philosophy requires, for a sound
and legitimate deduction, whicb no statistics have ever yet
given, we have no strict logical right to decide for or against
either system. Under the guidance of reason and expe-
rience, we determine to leave one case almost entirely to
nature, whilst in another, the phenomena of oppression are
so grave, or the reaction is so intense, that wre deem it our
duty to interpose, actively, for the relief of our patient.

Whilst, then, we do not think that any safe rule of prac-
tice can be deduced from statistics, especially from hospital
statistics, as applied to private practice ; and whilst we
should, for the reason above stated, and a strong faith in
the restorative energies of the system, prefer to trust all our
cases to the expectant s}Tstem, rather than subject them in-
discriminately to general bleeding, no such alternative is
presented to the practitioner. In the independent exercise
of his judgment, he can adapt his treatment to each indi-
vidual case.

And is it not a humiliating reflection that in this favored
epoch of man's history, with the volume of nature open
before him, with the philosophy of Locke and Bacon to
guide him in its interpretation, and with all the expe-
rience of the past, as a lamp to his feet, that there should

490 Southgate. Essay on Blood-letting . [July,

be distinguished authorities arrayed on each side of this
question!

Embarrassing, indeed, is the position of the young prac-
titioner, who has entered upon the duties of his mission,
impressed by a due sense of responsibility. Anxious to
avail himself of the clearest light to guide him through the
storm and darkness, he diligently consults the latest and
most approved authorities in practical medicine. For the
sake of illustration, we will suppose that they differ as to
the value and safety of general blood-letting in Pneumonia.
The young physician is impressed by the views of the latest
authority, in opposition to the practice. He is summoned
to the bedside of a patient ; he has diagnosed Pneumonia,
and the rational symptoms and physical signs, if he has
been instructed in the interpretation of the latter, proclaim
the extent and gravity of the case. He is face to face with
congestion and inflammation of a vital organ ; and remem-
bering a lecture, in which the efficacy of general bleeding
was eloquently enforced, he decides upon a resort to the
lancet, but his hand is arrested by the force of the distin-
guished authority he last consulted, and he pursues a differ-
ent and less decisive course. The patient, we will suppose,
after a longer or shorter struggle with the malady, expires.
The young medical man now recollects, that another au-
thority of equal distinction, has declared, that in the early
stage of severe Pneumonia, blood-letting was imperatively
demanded; and the very natural and distressing question
presents itself Might not the result have been different,
had I made a decided impression by the use of the lancet,
when first called to my patient ? Now the case might have
terminated in death, if general bleeding had been resorted
to, for the result does not necessarily demonstrate the effi-
cacy or ineffieacy of the means employed ; and if it could,
by any conceivable process of reasoning, be proved that the
omission of bleeding had turned the scales against the
patient's safety, would not the exercise of ordinary charity
excuse the young practitioner, who, under a crushing sense
of responsibility, had yielded his judgment to an older, and

I860.] Transactions Medical Association of <l<>. r.'l

should be wiser head than his own. Should qoI the blame
rest with these who, in their writings and teachings, dog-
matically proclaim that blood-letting is useful, or that it is
injurious in Pneumonia, without impressing upon the mind
of the pupil, the Bimple, wholesome, and conservative truth
itial truth in all times, in all ages, and under all cir-
cumstances a truth that constituted the Pole-star, of the
medical worthies of formertimes, " Nil remedium, nisitem-
pestivo hsu >'V."

But could many of us now present, apply to our lacerated
feelings the same balm, that might give comfort and sup-
port to the young physician, under such circumstances.
Fifteen, twenty, or twenty-five years have, perhaps, past by,
since we commenced the great struggle against disease,
suffering and death. We have learned to read the great
volume of nature understandingly; to place a respectful but
just estimate upon the learned disquisitions of authors and
reviewers, and the eloquent lectures of erudite professors.
We have had practical illustrations of the value of all our
great therapeutic agents blood-letting, cathartics, emetics,
diaphoretics, tonics, stimulants, anodynes, all "remedia,
tent, -/.*' We have learned to use them discreetly,

considerately and gently, as aids to the struggling system ;
to control undue excitement, to solicit the return of arrested
secretions, to calm and strengthen, and co-operate in the
great work of Cure.

We are summoned to the bed-side of a patient; a chill has
sounded the alarm of impending mischief; fever has fol-
lowed ; and the cough, pain in the chest, and other symp-
toms, call our attention to the lungs, as the probable seat of
disease. Wre place our ear to the chest, and the physical
>igns make the diagnosis sure; for the soft music of respi-
ration is displaced by the crepitating, crackling and hoarse
intonations of disease. We have inflammation of a vital
organ pleading for relief. How shall we administer the
needed succor? It may have happened that the last case
of Pneumonia under our care, terminated with the life of
the patient, and general bleeding had been one of the

492 Southgate. Essay on Blood-letting. [July,

means employed. Shortly after the sad occurrence, we
encountered a learned disquisition, in which general bleed-
ing in Pneumonia was declared to be injurious, as shown
by the appended table of statistics, vouched for as correct.
We decide to abstain from it, and trusting to some other
remedy or remedies to subdue the inflammation, our patient,
on the ninth or tenth day, dies, as effectually strangled as
though a ligature had been cast around his trachea and
gradually tightened from day to day, until the last effort
at inspiration carried in scarce a thimble-full of air, and the
last attempt at expiration was little more than a startling
and convulsive gasp. A friend of our late patient calls, to
take a last look at his remains and remarks, "how little he
is changed;" and indeed, if we should weigh the corpse we
would find, perhaps, scarcely an appreciable diminution of
its normal and living weight. ~We open the thorax ! and
instead of the beautiful and buoyant structures the match-
less mechanism of the Architect Divine we find a pon-
derous compound of pulmonary tissues, bloody serum,
mucus and lymph ! Or if our patient should survive to the
middle or end of the third week the inflammation steadily
advancing, hurried on, perhaps, by the brandy toddy, ser-
pentaria and camphor, and beef tea, which the symptoms of
prostration with excitement are too often recklessly thought
to demand, and the odor of which, as we enter the sick
room, afflicts us with such a sickening presentiment of a
disastrous issue we open the thorax ! and we find the same
beautiful structures converted into a pulpy, softened, and
disorganized mass !

Xow, if we have attained to that frame of mind which
some medical men reach, who have been elevated to a dizzy
height by the partiality of their friends, who have magnified
every trifling recovery into a wonderful result of skill; a
frame of mind that makes them intolerant of the sugges-
tions of others, satisfies them that their diagnosis is infalli-
bly correct, their therapeutics indisputably the best that
could be devised, and that when their patients die, they
ought to have died ; if we have attained to this unphilo-

I860.] Transactions Medical Association of Ga. 498

sophical, this most antiprogressive state of mind, we may
not feel any misgivings at the sad event. Bu1 if we are
humane and reflecting, and most men, justly proud of the
triumphs of our art, humbled at times under a sense of our
defeats our pride and our humility proving fresh incen-
tives to greater diligence in our efforts to solve the great
problems oi' disease and cure might we not feel, that per-
haps, we had not acted altogether wisely and weir?

Now, wo all know that many cases of Pneumonia will
recover without blood-letting, or other active treatment;
that rest in bod, the removal of all sources of irritation,
warm poultices to the chest, mild diaphoretic and demulcent
drinks, will, in time, effect a perfect restoration. But if
from this we are in danger of arriving at a generalization,
false and if false, fatal that general blood-letting is never
necessary in Pneumonia, is it not our duty to pause and
reflect, whether the current with which the medical mind is
now drifting will carry it to a safe anchorage; or whether
our hark, freighted with such precious interests, is not
being wafted towards shoals and rocks, and deceitful quick-
sands, on which it may experience a disastrous shipwreck?

I have selected Pneumonia to illustrate my subject ; be-
cause, if I am not greatly mistaken, the apparently formi-
dable statistics to which I have referred, led to the reaction
against the remedy, and to the very natural extension of the
prejudice against it, to the other inflammatory disorders.
For if, in inflammation of organs so eminently vital as the
lungs, blood-letting had been proved to be not only not
simply useless, but positively disastrous, we must, a fortiori,
conclude that in inflammation of organs less immediately
vital, the remedy must be useless; and if useless, injurious,
(for we cannot occupy neutral ground, in reference to such a
powerful agent as general blood-letting is admitted to be,)
unless there was something peculiar in an inflamed lung
that constituted it an exception. And this peculiar some-
thing, pathologists have attempted to show; arguing, that
the exudation of lymph into the air cells of the lungs the
true seat of Pneumonia is the very process by which the

494 Southgate. Essay on Blood-letting. [July,

inflammation is mechanically extinguished ; and as blood-
letting arrests this exudation, it is therefore inexpedient in
Pneumonia ; and the analogy of the beneficial influence of
pressure in Erysipelas of the extremities, and of strapping

in acute orchitis, lias been plausibly brought to bear in sup-
port of the idea. I am free to say, that I do not see much
force in this reasoning. But admitting that there may be
some truth in this mechanical explanation, is it not like-
wise true, that congestion and inflammation are preliminary
to this process? and if, in blood-letting, we have a remedy
against congestion and inflammation, will it not be expe-
dient, in the carl y stage of severe Pneumonia, to prevent
this exudation, which might proceed to such extent as to
interfere with that due aeration of the blood, upon which .
the vitality of the great nervous centers of animal and
organic life depends.

The retrospect of my professional life brings the remedy
before me, as an agent of most beneficent power. Never
shall I forget the signal relief I experienced, whilst suffer-
ing under an attack of Intermittent Fever a disease in
which a resort to the lancet in these days would be consid-
ered little less, I suppose, than the act of a madman. In
the autumn of 1844, whilst on duty as a medical officer of
the army at Fort Gratiot, at the outlet of Lake Huron, a
locality where Intermittents are rife, I became the subject
of the disease, in a Quotidian form. The difficulty in my
case was an intense gastric irritability, that continued, more
or less, during the intermission ; and in addition, an agoni-
zing pain in the head was constantly present. In the third
paroxysm, my sufferings were so great, that I sent for the
only medical gentleman in the vicinity, with the view of
having some blood taken- from my arm, which I felt per-
suaded would give me the most prompt relief. The medical
man arrived, and my wishes were made known to him.
After making the usual examination, he declined acceding
to my request. There were present none of those symptoms
which were formerly considered indications for the loss of
blood. There was no violent throbbing of the Carotid and

I860.] Transactions Medical Association of Ga. \l.<~>

Temporal arteries, do full bounding and vigorous puls<
the wrist, no flush of the lace, no injected conjunctiva ; no
indications that the vis a tergo was driving into the organs
a ln>t current of hyper-vitalized blood ! The perverted and

ataxic condition of the Ganglionic centers, and their re-
flected influence upon the cerebrospinal system and nerves
of the heart, were antagonistic to such open and undis-
guised manifestations. After some persuasion, and the
assurance that all responsibility should rest with myself, lie
acceded to my wishes. My arm was tied up, and a vein
opened. Slowly and reluctantly did the blood trickle
down; soon the stream became freer, then bold and salient;
and after about twelve ounces had been abstracted, I felt
like a new man ; the pain in the head, and the gastric irri-
tability, ceased during the flow, and my convalescence
dated from that hour. The medical man was surprised at
the result; he anticipated symptoms of sinking; he beheld
relief and invigoration.

When I was assigned to the charge of the Military Hos-
pital at the same station, in 1841, I found many of its in-
mates the subjects of Chronic Irregular Intermittent Fever.
Shortly before my arrival, I had perused the masterly paper
by Macintosh, on the safety and utility of general bleeding,
in the cold stage of that disease. His reasoning was plausi-
ble, and as he was a man of high character, I had no right
to question his record of facts. I determined to test the
practice. The patients presented the peculiar physiognomy
of those who have suffered repeated attacks of the disease,
and there was. certainly, nothing in their appearance that
would have led one to infer that blood-letting would be of
advantage. I selected several cases, which had resisted the
action of quinine, and showed a pertinacious tendency to
return, when the remedy was- suspended. In each and
every case submitted to the trial, I was gratified by the
result ; the duration of the cold stage was lessened; the hot
stage was milder ; and the critical solution by diaphoresis,
more complete. The subsequent use of very moderate
doses of quinine established the cure. In no instance was

496 Southgate. Essay on Blood-letting. [July,

there experienced a sense of weakness ; a feeling of relief
and invigoration was the immediate result. The moment
for closing the orifice in the vein was when the trickling
was converted into a jet the signal that reaction was at
hand. Xor will it seem strange, that relief should have
followed the operation, when we reflect upon the crippled
condition of the nervous and circulatory systems, during
the prolonged cold stage of an Intermittent Fever the
beautiful equilibrium of the centripetal and centrifugal
forces of the system subverted, only to be restored, after a
long, painful and debilitating struggle. Xow, doubtless,
many who hear me can, in the retrospect of their profes-
sional lives, see many instances in which general bleeding
was followed by the most prompt relief. If such be the
fact, and it be also true that there is an increasing tendency
to dispense with this important agent, is it not our duty to
examine whether this tendency is in the right direction
the improvement in Therapeutics the aim and end of all
our investigations ?

Seeing, then, that blood-letting is, as it were, an institu-
tion of nature ; that it has received the endorsement of some*
of the most sagacious minds that have adorned the profes-
sion, and that our own experience bears ample testimony to
its value, I might leave the subject, as having claims upon
our future thoughtful consideration.

I know that a great and wholesome revolution has been
effected in the science and art of Medicine; for, to use the
language of an elegant scholar, "How tenderly and patiently
has Medicine, once so bold, aggressive and alert, learned to
wait on Nature, following her hints, assisting her efforts,
and relying chiefly on her own healing and recuperative
powers." But revolution/, in their headlong course, are
apt to bury, in one common tomb, the evil and lalse the
beautiful, the good, and the true. And as it is the duty of
the political philosopher to study the rise, decline, and fall
of empires, so as to derive from them maxims of wisdom,
for the benefit of the present and future of the race ; so is
it the duty of the medical philosopher to study the rise and

I860.] Transactions Medical Association of (1". 107

fall of systems, to discern the true and the false to discard
the false, to hold fast to the true, and apply it to the relief
of the sufferings of our common nature. I verily believe
that somo o( our most valuable therapeutic means arc fall-
ing into unmerited disrepute; and that the future improve-
ment of Practical Medicine will depend upon a careful
review of them all their powers for good and evil, and
their peculiar adaptation, under the cautious guidance of
reason, judgment and common sense, to the relief of the
various morbid conditions we are called upon to treat.

The diseases to which, until a few years past, general
bleeding was considered applicable, are Essential Fevers, in
the early stage of which there was vigorous action of the
heart and arteries, with symptoms of suffering in any of the
great cavities; Eruptive Fevers, when there were the same
signals of distress ; Malarial Remittent Fevers, of a high
grade, when the same signals were hoisted ; Idiopathic In-
flammation of the Organs, contained within the cranium,
thorax and abdomen ; Acute Hemorrhages ; Febrile Drop-
sies; Severe Articular Rheumatism, with high arterial
action; certain forms of Apoplectic Seizure; the various
disordered manifestations due to a state of Plethora ; the
annoying and distressing symptoms connected with the
Pregnant state; to which might be added, obstinate and
unrelenting Colics with Constipation, and in Obstetrical
practice, the rigid and unyielding state of the structures,
through which the feetus has to be forced into a state of
breathing and independent existence an extensive field
that might be re-surveyed with interest, and, perhaps, profit
to us all.

Xow, Continued Fevers, classed as Synocha, Synochus,
and Typhus (not embracing true Typhoid Fever, which
seems to be a disease of more modern origin), were the dis-
eases in which the physicians of other days were such close
and faithful observers of nature. Whilst they recognized
the great truth, that, with rare exceptions, they could not
be suddenly suppressed by remedial means ; they did not
hesitate to moderate their earlv violence, by venesection,
32

498

Southgate. Essay on Blood-letting. [/July,

cooling aperients, cold drink-. &c., and they had the satis-
faction of seeing them terminate by some critical evacua-
tion, on the seventh, ninth, eleventh, fourteenth, or twenty-
first days; so rarely beyond the last period, that they were
denominated Twenty-one day Fevers.

The principle upon which they acted was, that as all
violent actions in the system must be followed by the i
tion of prostration ; and as the prostration was generally in
a direct ratio to the previous excitement, it was alike the
dictate of reason and common sense to diminish the excite-
ment, as the surest means of economizing the strength, and
enabling the system to effect a critical solution of the dis-
. I believe the principle upon which they proceeded
was a sound one sound then, sound now, sound in all time
to come.

Xow, what is the course pursued in many parts of our
country (and perhaps some of us have pursued it,) in these
Continued Fevers? We administer fifteen, twenty, twenty
five, or thirty grains of quinine in forty-eight hours, with
the hope of suppressing the fever; but the fever laughs at
as and ourquinine. We withdraw it, for we have witnessed
no good result. We leave our patient alone for ten or
twelve hours, and we find at our next visit just what we
might have anticipated after the withdrawal of such a
tonic as quinine the pulse somewhat more feeble and fre-
quent. Xow commences the wine and beef-tea, and after
a while the whiskey-toddy system, with perhaps the plac<
(A' cold spongings, and an occasional foot bath. .V diarrhoea
sets in. and for fear of weakness, and not reflecting whether
it may be critical or otherwise, it is promptly checked; and
so we go on checking the recurring diarrhoea, diminishing
or increasing the quantity of stimulus, occasionally slipping
in a little quinine: and the fever, in spire of our treatment,
sometimes terminates on the fourteenth or twenty-first day:
but frequently continues to the close of the fourth, fifth,
sixth, and even the seventh and eighth week: and we con-
gratulate ourselves, that we have carried the patient safely
through his long illness, when I verily believe, we have

18G0.] Transactions hedical Association of Qa. 499

most miserably thwarted the recuperative tendencies of the
By&tem, by our false method. This is strong language, bu1
I have had some experience in these fevers, and must think
that we would not have such lingering cases, it' a sedative

treatment were adopted in the first stage of excitement.

1 am now in attendance upon a case, that illustrates the
value of sedative treatment, aided by a spontaneous epis-

taxis in favoring a prompt solution of fever.

I was summoned to sec a little girl, five years of age, who
had, previous to her attack, enjoyed excellent health. Four
days before 1 saw her, she had experienced chilly sensations,

which, after lasting several hours, were succeeded by \'vyv\\
that had continued with increasing severity, up to the mor-
ning of my visit. She was lying supine in bed, unwilling
to be disturbed. Her face was flushed, and had the febrile
expression ; the tongue was white and inclined to dryness :
temperature of the surface was elevated; the pulse num-
bered 13.0, and gave the linger applied at the wrist a sharp
and angry touch; there was frontal headache: a careful
examination detected no thoracic or abdominal trouble. I
had, certainly, reasonable grounds to diagnose Continued
Fever, and cautiously so expressed myself to the mother.
I prescribed a solution of sulphate of magnesia with anti-
monial wine to he administered evcrv second hour, until
some decided effect was produced ; after which it was to be
continued in diminished quantity and with longer intervals.
After the administration of the third dose, the medicine
was discontinued; gentle emesis had occurred twice; three
copious liquid alvine evacuations followed; spontaneous
epistaxis took plaee during the day, commencing with a jet,
and trickling away for some time, until it stopped by self
limitation. At my evening visit, I found my little patient
much better; the flush of the face had disappeared with the
frontal headache ; the cast of countenance was more natu-
ral; the pulse was soft and numbered 120 ; there was a
little moisture, here and there, on the surface. I prescribed
a warm foot and arm bath, to be followed by a cup of warm
balm tea; gentle diaphoresis and refreshing sleep followed;

500 Southgate, Essay on Blood-letting. [July,

at my visit the succeeding morning, the patient was free
from fever. The convalescence has been progressing favor-
ably. Now, whether it was a case of continued fever or
not. the prompt relief is manifest; and I cannot help think-
ing it fortunate for my little patient, so far as the duration
of her fever is concerned, that I have not become imbued
with that great partiality for quinine, in all febrile move-
ments, entertained by my medical friends in Augusta. I
have i>QQn cases setting in, in the same manner, and in
which quinine had been prescribed with the view of arrest-
ing them in their course, linger on for three or four weeks.
Now, this case, it is true, does not bear directly upon the
point under consideration ; but if there is an arterial seda-
tive, scarcely second to general bleeding, it is the antimo-
nial saline solution. I took the hint from Billing, when I
was a very young practitioner, and have profited by it, on
many occasions, to my own great satisfaction, and the
speedy and safe reduction of fever and inflammation.

From the admirable work of AVardrop on Blood-letting,
I draw the following case: In referring to the objections to
the use of bleeding in Fever, and the doctrine upon which
they were founded, he says: "I had an opportunity of wit-
nessing the fallacy of this doctrine, in the case of a youth
who was attacked with fever, and whom I accidentally saw,
just when he was brought from school, at the commence-
ment of the disease. He complained of a violent headache,
had a flushed countenance, a typhoid tongue, a hot and dry
skin, and a rapid pulse. I immediately bled him at the
arm, when in the supine posture, until he fainted ; ordering
1 ill li a dose of James' powder every four hours, alternately
with a purgative. The physician who attended the family
Was afterwards sent for, and in a few hours lie visited the
patient. When he heard the history of the case, and ob-
served the character of the tongue, he expressed his decided
opinion that the depletive system of treatment would be
injurious ; that the patient had all the symptoms of Typhus
Fever, which would endure twenty-one days ; and that it
would be followed by such a train of symptoms of exhaus-

I860.] Transactions Medical Association of Gfa. 501

linn and debility that, in place oi' blood-letting, the vnv
opposite system of treatment ought to have been pursued.
Contrary, however, to this prediction, the bleeding com-
pletely and permanently relieved the head ; the skin and
alimentary canal wore powerfully acted upon by the anti-
mony and calomel, and so early as the ninth day, the fever
ceased.*' Mr. Wardrop was an eminent surgeon and genera)
practitioner, in London. I quote the case to show thai there
is. alter all, not such terrible danger from depleting treat-
ment in continued fever as, in these days, we seem inclined
to believe. It was in these fevers that the application of
the doctrines of Brown, of Edinburgh, proved so disastrous.
He divided all diseases into Sthenic and Asthenic; the lat-
ter comprising cases wherein his uniform, indivisible property
of excitability, was either exhausted or morbidly increased.
These fevers were classed as Asthenic, in which the excita-
bility was exhausted and the indication of cure was, to rouse
the excitability by stimulants. Rasori, and Italian physi-
cian, was completely captivated by the apparent simplicity
of the doctrine, and introduced it into Italy. The occur-
rence of a Petechial Fever at Genoa, gave him an opportu-
nity of practically testing its value. The stimulant treat-
ment produced a frightful mortality. Seeing and acknowl-
edging his error, he faced about, and commenced a contra-
stimulant treatment, by which the mortality was vastly
diminished. From that time, the Brunonian theory fell
into disrepute ; and it is now regarded as the most pernicious
that had ever been invented, for the promotion of malicious
ends and selfish purposes. Brown, you know, was at first
the friend, but subsequently, the most inveterate enemy, of
Cullen. In the latter were centered (if the memory of my
early reading be not at fault) all the qualifications of the
popular teacher. His personal appearance was eminently
prepossessing ; his countenance the blended expression of
benevolence, sprightliness and intelligence ; his voice was
musical; his elocution fluent; his gesture graceful; his
rhetoric a felicitous combination of the simple and ornate ;
and withal, he had achieved an enviable reputation for pro-

502 Soutiigate. Essay on Blood-letting. [July,

fessional sagacity and skill. No wonder tliat crowds of
students gathered from all parts of the world to listen to his
eloquence! These shining qualities, which would have
strengthened the friendship of an ingenuous mind, proved
too much for the poor, miserable, selfish human nature of
Brown. lie had pained some eclat by a successful assault
upon a weak point of Cullen's Theory of Fever (what
Theory of Fever is there that does not present a weak and
assailable point?) and rendered arrogant by success, he
proclaimed the dogma he associated with his name. It
addressed itself to a weak point in the student's mind the
desire to obtain, by a short and easy process, to that know-
ledge which can only be acquired by faithful and laborious
investigation. His success was great, but ephemeral. Pos-
terity has rendered a righteous verdict. Brown is now only
remembered as an unscrupulous theorist ; while Cullen still
shines with a pure and steady light, in the firmament of
medical literature and science.

To Broussais, among others, we owe a debt of gratitude,
for having stemmed the burning current of the Brunonian
doctrines, and proved that it was not from debility we had
so much to fear, as from the exhausting and disorganizing
power of fever and inflammation. Broussais himself wan-
dered far beyond the limits of truth and safety ; but his
treatise on the " Chronic Phlegmasia?," is an enduring
monument of his intellectual power. And as we slake our
thirst in the refreshing stream that flows through its pages,
we experience a sentiment of regret, that one who gave
such early promise of being a successor, worthy of the im-
mortal author of the "General Anatomy of the Tissues,"
and an architect equal to the completion of the great work
lie had designed, should have dwindled into a visionary,
one-idea enthusiast, whose common sense had, long before
he was called to pay the great debt of nature, been con-
sumed by the fires the enthusiasm of his genius had kindled.
Believing, as I do, in a substratum of essential unity in all
these fevers, and that their modifications depend upon epi-
demic and other influences, I think the same treatment is

18(H).] Transactions Medical Association of Ga.

called for, bu1 aot in the Bame order. Sometimes the ner-
vous sedation is so great, thai early stimulation is accessary
to maintain the action of the heart and arteries; whilst the
presence of congestion in some of the organs may demand,
;it the same moment, depletion to relieve it; for, in the
language of Macintosh, vtii is qoI inconsistent with .good
pathology to bleed and stimulate at the same time." Then,
again, the reaction is so violent in the early stage that we
have to moderate it, in order to avoid secondary prostration ;
the subsequent treatment being either expectant, support-
ing, anodyne, or revulsive according to the indications
that may present themselves daring their course; always
bearing in mind their tendency to terminate on certain
days, dated from the access of chilly sensations, which,
whatever may have been the duration of the preliminary
feelings of malaise, seem to indicate the day oa which
nature commences the movement in the direction of her
own relief and restoration. If the twenty-first day should,
nn fortunately have passed, without the manifestation of
those signals, which indicate a favorable crisis, all other
considerations must he secondary to the great principle of
sustaining the forces of the system; aud I cauuot too strongly
commend to the young practitioner, the lectures on Con-
tinued Fever, by Dr. Todd, of London, in which the "nil
desperandum " practice is advocated, on the grounds of the
most admirable and gratifying clinical results.

I conclude what I have to say upon Continued Fevers,
with a ([notation from Sydenham, and no one will question
his thorough acquaintance with them. After stating that
the invention of the term "Malignity," has been far more
destructive to mankind than gunpowder, he goes on to say
(speaking of Congestive Typhus): "But if it be inferred
that there is sonic malignity in the case, not only from the
purple spots, but also from finding the symptoms of Fever
milder sometimes than should seem agreeable to its nature,
whilst, notwithstanding, the patient is more debilitated than
could be expected for the time; I answer, that all these
symptoms only proceed from nature being, in a manner,

504

Soutiigate. Essay on Blood-letting.

[July,

oppressed and overcome by the first attack in the disease,
so as not to he able to raise regular symptoms, adequate to
the violence of the fever all appearances being quite irreg-
ular. From the animal economy being disordered, and in
a manner destroyed, the fever is thereby depressed, which
in the true natural order, generally rises high. I remember
to have met with an instance of this kind, several years ago,
in a young man I then attended ; for though he seemed, in
a manner, expiring, the outward parts felt so cool that I
could not persuade the attendants he had a fever, which
could not disengage and show itself clearly, because the
vessels were so full as to obstruct the motion of the blood.
However, I said the}' would soon see the fever rise high
enough upon bleeding him. Accordingly, after taking
away a large quantity of blood, as violent a fever appeared
as I ever met with, and did not go off till bleeding had been
used three or four times."

Upon the subject of Malarial Eemittent Fever I shall say
but little. Satisfied as I am of the value and safety of gen-
eral bleeding in the cold stage of Intermittents, I would
not, even if my position were such as to make my recom-
mendations worthy of notice, have any one adopt the prac-
tice. Should it ever so happen that I should suffer from an
attack in the manner recorded in the first part of this paper,
I should insist on being bled the entire responsibility being
cheerfully assumed by myself. I attended a gentleman last
summer, similarly, but not so severely, affected. Remem-
bering my own case, I was desperately tempted to open a
vein ; for all the usual anti-emetic routine had failed. For-
tunately, Xature stepped in to his aid and my relief.
During a spell of vomiting, seemingly violent enough to
have torn all the abdominal viscera from their attachments,
about two tablespoons-full of red blood came up, with some
mucus from the stomach ; I had no further trouble with
that symptom. Xow, I feel morally certain, that had I
opened a vein, and thereby diminished the centripetal ten-
dency, by affording a centrifugal outlet, I would have given
my patient prompt relief. But if the case had, afterwards,

I860.] Transactions Medical Association of Oa. ~>M-~>

assumed an unfavorable aspect, a false togic would have

attributed it to the bleeding; and I am sure you will agree
with me, that a centrifugal movement on my pari would
have been not simply expedient, but absolutely necessary*
In the formidable Remittant Fevers I encountered, dur-
ing my service, on the Red River in the Choctaw Nation
West, I resorted to general bleeding, to subdue tin4 violent
excitement of the circulating forces, and followed it by
other sedative treatment, until the remission was so deci-
ded, that 1 deemed the interposition of quinine expedient.
I was not, at that time, acquainted with what may he denom-
inated the suppressing power ot^ large doses of the remedy;
and although the cure was not, apparently, so prompt, it
was equally satisfactory. Sometimes I found, that under
the use of moderate doses of quinine, the tongue would he-
come dry, and some tendency to delirium be manifested.
I have, under such circumstances, withdrawn the quinine,
recurred to a sedative treatment, and, after a while, found
that its use would he followed by its admirable anti-periodic
power. I know that the empirical treatment of these fevers
has almost entirely superseded the rational system ; but
sometimes it will fail, and then we have to revert to first
principles. Already is there a commencing reaction against
the empirical use of quinine. Thinking men, in and out
of the profession, begin to ask themselves May it be pos-
sible that the marked increase of severe neuralgias, intrac-
table nervous headaches and dyspepsias, may be due to its
vast consumption ? It is a weapon, wielded by every over-
seer of a plantation, and every head of a family with
nearly equal skill with ourselves. Verily, it is high time
for the profession to look to it, lest it fall into unmerited
disrepute.

[to be continued.]

506 Ostco-Plasiic Operations. [July,

Osteo-Plastic Operations. By B. Langbnbbck, Professor of
Surgery in the Oniversity of Berlin. Translated and
communicated by William F. Holcomb, M. !).

Osteo-Plastic operations are those which have for their
purpose the reparation of defects in bout', or the performing
of resection in such a manner thai the removed portion may
be supplied by a new deposit of osseous matter.

The reparation of defects in bone may be effected by
various operative methods.

i". By bringing together and uniting the borders or edges of the
fissures in hum-.

The closure of fissures in the bard palate is attempted in
this manner:

//. By transplanting a neighboring portion of bone to supply

the defect.

The moving and engrafting of the ossa intermaxillaria into
the fissure of the processus alveolaris, in double-cleft palate,
as accomplished according to Blandin's method, by cutting
through the vomer ; Gensoul's plan of breaking up the union
of the intermaxillary bones with the vomer, and my opera-
tion of dividing the cartUago-triangularis, illustrate this
method. Pirogoff's proposed plan of tiansplanting the
calcaneus to the sawed surface of the tibia, after a previous
exarticulation of the foot and the consolidation of both these
bones, belongs also to this class.

III. The reunion of a fragment of the detached bone.

The first attempts of this kind were made by Percy, who
endeavored to supply defects, occasioned by gun-shot
wounds in the lower extremities, by engrafting portions of
the tibia of an ox. These experiments failed. Von Walther
was more fortunate in replacing a piece of cranial hone,
trepanned from a man 36 years of age, as the greatest por-
tion of the bony disk healed, while only a small portion
exfoliated. The attempt made later by B. Heine, to reunite
an exsectcd portion of the rib of a dog, terminated just as
unfortunately as the experiments of Percy; and there is
reason to doubt the correctness of Vow Walther's observa-
tions, since portions of hone, which are set into or engrafted
into others, suffer erosion from long contact with the norma]
fluids from the bone or from pus, vovy similar to the destruc-
tion in caries or exfoliation. In many cases where I have
used ivory pins fov the purpose of uniting pseudo-arthroses,
after three weeks* use, even these were found to have sus-
tained a considerable loss of substance. The end which had

I860.] Osteo-Pkistic Operations. 507

been in the bone was rough, as if eroded by caries, and bad
lost even a third of its circumference. In the case related
by Von Walther, tin* portion of bone which was removed
by the trepan, was replaced and allowed to remain three
months, may have become reduced in size by a similar
process. This Bubjecl has Lately acquired a new, though
onlv a physiological interest, through the researches of
oilier. (See the work "On the Artificial Production of
Bone by Means of Transplantation of the Periosteum, and
by Osseous Grafts. By L. Oilier. 1859.) This author (v.
page L3) engrafted the bones of animals upon those of the
same Bpecies, (rabbits,) sometimes under the skin of the
axilla, and sometimes in cavities formed by the extirpation
of a corresponding hone, (os metatarsi :) the transplanted
bones continued to live and grow in their new home. On
account of the greater vulnerability of the human species,
and its slight recuperative power, as well as the impossi-
bility of employing corresponding material, it is impossible
to make these experiments in operative surgery. But that
it is possible, however, to effect reunion in a bone which
has been, completely separated from its bony connections,
provided it remains united to the parent bone by the perios-
teum, is shown by the following case:

Case Naso-pharyngeal Polypi; Resection of the Processus
Nasalis and the Bight Os Nasalis ; Extirpation of the Polypi;
Replacing and Reunion of the resected Bones. r

A healthy boy, of 18 years, was received into the clinic,
in whom the space behind the soft palate was completely
tilled by two fibrous polypi. The smaller tumor was
attached to the vicinity of the spina nasalis posterior; and
the larger, near the right . tuba eustachii ; and from it, a
prolongation extended into the right nasal cavity, by which
it was completely closed. Respiration was difficult, and
considerable haemorrhage had taken place. As it appeared
impossible to remove the tumors cither through the nasal
cavity, or by division of the soft palate and resection of the
palate bones through the mouth, I decided to resect the
processus nasalis of the superior maxilla, as I had done be-
fore in similar eases. ( Vide Th'eo. Billroth on 'Resection of
the k* Processus Nasalis." Deutsche Klinik. 1853.) In
the former cases I had only resected and removed the pro-
cessus nasalis of the superior maxilla. But as, in this case,
the hone referred to was not driven forward, I had reason
to fear the passage to the pharynx made by its removal
would not be wide enough to enable me to reach the tumor.

508 Osteoplastic Operations. [July,

As the permanent resection of the right nasal bone would
leave a proportionate disfiguration, ! decided on trying to
replace the resected bqne. The operation was performed
Nov. 3d, 1859. A. nearly straighl incision was made from
the glabella, passing downward to the right over the pro-
cessus nasalis, running to the ala nasi. The skin, carefully
dissected, was so far separated that the processus nasalis of
the superior maxilla, and the whole of the right os nasale,
were brought into view, and then the upper border of the
right ala nasi was detached from its corresponding connec-
tions with the above mentioned bones. By means of sharp
bone forceps, an incision was made from the nasal cartilage
along the sutura nasalis to its union with the os frontis ; and
by a second incision, extending into the sinus maxillaris,
the base of the processus nasalis was divided. This incision
terminated where the angle of the superior maxilla, below
the orbit, joins the os lachrymale. An elevator, introduced
into the nasal cavity, was used to raise both bones from
their bed, and at the same time the nasal bone separated
at its suture with the os frontis, so that the whole, adhering
to the periosteum, could be thrown up and held on the
forehead. The polypi were then removed. After the
bleeding was checked, the boxy flap was brought to its
former place, and the external wound was closed by silver
sutures, (which were tied like a thread,) and the nasal cavity
carefully plugged with charpie. These resected bones were
completely detached from the superior maxilla, frontal and
left nasal bones, but were held together by periosteum and
mucous membrane, and were also joined to the ossa frontis
and nasal cavity by a strip, about an inch wide, of perios-
teum and mucous membrane. For a few days after the
operation, there was considerable swelling of the soft parts
covering the wounded bones, which had, however, nearly
disappeared on the 18th of November, by the application
of cold water compresses. Cicatrization of the soft parts
complete; no secretion from the nasal cavity; and the mu-
cous membrane, as far as can be felt by the linger, appears
to be healed. Respiration h}- the nose is entirely free.
Pressure of the linger on the resected bones causes no pain.
Between the nasal process and the superior maxilla there
exists a little tumefaction, but none at the nasal suture.
Patient left the bed.

IV. " Preservation of the periosteum and the surrounding
soft parts.'''

All sunreons who have resected bones, acknowledge that,

I860.] Osteo-Plastic Operations.

in order to have the bone reproduced, it, is of the bighesl
Importance that the surrounding periosteum be preserved;
and all experience demonstrates thai the removed portion
oi' bone will be more or less perfectly reproduced in pro-
portion as the periosteum is preserved. As long ago as
1843, [extirpated the entire ulna, together with the carious
Superior extremity, which was much hypertrophied from a
chronic trumatic inflammation of Long standing. In this
case, the entire periosteum was preserved. A new ulna was
deposited, with its perfectly traceable processes. Themove-
inent of the dhow-joint was complete, and the new, bu1
more flattened, olecranon could be felt through the soft
parts. In the year 1846, I broughl this young man before
the meeting of the German Scientific Congress. (See Official
Report of the 24th Congress of German Naturalists and
Physicians, in Kiel, 1840.) Since that period, a very great
number of resections and extirpations of bone have con-
vinced me that, by preserving the periosteum, a perfect
reformation, (osteo-genesis,) or reproduction of bone, may
be expected with certainty, unless the bone is suffering
from discrasia. This opinion, formed before 1848, explains
why, in the Schleswig-Holstein war, I undertook the resec-
tion of the fragments of broken diaphyscs of bones, frac-
tured by gun-shot wounds an opinion for which I have
been greatly blamed, but which, I am thoroughly convinced,
will one day take its place in military surgery. In the
resections which occur in times of peace, it is very easy to
preserve the. periosteum which has become thickened, (as
In inflammed bones;) impossible, however, when we have
to exsect long bones which are attacked by tumors. The
preservation of the periosteum, in the resection of joints, is
inadmissible, (so far as it can be preserved,) in case we wish
to obtain a movable joint. These operations, according to
our former ideas, offer no inducements for us to try to pre-
serve the normal, thin periosteum. Every operation which
maims the patient is a "testimonium paupertatis" for the
surgeon.

This reflection always forced itself upon me at each one
of the numerous resections of the upper jaw which I have
performed, and, nevertheless, (I am ashamed to confess it,)
the idea never occurred to me that it might be possible to
bring this operation directly into the field of conservative
surgery, by detaching the periosteum from the exsected
bones and leaving it in connection with the adhering soft

510

Osteo-Plastic Of>< rations.

[July

Darts. The complete extirpation of the superior maxilla, or
of half of it, not only deforms the face in a sad maimer,
hut Leaves behind a far worse result as regards articulation
and deglutition, "because the partition between the mouth
and nasal cavity falls away. The conservation of this par-
tition I consider as certainly secured, if we do not remove the
involucrum palatiduri, but preserve it, detaching it with the
periosteum from the hard palate. I even regard it as ]><s-
sible to preserve the periosteum of the facial and orbital
surfaces of the superior maxilla, and thus, perhaps, render
the disfigurement less noticeable. It is unnecessary to pay,
however, that when extirpation is performed on account of
cancer, this is impossible. But this operation is practicable
in the majority of osteo-sarcomatous, fibrous, enchonaromatous
and myeloid growths of the superior maxillary. The de-
taching of the periosteum from the superior maxillary bones,
the surface of which is so irregular, is difficult and trouble-
some, and thus additional labor in extirpation will detract
considerably from the precision and rapidity of the opera-
tion. Further experience will show which incision (through
the soft parts) will render the detaching of the periosteum
the most convenient. In any case, I would commence the
most difficult part of the operation by .first making an in-
cision along the lower and outer margin of the gums, and
then, by means of a denuding instrument, would detach the
gum with the periosteum from the bone ; then divide the
gums along the inner surface of the alveolar process as far
as the soft palate, and separate it, with the perigsteum, from
the roof of the mouth. Then the incision of the external
soft parts, which should be separated from the bone with
the periosteum, should follow. The periosteum of the orbit
should also he most carefully preserved ; and lastly, the
bones can he divided in the usual manner. I would finally
join the gums and the periosteum of the facial surface to
the border of the detached involucrum palati duri by means
of sutures. The cases in which I have operated in this
manner are yet too recent to admit of an opinion as regards
the reproduction of hone; nevertheless, I may be allowed
to communicate them.

First Case. A large Enchondroma on the under surfac< of
the Polatum Durum Removal of the Tumor Preservation of
the Bone and the Involucrum Palati Duri Healed by jirM
Intention.

AW, ~ years of age, of healthy appearance, and, except-
ing having contracted a primary syphilitic affection live

i860.] (ktco-Plastic Operations. 511

years ago, said he was never sick; in 1857, observed q
swelling, of the size of a pea, in the lefl half of the hard
palate, which caused no pain. At first, this increased very
slowly; bu1 after a while, and particularly since the fall of
that year, it grew very rapidly, softened in several places,
and ulcerated near the teeth <>f the lefl side. The tumor
occupied no longer a small surface, bu1 spread over the
entire palatum durum, and pressed everywhere upon the

fine, sound teeth of the superior maxilla, and when the jaw

was closed it nearly filled up the mouth ; it also pushed the
soft palate posteriorly towards the basilar portion of the os
occipitis. The swelling, which was firm, hard, uneven, and
free from pain, was covered by the invohicrum palati duri,
which appeared healthy until near the margin of the alveoli
of the let': Bide, where the ulceration existed, through which
the probe could he introduced into the substance of the
tumor. The probe, and also the acupuncture needle, when
paVsed into the swelling as far as possible, encountered
everywhere osseous matter scattered throughout the semi-
solid mass.

According to tie1 patient, many small pieces of bone had
been thrown off. Whether these belonged to the palatum
durum, or whether they were ossified portions of the tumor,
which haul been regarded as enchondromatous, could not be
decided with certainty. The entire facial surface of the
superior maxilla appeared unchanged, except a small bony
tumor the size of a cherry, which was situated on the out-
side ^i' the alveolar processes above the first molar of the
left side. The voice was gone; the articulation indistinct;
the respiration was difficult when the mouth Was closed ;
the nasal passages were, nevertheless, perfectly free. On
examination with, the finger, per nasum, the upper surface
of the palati duri was found to be smooth, and of normal
resistance. But in the left nostril, the inferior condha felt
rough, and it appeared as if there was a communication
between the tumor and the bottom of the nasal cavity: as
formerly, by pressure on the tumor in the mouth, blood
flowed from the left nostril.

According to the first impression which the disease made
upon many physicians, (and on myself also,) who examined
the patient, we were led to regard the resection of the left
half of the superior maxilfa and the entire palatum durum,
as unavoidable : and the young man had decided to have
the operation peformed in the Clinic, but the sound and
firm teeth, as well as the normal condition of the nasal

512 Ostco-Plastic Operations. [July,

cavity, warranted (after repeated examinations) the hope
that such disfiguration might be avoided. The operation
was performed Nov. 15, 1859. A firm incision along the
inner margin of the teeth of the left superior maxilla divi-
ded the involncrum palaii duri, together with the periosti um]
which were now loosened partly by means of the raspatory,
and partly with the knife.

This part of the operation was very difficult in the vicinity
of the ulcerated opening, but became easier in proportion
as I advanced posteriori}", and succeeded so completely that
both membranes terminating in the soft palate hung- down
like a flap of skin, and the entire swelling was brought into
view. The periosteal surface of this flap was smooth
throughout, excepting only in the vicinity of the ulceration,
where some fragments of the tumor remained, which were
carefully removed. The tumor itself was now (by means of
a sharp chisel) separated from the palatum durum. Some
isolated inequalities of the bony palate (which appeared en-
tirely free from disease) were then removed, and I replaced
the flap directly against the bony surface, and fastened it
to the gums by a Arm suture. A moistened sponge was
inserted, into the mouth, and held in place against the palate
on the tongue. The tumor appeared to be purely enchon-
dromatous, with an abundance of bony scales scattered
through it. The whole wound healed by first intention,
without the occurrence of the least accident. The flap ad-
hered firmly and smoothly to the bony palate, except at two
points in the centre, where it had not united to the bone,
without, however, any suppuration having occurred. If a
superficial exfoliation should follow this operation, requiring
removal, we have the proof that it is possible, even in the
resection of the superior maxilla, to preserve the periosteum
and involucrum paluti, and reunite them to the gums, as was
done in this case.

Second Case. Exostosis of the Processus Alveolaris Re-
section of the same, with the preservation of the Gums, Involu-
crum Palati Duri, and Periosteum.

H. "W., 7 J years old, a boy of very anaemic appearance,
was brought to be operated on in the Clinic Nov. 14th,
1859. The enlargement of the processus alveolaris, of three'
years' growth, extended from the gap occasioned by the
removal of the upper posterior molar of the right side, to
the second incisor of the left side, and extended outward
towards the right ala nasi. The tumor was about the size
of an English walnut, and projected equally inward (towards

/

I860.] Osleo-Plastic Operations. 513

the hard palate) and outward, bo that the upper lip and ala
nasi appeared Blightly pushed forward. The tumor is hard
as bone, painless, except on firm pressure, when the pain is
so great as to prevent a faithful examination. It was diag-
nosticated as hypertrophy of the medullary substance of the
bono.

Operation. An incision was made through the gum,
near the processus alveolaris, from the superior posterior right
molar to the second superior incisor oithe left side, which
had been previously extracted. A similar incision was
made on the inner margin of the processus alveolaris, through
the involucrum palatiduri. The integuments of the tumor,
together with the periosteum, were detached without serious
difficulty, by means of a raspatory. The bone was then cut
out with bone nippers, in a triangular form, the base look-
ing downward. The second incision crushed the thhrplates
of the alveolar processes. At this juncture a small, smooth
bony substance, about the size and form of a musket-ball,
sprang out of the opening.* The soft coverings of the alve-
olar processes were now brought into place, and the edges
of the wound exactly joined by a suture. During the first
days following the operation only a slight swelling was ob-
servable, and the immediate healing of the wound seemed
certain. On the fourth day, while the patient was feeling
perfectly well, there appeared (in consequence, probably, of
some mental agitation,) an unimportant arterial haemor-
rhage from the wound. The bleeding ceased after removing
the sutures, and syringing the wound with cold water. It
returned, however, the following day, and was arrested by
the application of a tampon of tannin. On November 21st
it reappeared ; small pellets of lint, wet in tinet. ferri ses-
quichloridi, were pushed into the cavity, and effectually
checked the haemorrhage. Previous to the first bleeding,
the edges of the gums and of the involucrum palati duri
came so closely together that the defect in the bone was
completely covered ; only the teetli appeared to be wanting.
Notwithstanding the union was destroyed by the haemor-
rhage, yet I hope to be able to repair the defect in the bone
at some future period. Since non-malignant tumors of the

* This " small, smooth bony substance" which the reporter seems to fail to
recognize, was unquestionably a young tooth forced out by his operation, from
its bed under the alveolar process of the child 7 1-2 years old, upon which he
was operating. The age of the child favors this supposition, but more strongly
still, the fact that we have ourself, seen exactly the same thing in operation.
upon the jaws of children of this age, and were convinced at the time of the
true nature of the object. h. f. c.

33

514 Osteo-Plastic Operations. [July,

alveolar process of the superior and inferior maxillary bones
very often occur, and as, until now, the soft parts covering
them have always hecn removed n-ith the tumors, therefore I
regard this Bab-periostea] resection, which may he resorted
to in the majority of these cases, as a real progress in this
operation.

On November 15th, 1859, this case prompted me to try
to detach the periosteum, and also the involucrum palati duri,
in the total extirpation of the right superior maxilla of a
boy, 14 years of age. The attempt failed, the mouth and
pharynx being nearly filled by this fibrous tumor of the
superior maxilla, which had been previously, and for a long
time, treated by caustics, in the hope of destroying it. This
cauterization was carried on with great energy, and by
means of some caustic unknown to me. At the time the
hoy was received into the Clinic, on that part of the tumor
which protruded from beneath the upper lip there was still
a suppurating surface, and the involucrum palati duri appeared
to be degenerated into an indurated, granulated mass. The
soft parts immediately covering the superior maxilla had be-
come so friable, in consequence of the long-continued sup-
puration, that they crumbled into pieces as I attempted to
detach them from the bones. The covering of the palatum
durum and the gums, together with the periosteum, should
have been detached from the bones, but I only succeeded in
detaching a large portion which covered the facial surface of
the bone. As regards the reproduction of the bone in this
case, I shall report at a future period.

V. Transplantation of the Periosteum upon Defects in bone.

The experiments of Oilier upon animals (rabbits) have
greatly enlightened us in regard to the power of the perios-
teum 'm the reproduction of bone. lie separated flaps of
periosteum from the tibia, in such a manner that they
remained attached to the bone only by a small strip, and
inserted the free end between the museles of the limb.
After a comparatively short time, an exostosis had sprung
from the flap thus transplanted, the growth of which did
not cease, even when, a few days after the transplantation,
the strip connecting it to the parent bone was divided. So
active was the independent power in the periosteum of form-
ing bone, that when Haps of it were entirely detached from
the tibia, and inserted into the axilla of the same animal,
or of another of the same species, it continued to produce
bone. To what extent these observations may be applicable
in operative surgery, experience must determine. A priori,

1800.] Osteo-Plaetic Operations. 515

we slmulil expect that human periosteum will perform its
functions aa well, when it can be transplanted under as
favorable circumstances, as in the case of Oilier; that is, if
we can convey to the living tissues detached periosteum,

before it has lost its temperature and natural vitality, and
insure immediate reunion of the wound. My firsl experi-
ment was made by transplanting the pericranium (from the
os frontis) to the nose, to reproduce the ossa nasaha, which
had been completely destroyed by disease. Notwithstanding
it was evident to me that this experiment, carried on as cir-
cumstances required it to he, would be regarded as uwphysi-
lor/ieaf, yet that could not deter me from making it, since
no unfortunate result could occur to the patient. I can
form no opinion as to the termination, yet I do not hesitate
to communicate at this time the principal features of the
operation, at the same time, however, calling attention to
the unfavorable circumstances under which it was neces-
sarily performed.

Cask. Mrs. L., 40 years of age, was received into the
Clinic at the commencement of the present session (1859.)
More than two years ago an ozoena developed itself, which
led, on the one hand, to a perforation of the hard palate ;
and. on the other, to an entire loss of the hones of the nose,
conchae and septum narium. In consequence of this
destruction, the bridge of the nose was completely sunken,
and the external uninjured soft parts of the nose were
drawn back against the nasal processes of the superior
maxilla. Notwithstanding the decided denial of the patient
that she had had a primary affection, yet the uneven sur-
face of the cranium, and the means employed before her
admission into the Clinic, authorized the conclusion that
the destruction of the bones was caused by syphilis. A
purulent secretion from the mucous membrane of.the fauces
was arrested by four weeks' treatment with the iodide of
potassium. I wished to defer the operation until spring,
but was obliged to yield to the pressing solicitations of my
patient, and the operation was performed Xov. IT, 1859.
The soft parts of the nose were divided by a semicircular
or D incision, (or rather in the form of a horse-shoe,) ex-
tending from the processus nasal is of the superior maxilla
over the nasal cartilage, from one ala nasi to the other,
opening completely into the nasal cavity separating the
lower from the upper portion. The point of the nose was
then drawn downward and forward, in such a manner that
the tip nearly touched the lip. Into the wound, thus made,

516 Osteo-Plastic Operations. [July?

a similarly shaped flap from the forhead was transplanted,
whose pedicle or nourishing point was near the inner corner
of the right eye, the borders of which were united to the
edges of the nasal wound by silver sutures. When I formed
the flap from the forehead, I cut, not only through the skin,
but through the pericranium to the bone, and the whole
together was then separated from the os frontis, by means
of a raspatory. This operation differed from others which
I have performed for repairing defects of the nose, only in
the fact that the periostea//) was detached with the skin, and
formed the base of the flap which was transplanted into the
space where the nasal hones were wanting. Afterwards,
the edges of the wound in the forehead were "brought
together as much as possible by two sutures, the denuded
portion of the os frontis covered with lint, the nasal cavity
tilled with charpie, and the nose covered with a cold-water
compress. I will only state, concerning the subsequent his-
tory of the case, that to-day, (Xov. 22,) five days after the
operation, the turgescence and swelling of the rose-colored flap
are much more marked than I have observed in my former
cases. The edges of the wound are perfectly healed at
nearly all points, only here and there a superficial suppura-
tion. The defect in this operation is, according to my idea,
that the periosteal surface of the flap, twisted to cover the
opening in the nose, will be in constant contact with the
current of air from the nostrils, and as a natural result,
must suppurate and granulate. Whether the pericranium
remains capable of producing bone under these conditions,
seems very doubtful. The denuding of the os frontis, and
the possible superficial exfoliation of the same, would hardly
be thought of any account, if the design of the operation is
thereby accomplished. In cases of complete destruction of
the nose, the chances of this operation would be far more
favorable. We could cut the skin (surrounding the nasal
defect) to the bone, loosen it with the periosteum, and twist
it over so that the epidermis would be turned towards the
nasal cavity, which would leave the periosteal surface look-
ing upward. Upon this surface, for a basis, a flap of skin
and periosteum could be transplanted from the forehead,
and in this manner the pericranium of the frontal flap would
lie on the periosteum of the facial flap ; that is, two periosteal
surfaces would be together, and thus render the chances for
bony deposit much more favorable. I have frequently,
when supplying defects in the nose by frontal flaps, used
the surrounding skin in the manner just cited, (but without

Ost o-Plastic Operations. 517

the periosteum,) to form a lining fipr the other Maps, particu-
larly, as in this manner 1 prevented the adhering of tl e

nasal surfaces, which so easily ocelli's in these operations*.

(appendix.)

Berlin, January 31st, I860.

Having seen the operations referred to in this paper, and
ohserved the patients, I am able to give testimony in regard
to them. The young man from whom the fibrous polypi
were removed from the posterior nares, via an opening made
by the resection of the right nasal hone and the processus
nasalis of the right superior maxilla, left the Clinic perfectly
healed. No exfoliation occurred, and only for a tew days
was there a discharge near the lachrymal sac. The bony
union was complete and firm, when I last saw it, about a
fortnight since. Xo irregularity of the bone or mucous
membrane could be felt in the nares.

In case 1st, under division 4th, (enchondroma of the
under surface of the palatum durum,) there was a most
favorable result. The gums and involucrum palati duii
healed to the bone, and no exfoliation took place. The cure
is complete.

The boy from whom was resected the processus alveolaris
went directhT to the country, and died (as was communica-
ted by letter) one week after the operation, from peritonitis.
Xo post-mortem was made.

In case 1st, division 5th, in which there was a transplan-
tation of the pericranium, to supply defect in the nose, a.most
satisfactory result has followed. There was complete union
by first intention. There was no morbid secretion from the
under (pericranial) surface of the Hap, which was greatly
feared would be troublesome ; but this surface seemed to
take on the character of mucous membrane. The appre-
hended exfoliation of the os fro litis did not take place, tree
granulations having quickly sprung directly from the bone,
so that now only a small spot remains uncovered by new
skin. In fact, Prof. Langenbeck says it has cicatrized as
soon as in the cases where the pericranium was left. The
nose feels firm, and has a regular form. A small portion <>f
the Hap (which was removed in order to raise the nose up a
little) was examined under the microscope, and found to
contain an abundance of osseous and cartilaginous cells.
Several other osteo-plastic operations have been performed
since the above paper was written, the history of which I
will endeavor to communicate at a later period, w. p. n.

American Medical Monthly.

518 Lectures on Rickets. [July*

A Series of three Lectures on Rickets, delivered at the Hos-
pital for Sick Children, in December, 1859, and January,
1860. By AVm. Jbnnbr, M. D., Physician to University
College Hospital, and to the Hospital for Sick Children.

LECTURE I.

Three Striking Peculiarities of Infant Life, viz : The Sensitiveness of the Ner-
vous System ; the Unity of Organic Disease ; the Frequency of Diathetic
Disease The Four great Diathetic Diseases of early Childhood, viz': Rickets,
Tuberculosis. Scrofulosis, Syphilis The Grounds for their Separation
Rickets the most common and the most fattil of the Diseases which exclu-
sively or chiefly affect Children Rickets a General Disease Enumeration of
the most common and striking Anatomical Lesions in Rickets The Anatom-
ical Lesions of the Bones and the Deformities that result considered at length
I. Enlargement of the Ends of the Long Bones Its Anatomical Causes 2.
Softening of the Bones Chemical Constitution of the Softened Bones 3.
Thickening of the Flat Bones ; Its Anatomical Cause 4. Deformities follow-
ing on Softening of the Bones Curvature of Spine Differences before and
after Walking Liable to be confounded with Angular Curvature Deformi-
ties of Femur. Tibia. Ulna, and Radius, Humerus and Clavicles, the Result of
Pressure and not of Muscular Action Defoftnity of the Thorax, the Result of
Atmospheric Pressure Mechanism of its Production.

Gentlemen If you have ever conversed with several per-
sons who have visited together a spot celebrated for its
beauty, you must have been astonished at the different
impressions each conveys to you of the most striking
character of the scene. One dwells on the general beauty
of the landscape, one on the extent of the prospect, one on
the height of the mountains, one on the richness of the val-
leys. Those only agree in their description who have seen
everything through the guide-book. So is it with those
who look at disease. Each may see the whole of what is
before him, but the impression made by individual parts of
that whole on each wTho looks for himself is different. To
one, this peculiarity, to another, that, gives its feature to
the disease. Nearly 60,000 sick children have been patients
at this Hospital since its opening. A fair proportion of
these have come under my observation; and I have endea-
vored to look at them with my own eyes. Some of the
general impressions I have received I shall, I hope, convey
to you ; and some of the facts that I have seen I shall
describe to you. Much of what I have to say may be found
here or there on recprd; but, having looked for myself, I
shall describe only from my own observations; and trust
that what is thus lost in general completeness will be gained
in freshness, and in fulness of details in reference to special
parts of the subject ; those points in the view which have
made most impression on my mind will doubtless stand out
most prominently before you. Before occupying my present

I860.] Lectwres0on Rickets. 519

office I bad road many excellent guide-books; I had been
connected lor some time with a large Hospital; I had seen
among my out-patients, there and elsewhere, many sick
children; 1 thought I knew most of the paths and passes of

that great section iA' Pathology, diseases of children ; and.

had I been required, I should probably have undertaken to
guide others through them. But a very brief experience
taught me that I was mistaken that I had much to learn
before I ought to offSr to lead others.

The first thing, then, I may say, which impressed me
.when I came to sec diseases of children on a large scale,
was the smallness of my knowledge in regard to them. I
tell yon this because 1 am anxious to impress on you my
conviction that diseases of children do require special study,
and time, and attention, to master them. At the same time
[ readily admit that the diseases of children are more easy
to diagnose, and more easy to treat successfully than are the
diseases of adults. Coming, as I did, to the study of the
diseases of children after I had been engaged in teaching
the diseases of adults, my mind was strongly impressed by
three of the peculiarities of infant life

1. By the comparative sensitiveness in the child of the
nervous system generally to impressions, but more espe-
cially of those parts of the nervous system which are con-
cerned in the production of reflex movements, and in the
development of the so-called sympathetic derangements.
In reference to these points the child seems at one end of
the scale, the aged at the other.

A striking illustration of the sensitiveness of the child of
reflex stimulation is afforded by the following experiment :

Pass the finger gently over the inner aspect of the upper
two-thirds of the thigh of a young boy, and notice at the
same time the movement of the testicle. You will see that
it is instantly drawn up close to the external abdominal ring
by the cremaster, and that with a rapidity which will sur-
prise those who witness it for the first time. The scrotum
remains flaccid ; the testicle slowly descends. Repeat the
stimulation on the opposite side, and the testicle on that
side is now drawn up. Pass the finger over the skin of the
outer part of the thigh, and the testicle is motionless.
Touch the skin above the right pubis, and the right cre-
master draws up the right testicle. Touch the skin above
the left pubis, and the left cremaster is thrown into action.
Stimulate the skin higher on the abdomen, and no move-
ment of the testicle follows. Repeat the experiment many

520 Lectures on *Rkkets. [July,

times, or use powerful stimulation, and the contraction of
the cremaster grows gradually weaker, till at last you fail
in your effort to excite it to action. Rest restores the exci-
tability of the part. You will remember that branches of
the ilio-inguinal and genito-crural nerves supply the skin at
the situations I have mentioned; and you may, I believe,
in every ease map out by the experiment I have referred to
the exact portions of skin supplied by those nerves.

With reference to the derangements commonly called
sympathetic. The old man may, nay often does, die from
acute inflammation of the Lungs with mind entire, a pulse
scarcely more frequent than in health, respiratory move-
ments only a little quicker than natural, and a skin of nor-
mal temperature. The child eats some indigestible food,
and forthwith its pulse is rapid, its respirations are doubled
in frequency, its skin is burning hot, its mind rambles, it is
convulsed in every limb.

2. By the frequency with which, at examinations after
death, structural disease of one organ only is found. Xow,
the pathological anatomist who examines all the organs and
structures of the subject, and not merely that which during
life was supposed to be mortally affected, cannot fail to
have noted that death from uncomplicated acute disease is
of comparatively rare occurrence in the adult. This seems
to be the consecpience partly of degenerations commencing
in some structures long before what we call old age, and
partly of organs or tissues once structurally diseased, rarely
if ever recovering their absolutely healthy condition.

3. By the far larger proportion of children than of adults
that are the subjects of profound diathetic diseases before
they are the subjects of local lesions of structure; and
when the subjects of diathetic disease, by the vast number
of organs found after death to be seats of structural change.

The great diathetic diseases of childhood are four, viz :
rickets, tuberculosis, scrofulosis, and syphilis. All manifest
themselves primarily by deviations from the standard of
health, which deviations, per se, we do not call disease. For
example, the delicate skin in tuberculosis, the thick com-
plexion in scrofulosis. the muddy tint of the skin in syphilis,
and the low muscular power in rickets.

All arc distinguished by their more decidedly pathologi-
cal tendencies, that is, by the frequency with which they
produce or are accompanied by striking and peculiar devia-
tions from the healthy structure of particular organs and
tissues; e. g. by softening of the bones in rickets, by the

L860. ] Lecture 3 on Rickets.

deposit or formation <>t* tubercle in tuberculosis, by a pecu-
liar kind of ophthalmia in scrofulosis, by characteristic dis-
eases of the skin and mucous membrane in syphilis.

I shall enumerate briefly the leading feature of a typical
case of each of these four general conditions.

TUBERCT LOSIS (a).

Nervous system highly developed ; mind and body active ;

figure slim; adipose tissue small in quantity; organization
generally delicate; skin thin; complexion clear; superficial

veins distinct: blush ready: eves bright; pupils Long; eye-
Lashes long; hair silken ; face oval, good-looking; ends of
Long bones small, shafts thin and rigid; limbs straight.
Children the subjects of tuberculosis usually cut their teeth,
run alone, and talk early.

Leading Pathological Tendencies. Fatty degeneration of
liver and kidneys ; deposits or formations of tubercle (b),
and their consequences ; inflammation of the serous mem-
branes.

BCROFULOSIS.

Temperament phlegmatic ; mind and body lethargic ;
figure heavy: skin thin and opaque; complexion dull,
pasty-looking; upper lip and ahe of nose thick; nostrils
expanded; face plain: lymphatic glands perceptible to
touch ; abdomen full ; ends of the long bones rather large;
shafts thick.

Leading Pathological Tendencies. Inflammation of the
mucous membranes of a peculiar kind; so-called strumous
ophthalmia; inflammation of the tarsi; catarrhal inflamma-
tion of the mucous membrane of the nose, pharynx, bronchi,
stomach, and intestines ; inflammation and suppuration of
the lymphatic glands on trifling irritation; obstinate dis-
eases of the skin ; caries of bone.

KICKETS.

Mental capacity and power small ; muscular force defi-
cient ; mind and body inactive; figure short; closure of the
fontauelles retarded ; face small, but broad; skin opaque,
often set with downy hairs. Children the subject of rickets

(a) I use this terra to signify the condition of the system which precedes and
accompanies the deposit or formation of tubercle, and which may or may not be
accompanied by the deposit or formation of tubercle.

(b) I use both terms because I am unwilling here to express an opinion on
the question whether tubercle be a deposit, as is generally believed, or a forma-
tion, as some Pathologists are now disposed to regard it.

Lectures on Rickets. [July,

are Late in cutting their teeth, in running alone, and in
talking* and their teeth drop early from their sockets.

Leading Pathological Tendencies, Softening of the bones;
enlargement of the ends of the Ions: bones ; thickening of
the flat bones; so-called hypertrophy of the white matte:' of
the brain; chronic hydrocephalus; pulmonary collapse;
Laryngismus stridulus; convulsions; albuminoid infiltra-
tions of the liver, spleen, lymphatic glands,

syphilis.

Adipose tissue small in quantity; muscles flabby; cutis
rough deficient in contractility; complexion muddy.

Leading Pathological Tend ncies. Suppurative inflamma-
tion of the mucous membrane of the nose; ulceration of the
mucous membranes of the nose and of the lips, mouth,
throat, and anus; falling' of the hair ; eruptions on the skin
of peculiar character; induration of the liver; suppuration
of the thymus, lungs, etc.

There are Pathologists of high repute who regard rickets,
scrofulosis, and tuberculosis to be mere modifications of the
same disease. I and others hold them to be distinct affec-
tions (c). The whole difficulty of the question lies in the
difficulty of determining what is necessary to constitute
identical diseases (d). with reference to some diseases the
grounds of separation are broad and unequivocal. Scarlet
fever and measles are distinct diseases, because their specific
cause is different. Syphilis and tuberculosis are undoubt-
edly not identical, because syphilis owes its origin to a spe-
cific cause, and tuberculosis does not. Rickets, tuberculosis
and scrofulosis are due, it is said, to malnutrition, and
therefore it is urged the}' are essentially identical ; but it is
manifest that the term malnutrition is at once very vague
and very comprehensive. All diseased action by which
unhealthy structure is formed in the place of healthy may
be called mal-nutrition. Pus is the result of malnutrition,

(c) It has even been suggested that rickets is a variety of congenital syphilis.
that it is not so seems to be proved by a consideration of the following facts :
The parent who infects his offspring has usually contracted syphilis before mar-
riage, and the children first begotten after infection are those who suffer ; while,
as a rule, it is only the younger children of a family that suffer from rickets.
The first-born of their parents being commonly healthy, though the later born
are highly rickety.

(d) Many of the disputes which have arisen on the subject of identity of dis-
eases have been the consequence of a want of definition of terms. Two diseases
may agree in many very essential points, and yet not be identical, c. g. measles
and scarlet fever. " A and B are both letters of the alphabet, but A and B have
very different significations. 1 and 2 are both numerals, but 1 and 2 are any-
thing but identical.

I860.] I fures on Rickets, 528

cancer is the result of mal-nutrition, tubercle is the result
of mal-nutrition and yet the purulent, cancerous, and
tuberculous diatheses cannot be held to be identical.

I hold rickets, tuberculosis and scrofulosis to be distind
diseases in the sense in which tuberculosis and cancer are

distinct diseases, and for the following reasons:

1. Because the general condition in each is perfectly dif-
ferent from that in the other.

2. Because the pathological tendencies of those who
manifest these different general conditions are different.

3(e). Because we so rarely see the pathological tenden-
cies of the one manifested by those, the subject of the oth-
ers, e. a. rickets is absolutely unfavorable to tuberculization
(f) tuberculization to strumous ophthalmia.

4. Because, tuberculosis being unquestionably hereditary,
we do not find the children of phthisical parents specially
prone to rickets or to scrofulosis.

5. Because, although we often find several members of
the same family the subjects of rickets, of tuberculosis, or
of scrofulosis, it is comparatively rare for members of the
same family to be the subjects of more than one of these
diatheses.

6. Because rickets is not hereditary in the sense in which
tuberculosis is hereditary.

7. Because the course, prognosis, and treatment of each
of these diatheses are different.

Among the children of the poor in London, the. most
widely-spread of these diatheses is rickets. It is, however,
by no means limited to the poor, or to London, or even to
large towns. I have very often seen it in the children of
the wealth}-, and even in the children of the wealthy living
in the country. It was a consideration of the enormous
number of those that suffer from rickets, the very large
number that die annually from its effects, its remarkable
anatomical characters, its limitation to children, its perma-
nent effects, the very small space which it occupies in Eng-
lish books devoted to the diseases of children, and the con-
tradictory statements on several most important points
made by the best Pathologists who have bestowed attention

(e) I propose to analyze the facts on which 3, 4, 5 and G are founded in a sep-
arate paper. It is sufficient now to say the facts I have collected point to the
conclusion that while more than forty per cent, of tubercular children are born
of phthisical parents, about nine per cent- only of rickety children come of
phthisical parents.

(f) Rickets does not by any means exclude tubercle. Rickety children may
be tubercular, just as syphilitic children may be.

.024 Lectures on Rickets. [J ulv,

on the disease, that determined me to examine minutely
the cases of rickets which came under my care in the Hos-
pital.

I shall in the remainder of this, and in my two succeeding
lectures, detail to yon what I know, from my own observa-
tion of that which seems to me to he without question the
most common, the most important, and in its effects the
most fatal of the diseases which exclusively affect children.

Rickets is a general, or diathetic disease, manifested niter
it has existed a longer or shorter time, by certain lesions of
the structure of the bones and, I say, manifested after a
time, because in some cases the general disorder unequivo-
cally precedes the local changes, and before these latter
occur, we can predicate that they will occur.

In some books, rickets is classed among diseases of the
bones. This is a mistake ; rickets is no more a disease of
the bones, than is typhoid fever a disease of the intestines.
Eickets leads to disease of the bones in the same way that
typhoid fever leads to disease of Peyer's patches: but there
is a general disease preceding and accompanying the dis-
ease of the bones in the one case, as there is preceding and
accompanying the disease of the intestines in the other.
The change in the bones is the anatomical character of
rickets.

The most constant and striking anatomical lesions in
rickets are

1. Enlargement of the ends of the long bones of the
parts where the bone and cartilage are in contact, L e. where
the cartilage is preparing for ossification, and where ossifi-
cation is advancing in the cartilage.

2. Softening of all the bones.

3. Thickening of the flat bones, e. j. the bones of the
skull the scapula.

4. Deformities which follow from mechanical causes act-
ing on the softened bones, c. g. the deformities of the thorax,
pelvis, spine, long bones.

5. Arrest of growth, not only of the bones, but of all the
parts directly related anatomically and physiologically to
the bones, i. e. of the muscles, vessels, nerves and teeth.

6. Certain lesions of the pericardium, lungs, and capsule
of the spleen, the direct consequences of the thoracic defor-
mity.

7. Less constant, but highly important changes, most
commonly affecting the nutrition of the brain spleen, liver,

I860.] Lectures on Rich ts.

lymphatic glands, and muscles, and now and then of evi \\
organ.

I shall now consider the anatomical lesions of the bones,
and the deformities thai are their consequences, al greater
Length.

1. Enlargement of the Growing Ends of the Long Bones.
When we look at i! child suffering from rickets, we are a1
once struck by the large size of the wrists. It has been
supposed that the enlargement is apparent, not real ; that
the wrist looks largo because the arm lias wasted ; this,
however, is incorrect. I measured the circumference of
several wrists in the rickety and the non-rickety, and found
that whether reference was had to the age or the height of
the child, or to the length of the forearm, the circumference
of the wrist was greater in the rickety than in the non-
rickety. I recently measured the height, the length of the
forearm, and the circumference of the wrist of three chil-
dren, two of whom are now in the Hospital, and obtained
these results:

Disease. Age-
Rickets 4 yrs. 0 m.

Rickets 3 li 2 :'

Tuberculosis 3 '' 0 "

We find similar enlargement of the costal ends of the
ribs, of the ankles, of the olecranon process of the ulna; in
factfof the extremities of all the long bones. Some Pathol-
ogists have stated that the ends of bones which are the
least covered by soft parts, are the most affected; my expe-
rience is opposed to this assertion. The head of the thigh-
bone and of the humerus suffer as much as the more
exposed extremities of the long bones. As to the intimate
anatomical structure of the large ends of the bones, there
is excessive formation of the structures which precede or
form the nidus for ossification, there is retardation and
incomplete performance of the process of ossification (g.)
In the healthy child the ends of the long bones measure
more in circumference than the shafts, as the process of
ossification is completed, the bone diminishes in girth.

(g) Die Rhaehitis, cine Krankheit des Kindersalters, bestcht in folgenden die
beiden Momente im Wachsthume des Kuochens betreffenden Anomalien 1. In
ubermassiger die Ossification vorberei tender Zellen-Wucherung im Epiphysen
Knorpel mit Verbreiterung desselben, Markraumbildung in demselben, wahrend
der Verkalkungsprocess zuruckbleit. (Virchow) . 2. In wuchernder sog. perios-
talcr Aufiagerung an der Diaphyse, welche nur sehr spat in Folge der Aufnahme
von Kalksalzen verknochert, wahrend im Inneren die Markraumbildung vors-
chreitet. Rokitansky Lherb. der Path. Anat. Vol. ii. p. 135. Third edition.

Length

Circumference

Height.

of Forearm.

of Wrist.

30 in.

U in.

\% in.

30 u

4-i"

4* "

35 '

5 "

-15 '

526

res on Ri

[July,

In rickets there La an exaggeration of the condition we
find in the first stages oi ation in tlie healthy subject,

the completion of tne process only is stayed. There is great
development of the spongy tissue of the head of tlie hone,
and of the epiphyses, and also of that layer of cartilage in
which the primary deposit of calcareous matter takes place.

The layer of cartilage in which the cells are arranged in
linear scries instead of being half-a-linc, is from a quarter
to half an inch in breadth.

Again, the calcareous granular deposit is wanting at the
boundary of ossification, and there the cartilage cells calcify
before the matrix ; the consequence of this is that you
the cartilage cells, being apparently converted into lacunae
and imperfect caniliculi.

You may easily trace all stages in the deposit of calca-
reous matter on the inside of the cells, from that in which
it forms a mere ring to that in which it is so thick as to
leave only a vacant space resembling an almost perfect
lacuna. (h) Kolliker has generalised from his observations on
ricketty bone, thinking that in rickets the normal process
by which the lacumse are formed is visible. My observa-
tions lead me to quite another conclusion the calcification
of the cartilage cells in the growing cartilage in rickets
seems to me identical with the calcification of the same
parts (i) occasionally seen in enchondromata. It is a patho-
logical process, a petrefaction. The spongy tissue is much
more spongy in appearance than natural, and from the
interstices of its meshes a deep red pulp is expressible.
This pulp is composed of colorless nucleated cells usually
containing only one nucleus, now and then two. and occa-
sionally several blood globules, and in some cases a very
large quantity of free fluid fat. If, as Sharpy. Somes and
]>e Morgan have supposed, these cells play an important
part in the completion of the process of ossification, and I
am from my own observation on ricketty bones, etc.
inclined to think they do, we see in their abundance in
ricketty bones only a farther evidence that in ricketty bone
there is excessive preparation for the process of ossification
and arrest of the completion of the process. The periosteum
is thickened over the head of the bone as over the bone
generally. It attains its maximum degree of thickening just
at the point of junction of the bone with the cartilage.

(h) Kolliker has figured this at page 241 of bis "Handbook."
(i) See Quekett's ;' Lectures on Histology ;'; West's Translation of Muller;
and Gaingee ' On Encbondroma of tbe Testicle."

[860. ] I ctures on

The periosteum of the whole bone is often more rascular
and thicker than natural, bu1 in the many post-mortem
amination8 of extreme rickets which I have made, I have
never Been any bloody fluid as described by G-uerin beneath
that membrane. A crimson pulp fills the canal, and all the
interstices of the tissues of tin- long bones. It is composed
of elements identical in appearance with those expressible
from the spongy tissue of the head of the bones. In this
pulp, however. I have never observed any such quantity of
tree fluid fat, as I have noted in the heads of the hours near
the line of progressing ossification.

2. The softening 01 the bones is sometimes so great that
the hones which in their healthy condition are the Strongest,
may be bent by the most trifling force, and those which
naturally are the thickest, may be cut by a knife with
facility.'

This softening of the bones is chiefly the consequence of
the diminution of their earthy salts. It seems, however,
from the experiments of Lehmann and Man-hand, that the
animal matter of rickctty bones differs, in some cases, from
that of healthy bone ; for, in some of their experiments, the
bones yielded no gelatin on boiling.

Putting together the results of the analyses of several
observers, we gather that the bones of healthy children
yield about 87 parts of organic and 63 of inorganic matters :
and that those of rickctty children yield about 79 parts of
organic and 21 of inorganic matters.

3. The thickening of the flat bones is the consequence of
thickening and increased vascularity of the periosteum, and
of the abundance of the nucleated cells, which, with blood,
form the pulp, which occupies all the meshes of the bone.
The thickening is usually greatest just within or at the
growing margin of the bone, so that in the cranial bones it
is greatest near to or at the sutures, and least at the centres
of ossification.

4. Deformities which follow from Pressure on the Softened
Bones. The spine is bent ; the cervical anterior curve is
inwards. This curvature is only strongly marked when the
muscular debility of rickets (of which I shall speak here-
after) is very decided. The vertebra? being softened, and
the muscles weakened, the head is no longer supported, and
it falls forwards or backwards as eircumstances may deter-
mine. Usually the child favors the falling of the head
backwards, in order that it may see what is going on around
just as when suffering from paralysis of the third nerves,

528

Lectures on Rickets.

[July,

the child sits or walks with the head thrown backwards, in
order that it may see under the fallen upper eyelids. There
is a posterior curvature of the spine, if the child is unable
to walk, commencing at the first dorsal and extending to
the last lumbar vertebra. If the child walks, then the pos-
terior curvature is limited to the dorsal region, and there is
an anterior curvature in the lumbar region. This posterior
curvature in the child yet in arms, is sometimes so extreme
that it may be easily mistaken (and I have known it mis-
taken) for angular curvature. They arc distinguished thus ;

If the child be held by the upper part of its trunk, the
weight of the lower limbs will usually remove the ricketty
curve, and it may certainly be straightened if the nurse,
hold the child by the upper part of the trunk and the Pysi-
cian raises the lower limb with one hand and at the same
time places the other on the curved spine.

This curvature of the dorsal and lumbar spine in rickets
is the consequence of the muscular weakness, and softening
of the bodies of the vertebra; its direction is determined by
the weight of the head, etc. It is an exaggeration merely,
of the curvature always existing when the child of three or
four months old is sitting unsupported on the nurse's arm.
Lateral curvature in the young child are less common than
the antero posterior. Their direction is determined by the
position accidentally assumed by the child. For example,
if the child be carried on the left arm constantly, there is a
disposition to lateral curvature, and the convexity of the
curve will be towards the left.

The femur is curved forwards and outwards. This cur-
vature is produced before the child walks, by the weight of
the legs and feet. The child sits on its mother's lap, or on
a chair, and the lower extremities hang pendant. The
bone being flexible, yields. After the child walks, the
weight of the trunk is the chief agent in determining the
curvature of the femur. The curve which existed before
walking will be exaggerated.

When the tibia curves before the child walks, or has
been placed on its feet, the curvature is almost always out-
wards an exaggeration only of the normal curve in the
young child, and is produced by the child sitting somewhat
cross-legged, and bearing on the floor or bed with the outer
malleolus. After walking, the weight of the trunk is the
chief agent in determining the bending of the tibia, and the
direction of the curve will depend on the circumstances
which determine the point on which the chief amount of
pressure is brought to bear.

I860.] teres on Rickets, 520

The curvature of the ulna and radius has beeo attributed
to muscular action to the child placing its arm around the
breast of the mother, etc.; these causes are altogether ineffi-
cient for its prodnction. The curvature of the bones of the
forearm is produced by the child, owing to want of muscu-
lar power to support itself in the sitting posture, throwing
part of its weight on to its arms. The child places its open
hands on the chair, bed or floor, and throws a large share
of the weight of its trunk on to the bones of the upper ex-
tremities; the bones of the forearm are twisted as well as
curved outwards.

The humerus is sometimes bent at an angle, just where
the deltoid is inserted. This curve is produced by the
weight of the arm when the limb is raised by the action of
the deltoid, and is increased by the cause which determines
curvature of the forearm.

The clavicles are often the subject of extreme angular
curvature. The chief bend is always at the same spot, viz:
just outside the part to which the sterno-clcido-mastoideus,
and the pectoral muscles are attached. The second bend is
about half an inch from its scalpular articulation. The
first curve is forwards, and somewhat upwards: the second
backwards. The curvature of the clavicle is produced
partly by the weight of the arm on the humeral end of the
clavicle the sternal end being supported by the muscles
just mentioned, and by its ligaments but chiefly by the
force brought to bear on it, when the weight of the trunk is
thrown on to the upper extremities, the child being in the
sitting posture, with the hands on the Moor, or crawling.

The deformity of the greatest interest to the Physician is
that of the thorax. The back is flattened. The ribs are
bent at an acute angle where the dorsal and lateral regions
unite. At that part the lateral diameter of the thorax is the
greatest. From it, the ribs pass forwards and inwards to
the point where they unite with their cartilages ; on that
line the lateral diameter of the thorax is the least, the carti-
lage curving outwards before turning in to unite themselves
to the sternum. The sternum is thrown forwards, and the
anterior-posterior diameter of the thorax is abnormally
great. The consequence of the direction of the ribs being
inwards, and. of the cartilages outwards, is, that the thorax
is grooved from above downwards on its anterolateral face
from the 1st to the 9th or 10th rib; the deepest part (^' the
furrOw being just outside the nodes formed where the ribs
and cartilages unite. This groove extends lower on the
U

530

Lectures on Rickets.

[July,

left than on the right side, but it is deeper ou the 5th
and 6th ribs on the right than on the left side ; the heart
and the liver respectively supporting, to some extent, their
corresponding ribs. The points of maximum recession cor-
respond to the 5th, 6th and 7th ribs. A little below the
level of the nipple the chest expands considerably, the chest
walls being borne outwards by the liver, stomach and spleen.
If we examine the thoracic walls from the inside, the ap-
pearance is most remarkable, where the ribs join with the
cartilages there are much greater projections than on the
outside ; but the 11th and 12th ribs, which are notinflexed,
have the same enlargement on the inside as on the outside.

The great determining cause of the thoracic deformity is
atmospheric pressure; this is aided by the elasticity of the
lungs. How is the pressure of the atmosphere brought to
bear on the thoracic parieties were made of cast iron or
other unyielding material, then the diaphragm could de-
scend only so fast as the air could enter at the orifice of the
larynx, and overcome the elasticity of the lungs. The
thoracic parieties, however, in their normal condition, are
not absolutely unyielding ; but then there is a due relation
between their strength, the power of the diaphragm and the
rapidity of its contractions, the size of the orifice of the
larynx, and the elasticity of the lungs. The chest-walls
being healthy, and the orifice of the larynx of normal size,
if the young child sobs violently /'. c. contracts the
diaphragm with abnormal rapidity and force the most
flexible parts of the thoracic parietes will fall in during
inspiration.

If the orifice of the larynx be narrowed, and if the
diaphragm contract with only normal rapidity and force,
there will be recession of the softer parts of the chest-walls
at each inspiration.

Again, if the orifice of the larynx remain normal, the
diaphragm act as energetically as in a healthy child, and the
chest-walls be softened, then, at each inspiration, there will
be recession of the most yielding part of the thoracic walls.

It is this last condition which exists in the ricketty child.
The part of the rib where ossification is imperfect and in-
complete, is so soft that, at each descent of the diaphragm
it recedes, and the furrow of which I have spoken is the
consequence. Just in proportion as the ends of the ribs are
forced inwards, the sternum is carried forward, and the
c tnsequence is the remarkable form of thorax, of which a
model is on the table, of which some examples are now in

I860.] fment of Intussusception. 581

the Bospital, and of which it is rare to pass a day without
seeing cases in the out-patients' room. Rokitansky has
maintained thai this deformity of the thorax is the conse-
quence of want ofpowerin the inspiratory muscles. I have
repeatedly dissected subjects in which this (Jeformity was
strongly marked, and find that there is no correspondence
between the points of insertion of the muscles of inspiration
attached to the outer surface of the chest-walls and the
points of recession. The preparations on the table hear out
my assertion. Weakening of these muscles would have as
its consequence general want of expansion of the Lungs, and
the thorax would have the form that it obtains in senile
atrophy viz., long, with narrow antero-postcrior and lateral
diameters.

Again, the diaphragm is said to cause the circular reces-
sion by its direct action by drawing in the receding parts
at each contraction. On the table are some dissections,
which prove, when compared with the cases and the model,
that the line of recession does not correspond to the points
of attachment of the diaphragm. But it does correspond to
the upper margin of the liver, spleen and stomach ; and is
produced as the longitudinal furrow is by atmospheric
pressure : the parts of the parietes below being prevented
receding by the organs I have just mentioned. The in-
fluence of the organs beneath in preventing the recession
of the chest-walls is illustrated by the apparent bulging of
the precordial region in every case of well-marked ricketty
thorax. The chest-walls covering the heart do not recede
so much as on the opposite side, and the consequence is
that the left side is much fuller than the right ; and, at first
sight, it might be supposed that there was abnormal fulness
of the precordial region.

In excluding muscular action from all direct share in the
production of curvatures of the lying bones in rickets, I am,
so far as I know, unsupported by any authority. Med.
Times and Gazette.

The Symptoms, Diagnosis, and Treatment of Intussusception.

With Cases. Report read before the College of Physicians
and Surgeons, by David W. Yaxokll, M. I).

In the following report, I have attempted to embody an
account of all the cases of Intussusception contained in the
very large number of medical periodicals, and other works, to

532

Treatment of Intussusception.

[July,

which I have had access. I have also attempted to condense
the materials, which I have thus gathered, into limits suited
to the sitting of the College, but in this I fear I shall disap-
point the Fellows. I trust, however, that I shall, in some
dcgvee, at least, atone for the fault, by the practical deductions
which will conclude the report :

Case I. A healthy hoy, aged six months, had, on the 8th
instant, two small, loose dejections, containing blood, passed
without pain. Oth Restlessness, nausea, and occasional dis-
tress, referable to the bowels. 10th Distress greatly in-
creased, without marked heat, tenderness or fullness of abdo-
men; slight retching, no dejection, thirst, pulse very weak.
Castor oil, gss. given and retained, followed in a few hours by
a large, fecal and bloody evacuation, after which the abdomen
began to swell and became greatly enlarged ; no proper
tenesmus, though throughout the day there was frequent and
sudden action of the abdominal muscles, a kind of incomplete,
abruptly terminating strain. At 2 p. in. patient was found
moribund, gasping, gagging ; intussusception diagnosticated ;
unsuccessful attempts made to force water up the bowel.
Just before death, which occurred at G p. m., patient threw
up it could hardly be called vomiting a little thin liquid.
Necroscopy : The ileum had passed through the caecum and
into the ascending colon, the whole lying over the right kid-
ney ; the gut was red from increased vascularity, but soft, and
so far from being strangulated as to be easily withdrawn ;
ccecal appendage scarcely involved ; upon the inner portion
of the bowel, Fever's glands were as much developed as in
typhoid fever, being soft, with some red points and some
lymph upon the surface, which was very irregular, the mu-
cous membrane itself not being remarkable. Midway the
bowel, the mucous membrane was inordinately red and rugose
for about half its extent from the free extremity, but without
mucus, blood or lymph. The passage through the intussus-
ception before it was withdrawn, seemed sufficiently free, the
intestine above being filled with liquid, and that below com-
paratively empty. Dr. Cottlng in Boston Soc. for 2cd~
Impt. 1852.

Case II. An adult, with obstinate constipation and tender-
ness over a circumscribed spot, relieved by copious injections
into the rectum of warm water Dr. Baldwin. Amcr. Jour,
of Med. Sci. 1S52.

Case III. A man, aged 23, robust, subject to frequent
attacks of colic. On the 12th of February, he was seized at
night with violent pain in the lower part of the abdomen,
with shivering, frequent vomiting and purging. Next morn-

I860.] Treatment of Intussusception, 533

ing head hot and painful, tongue foul, thirst, abdomen swollen
and tender to the touch ; pulse fall, hard, frequent ; vomiting ;
watery stools, tinged with blood. L9th Tenesmus. 23d
Prolapsion of part of the intestine, which was easily reduced.
26th Passed twenty inches of bowel, being a portion of the
ileum, the coecum, vermiform appendix, the whole of the
ascending and a part of the transverse colon, A month after,
the patient lett the hospital well. Dr. Nagel. Gazette
Medicate. 1854.

Case 1 V. A lad, aged 1 < . May 26th Taken with general
febrile Bymptoms; expression anxious; abdomen becoming
tympanitic, not tender; painful tenesmus; no dejection;
everything rejected by the stomach, matters vomited being-
grass given. Calomel, opium, purgatives and turpentine
glysters were given during two days. 28th There was gene-
ral tenderness of the belly, especially of the left hypochon-
driuin, where a distinct and hard tumefaction was observed.
Leeches, fomentations, etc., were used, but no evacuations
occurred until the 31st, when they were copious and very
offensive. The vomiting now ceased and the patient gradu-
ally improved, dune 8th Passed two and a half or three
inches of what was supposed to be a small intestine. Com-
plete recovery. Am. Jour. Med. Sci.

Case V. A man, in vigorous health, ?>7> years of age, sud-
denly seized with excruciating pains in the abdomen, with
partial remissions and obstinate constipation, which resisted
all means of relief, died in intense agony in thirteen days.
At the necroscopy, the ileum was found to have made a com-
plete revolution upon itself with the peritoneum as its axis, so
as to strangulate a knuckle of intestine live inches in length.
There were two points of strangulation ; the h'rst, immediately
above the intussusception ; the second, twelve inches above
the last. They were twisted around each other so as to form
a knot, which it was difficult to undo after the gut had been
removed from the body. The intussusception was one and
a half inches in length and four inches above the termination
of the ileum. The coats of the intestine were so firmly agglu-
tinated that they presented the appearance of a fleshy tumor.
blocking up its entire caliber. The ileum was of a dark red
almost black hue throughout all its coats, extending even to
the mesentery ; and about twenty inches of the bowel were
congested. Dr. Gordon. Southern Med. and Surg, Jour.
1846.

Case VL A man. aged 35, health not good, subject to
colic, was attacked with severe pain in the right lumbar
region. V. S. and cathartics produced partial relief. Three

>34

Treatment of Intussusception.

[July,

days after, when seen by Dr. D., patient had pain in its origi-
nal seat, general tenderness of the abdomen, and at short in-
tervals most excruciating pains, except when under the influ-
ence of anodynes. This state continued for four weeks, deatli
seeming inevitable, when a portion of small intestine, a foot
and more in length, was voided per anum, and the patient
recovered. There was no vomiting in this case, and cathartics
operated without unusual pain or difficulty. Dr. Dayton.
X. Y.Jour. Med. 1845.

Case VII. A girl, aged 9 years, after an attack of dysen-
tery, had vomiting, great prostration, and immense distention
of the belly. On the fifth day she passed large quantities of
bloody serum without feculent matter. From the seventh to
the twelfth day, there were small quantities of f\eces dis-
charged, when perfect relief ensued upon the passage of a
portion of intestine, doubly invaginated, ten inches long.
The treatment consisted in opiates endermically applied and
thrown into the rectum. Dr. Paterson. London Lancet.

Case VIII. A girl, six months old, cried violently Friday
evening, but was quieted by Godfrey's cordial. Xext morn-
ing she was feverish, and cried. Castor oil was taken, but re-
jected. At VI M. vomited all ingesta ; no fever or unnatural
fullness of the bowels ; tranquil ; somewhat disposed to play ;
obstinate constipation ; purgatives ; opiates ; a good night.
Following night, the skin was cool; no tympanitis ; no ten-
derness ; gradually grew cooler and more languid, and died
Monday, a. m., fifty-live hours after the first appearance of
the disease. Necroscopy. A knot was felt through the ab-
dominal walls in the right iliac region, which proved to be
about eight inches of the small intestines which had slipped
through the ileo coecal valve. Dr. Shipmcm. 2V". Y. Jour.
of Medicine.

Case IX. Boy, set. 12, previously healthy, complaining of
pain in the belly for two or three weeks, was seized with
severe pain in the left abdomen. In two days after, the pain
had extended over the whole abdomen : not much tenderness
on pressure ; great thirst : constant vomiting of foetid and
greenish matter. A hard body was felt, and its outlines seen
in the position of the transverse and descending colon, and the
finger carried into the rectum touched the tumor. The treat-
ment consisted of cathartics, injections, sinapisms, opiates, a
tube carried into the colon, etc. Death ensued on the evening
of the fourth day. Necroscopy. Twelve inches of the jeju-
num were found forced into the next twelve inches below.
At the commencement of the fold, the intestine was so much
contracted as scarcely to admit the point of the finger, and
felt like a cartilaginous ring. Am. Jour. Med. Sciences.

I860.] Treatment of Tntussusceptkm.

Case X. A girl, aged six years, after eating a quantity nf
niw carrots, waa seized with pains in the bowels, which con-
tinned more or less for eight montlis, when Bhe died. The
bowels, meantime were regularly open, about three limen n
day, but the Btools were always very thin and watery, and
during the last three months they were mixed with slime and
blood. As the lower half of the colon waa lined with the in-
verted upper half, it followed that no part of the l;ecal remains
came in contact with the colon, the termination nf the ileum
being drawn through the centre of the intussusception to the
anus. This may account for the stools being thin and \va ery.
There was no remora in the large intestines for the fornwtiion
of natural stools. Mr. Davies. Med. tihir. Rev. 182;>.

Case XI. A man. collecting wood, felt all at mice a drag
ging pain in the region of the umbilicus, which quickly
augmented and forced him to cease work. Ue crawled home
with difficulty and lay down. In the evening had a motion
Next day worse, with colicky pains every 20 or3U minn es.
Castor oil, salts. V. S. Temporary relief ; pains returned in
the evening, with increased violence, and ranch discharge of
wind; symptoms continued the same for four days. The Dr.
found the patient in bed, not then in pain, but the counte-
nance pale and anxious; temperature not much increased,
abdomen not hot or distended, but sensitive on pressure, pulse
sixty, regular and soft ; a tumor detected about the angle
formed by the ascending and transverse colon; no stools for
five days ; had vomited only once. In half an hour agonising
pain came on, the tumor appeared abont the size of ;he fist,
was hard, and itself the seat of pain. V. S. and leeches to the
part. Strict antiphlogistic treatment until the eighth day,
while baths, fomentations, glysters, etc., were tried without
avail ; an operation proposed, but not assented to ; red oil and
opium given hourly for six hours; large quantities of cold
water thrown into the rectum ; patient felt it reach the har-
dened part, but no further. Vomiting on the ninth day; not
stercoraceous ; abdomen greatly distended ; tumor unchanged ;
six ounces of mercury, without effect. Operation consen ed
to and performed on the tenth day. Operation Abdomen
opened at the outer edge of the. right rectus muscle two inches
above the level of the umbilicus. The hardened part, being
a portion of the ileum, was withdrawn, the gut incised at one
end of the intussusception for two inches, the finger in;ro-
duced into the opening, and the intussuscepted part pushed
back from right to left, the operator gently drawing that part
of the intestine containing the intussusception toward him.
The entangled intestine, when unfolded, measured two feet ;

536 Irmtment of Intussusception. [July,

no traces of inflammation ; the intestinal wound was closed
by the Glovers sntnre, the qw\< brought out of the wound ;
the integuments secured by the interrupted suture. Natural
stool on the second day. I>y the fourteenth day lie was com-
pletely cured. Dr. Fuschttus. Tluf eland's Jour. 1825.

Case XII. A young man (Mrs. Belzoni's servant) had a
severe abdominal inflammation some years before, and since
had been very irregular in his bowels, and subject to prolong-
ed constipation ; was seized with abdominal pain while lifting
a heavy weight. This was attended with obstinate constipa-
tion which was never overcome. lie died in agony ten or
twelve days from the commencement of the disease. Xecr<<-
copy. The intestines above the obstruction were greatly dis-
tended, but no inflammation to account for death. A portion
of ileum had become entangled under an old band, formed,
probably, during a previous illness, and though easily drawn
out, complete obstruction had been the conserpience. Med.
Chir. Rev. 1825.

Case XIII. A man, aged forty years, after some muscular
exertion, felt acute pain in the right iliac fossa, followed by
colic, frequent vomiting and purging, with intervals of ease:
had occasional discharges of blood. During the paroxysms
the left iliac region presented the figure of a large convolution
of intestine. Countenance drawn, tongue, furred, thirst, slow
pulse. Leeches, fomentations, demulcent drinks, and the
like. Six days after admission, and four months and three
days after first seizure, while straining at stool, he felt some.
thing give way in the abdomen, and in a few moments he
became very ill, abdomen inflated and exquisitely tender.
He died at 8 o'clock the same evening. Necroscopy. Uni-
versal peritonitis, but no extravasation. Recent coagulable
lymph abundant. The ca?cnm and ascending colon were
carried forward and enclosed in the last half of the transverse
arch and in the sigmoid flexure, which was as thick as a man's
arm, and hard or solid to the touch. The caecum was found
in the sigmoid flexure in the iliac fossa. The invaginated
parte were agglutinated together, and in some places gangrene
had commenced. Up to the day before the patient's death,
he had fluid evacuations. Jf. Bu<t. Arch. Gen I. 1828.

Case XIV. A man, aged 22, admitted 8th Aug., 1825, had
had colicky pains and diarrhoea for some time, with intervals
<>f ease. Ordered emollient fomentations, diluents and lave-
ments. On the 12th and 13th the symptoms were aggravated,
features sharp, pulse concentrated, and the left iliac fossa very
painful on pressure. Leeches and opiates. 14th, pain insup-
portable, nausea, vomiting and spasms. 16th, symptoms of

18G0.] Treatment of Intussusception. 587

peritonitis; a great number of leeches were applied, bul the
disease was unchecked, and death occurred on the L8th, ten
days after admission, and six days after the appearance of
argent symptoms. Necroscopy. Genera] peritonitis; nume-
rous adhesions and false membranes, bul no effusion or extra-
vasation. By moderate traction il was discovered that the
caecum, ascending and transverse colon were engulphed in the
descending colon. The caecum was gangrenous.- M. Buet.
Arch. Gen. Vol. VIII. 1828.

Case XV. A man, aged 11, was taken suddenly with pain
in the bowels Nov. 25, which increased until next morning,
when be was seen. Pulse full, but not hurried, tongue clean,
face anxious, belly not distended, no evacuations since attack-
ed, excruciating pains which were partially relieved by pres-
sure about the umbilicus with intervals of three or four min-
utes ease, severe vomiting and thirst. Purgative glyster ;
repeated, no relief; blister over the whole abdomen, and
opiates ; vomiting allayed ; pains in some degree dulled ;
twelve grs. of calomel ; twelve hours after, pain and vomiting
had returned as violently as ever; copious warm water injec-
tions tried, but with no avail ; twelve grains of calomel on the
morning of the 27th, without relief; pain, on pressure in the
right iliac fossa ; a gallon of warm water thrown up ; no
benefit; air was then injected with a common bellows with
immediate relief, and on the fourth trial an evacuation was
obtained, the vomiting ceased, and lie complained only of
general soreness ; eight grs. calomel and one gr. opium, fol-
lowed by free evacuations and complete cure. Med. Oh. U< v.
1839.

Case XVI. A woman, aged 11, weak and small, the mother
of many children, subject to tits of colic, bad an attack on
Sept. 19th, which was not relieved by customary remedies and
was attended with constipation. Seen on the morning of the
21st. Paroxysms every two or three minutes of violent, deep
seated pain ; tenderness on pressure, especially in the right
iliac region ; heat little increased ; pulse small and hard ;
urine scanty; no evacuation since the 19th; everything swal-
lowed was rejected. Various remedies were tried until the
23d, but without relief. On that day, faeces were discharged
by the mouth, and hiccough had commenced. Dr. Ebers
then considering the case hopeless, administered Sij. of quick-
silver, 10 drops of laudanum and several small cathartic
doses; a few hours after, j. more of mercury. Soon after,
every symptom indicated relief, gurgling was heard in the
intestines, but no evacuation. The favorable symptoms dis-
appearing, other 5iij- of mercury given at 2 o'clock in the

538

Ireatrm nt of Intussusception.

[July,

morning of the 24th ; patient fell asleep and remained quiet

for two hours, when at Length copious feculent evacuations
occurred, and all her sufferings were relieved. By the mid-
dle of October, with the exception of weaknese, her health
was re-established. No salivation. Dr. Ebers. X. V.Med.
andPhys. Jour. 1830.

Case XVII. A woman, several days ill with obstinate con-
stipation, dreadful abdominal pains and vomiting, was admit-
ted into hospital. On that day she vomited a large quantity
of feculent matter. Countenance sunk, skin and extremities
cold, pulse small and quick, strength exhausted, abdomen
tender and doughy. A warm bath and giysters were tried
without avail, medicines were immediately rejected. Riv. of
mercury were given, and in a few minutes she became a little
quiet; in an hour had oij. more of quicksilver, after which
she fell asleep. In half an hour, she discharged an enormous
quantity of fetid feces. She recovered with great rapidity.
Jul. M. and S. Jour.

Case XVIII. A boy, aged 1G, ate some nuts Sept. 8th ;
unwell on the 9th ; seen by Mr. Fox on the 10th : pain about
umbilicus ; no motion for twenty-four hours. The case as-
sumed all the characters of intussusception, and resisted all
remedies. On the 16th, Mr. Fox determined to try inflation.
This was done by means of a common bellows, a bladder and
common enema pipe. The inflation was forcibly but slowly
persevered in for many minutes until the boy complained of
a disposition to " break wind." The tube was withdrawn, and
in twenty minutes a copious evacuation took place. On the
23d, at Mr. Fox's visit, he found the patient comfortable, but
the nurse showed him a large piece of bowel which had come
away with one of the stools. It was a portion of one of the
intestines, five inches long, with some of the mesentery still
adhering. The lad recovered perfectly. Mr. Fox. Med.
Chir. Sev.

Case XIX. A negro man, aged 20, seventeen days ill with
pain, stercoraceous vomiting, obstinate constipation, etc. In-
cision made in the linea alba, commencing two inches above
the umbilicus, and extending two or three inches below. The
intussusception was found in the ileum. The bowel was
grasped above and below the point of obstruction, and after
several efforts of considerable force, the adhesions gave way.
The parts seemed to be on the verge of mortification. The
wound was closed by a few stitches and adhesive straps. His
recovery was rapid and entire. Dr. Wilson. Transylvania
Jour. M(d. and Surgery.

Case XX. A woman of spare habit, admitted into hospital

1800.] '/' itment of Tnt 539

January 25, L840. Attacked the day before with pain in the
abdomen, vomiting, diarrhoea and tenesmus. When admitted,
the diarrhoea had ceased, but the vomiting and tenesmus con-
tinued until the 27th, when she died. No tumor could be
detected during life. Posl mortem: First stage of peritonitis ;
no effusion. The termination of the small, and commence-
ment of the large intestines, formed a tumor of considerable
size, extending trom the left Bide downward to the right iliac
fossa. It consisted of an invagination of the ileum, about
twelve inches of which had passed through the ileo-csecal
valve into the ccecum and colon. A pear-shaped, fleshy poly-
pus, about an inch and a half in Length, grew from the ileum,
and seemed to be the cause of the invagination. Dub. Jour.
\ed. 8ci. 1840.

Case XXI. A man ; usual symptoms ; movable tumor near
the umbilicus; duration not stated; diagnosed as malignant
disease; on post mortem found to be a retrograde invagina-
tion of the descending into the transverse colon to the extent
of three or lour inches; no general inflammation, but the
intussuscepted intestine was found in an ulcerated condition,
accounting for an unhealthy discharge which had existed
during life. Dublin Med. Press.

Case XXII. A man, aged 45, had an attack of violent
abdominal pain during the night of March 3d. Xext morn-
ing Dr. J. was summoned, and found the patient vomiting
frequently, pulse nearly natural, no fever, abdomen painful on
pressure. Cups applied, and camphorated effervescing draught
prescribed. In the commencement of the attack all the usual
remedies were applied, but the case ran the ordinary course
until March 12th, when a copious discharge of fetid, black
blood took place, followed by great exhaustion, and death.
Post-mortem: traces of peritoneal inflammation and alteration,
but not of great extent or severity. Fourteen or fifteen inches
of the ileum had passed through the ileo-coecal valve into the
caecum and colon. The colon contained a large quantity of
blood. The hemorrhage was undoubtedly the immediate
cause of death. An hour before it commenced, the symptoms
presented nothing indicative of immediate danger. Had the
hemorrhage not occurred, adhesive inflammation, followed by
sloughing of the invaginated portion of intestine, might have
left a free passage from the small into the large intestine.
The invagination probably commenced several months before
in a previous attack of colic, from which time he had uneasi-
ness in the right iliac region, with repeated relapses. The
large, fibrous mass which existed between the peritoneal coats
of the invaginated part, must have been the work of time, and

540 Treatment of Intussusception, [July,

could not have been produced at the last attack. Samuel
Jackson, Ai.nr. Jour, Med, Science, 1S33.

Case XXIII. A male child of three and a half years. He
was pawed by a horse two years before, and much contused
upon the back and in the left iliac region. From then up to
the first of November, he frequently complained of pain in
the abdomen in the vicinity of the injury. At that time it
became greatly aggravated, with occasional vomiting. The
mother administered large (loses of laudanum without benefit.
About the beginning of January my attention was called to
the case. Vermifuge was ordered, supposing the trouble
owing to worms ; no change in the symptoms. Aboir
weeks previous to his death, diarrhoea came on, with dis-
charges of bloody mucus; pain still severe, with great tenes-
mus at stool; two lumbricoid worms passed; prolapsus ani
also occuired; the child was greatly emaciated and suffered
intensely. Calomel and opium were given for some time, but
finally exchanged for sol. sula. morph., which was continued
pro re nata till death, July 10th. Post mortem Some peri-
toneal inflammation ; the lower part of the ileum, caecum,
colon and rectum were inflamed, the caecum approaching gan-
grene; it was inverted into the colon, passing through its
whole length, and lodging in the rectum near the anus ; the
caecum, all the colon except about ten or twelve inches of its
lower part, and a considerable part of the ileum, had passed
into the lower portion of the colon, and the rectum, making
altogether more than two feet of inverted bowel. The appa-
rent prolapsus ani was probably the protrusion of the caecum
through the sphincter. Amer. Jour. Med, Sci,

Case XXIY. Dr. William Merriman relates the case of a
child who was taken suddenly ill, appearing to suffer in the
bowels ; a good deal of purgative medicine was given without
effect; it died at the end of four days. On post-mortem, in-
tussusception was found, the caecum and its appendix, and the
cascal valve having passed into the colon. London Lancet,

Case XXY. Mr. Snow assisted at the post-mortem exami-
nation of a child that died of a similar intussusception, but to
a greater extent, for the ileum passed into the colon as far
as the commencement of the sigmoid flexure ; the coats of

the intestines were much swollen from congestion. London

-j. ~

Lancet,

Case XXVI. A man, aged 30, undertook severe labor after
eating a quantity of cherries, swallowing the stones. lie was
soon seized with pain in the hypogastrium, followed by vom-
iting. A short distance from the right iliac fossa, a shining
tumor the size of a pullet's Oixg was observed ; no action on

[860.] Treatment of Intussusception. 541

the bowels for four days; stercoral vomiting, As death
seemed inevitable, gastrotomy was performed. The tumor
was found to consist of a fold of ileum twisted upon itself so
as to form a ring, which could not be liberated. Under these
circumstances, three incisions were made into the projecting
intestine. The incisions were united for suture. Recovery
slow, but perfect. Dr. Reali. Rev. Med. Chir.

Case XX VI I. A man aged 63, had violent pain and
spasms in the epigastric and umbilical region ; violent vomit-
ing; frequent desire to go to stool ; passed nothing ; pulse 96;
weak. Castor and croton oil; flexible tube carried to the
sigmoid flexure; injection of three quarts of soapsuds, which
brought away large quantities of grumous "bjood mixed with
faeces ; in lour days he found the bowel hanging from him ; in
three days after, getting hold of it, the patient pulled it away ;
it measured four and a half feet. Dr. Sheldon. Med. Chir.
Rev. 1850.

Case XXVIII. Mr. Harlan, of London, reports the follow-
ing : A girl, live months old, became restless and suffered from
excessive gastric irritability; tongue furred and white; no
fever. Ordered calomel and castor oil, which, though retain-
ed, were without effect. When the patient strained, the
bowel protruded an inch or more at the anus. This was
thought to be an ordinary inversion of the rectum. The child
lived until midnight: At the post-mortem, the colon appeared
as if distended with black IVeces The intussusception com-
menced in the ileum just where it enters the caput coli, which
was foun<l in the left hypochondriac region. The parts
involved in the disease were about one inch of the ileum, the
whole of the caecum, with a portion of the colon these being
received into the remaining portion of the colon. The caecum
had descended into the rectum, which gave the latter the ap-
pearance of faecal distention, although very little faecal matter
was found below the commencement of the intussusception,
and that little was fluid. The caecum was thickened from
inflammation, and its inner serface, together with that of the
strictured colon, was gangrenous. It was this hardened,
tumefied and inverted caecum which protruded during the act
of straining, and had been mistaken by Dr. II. for a prolapsus
of the rectum *Med. Ch. Rev. 1831).

Case XXIX. During the same year, and in the same peri-
odical, Mr. Gorham details three cases. One was an infant,
four months old, who vomited when taken from the breast, at

*The post-mortem in this case is very loosely described, and in some portions
is manifestly incorrect.

542 Treatment of Intussusception. [July,

2 o'clock. ]>. m. This continued throughout the case. Between
7 and 8 o'clock the same evening, it was first observed that
pure blood alone was evacuated per anuni. The quantity
amounted to three or four teaspoonsful ; the skin was pale and
hot ; there was no emaciation ; the infant lay quiet for a few
minutes, and then cried out, the countenance expressing pain ;
abdomen soft and hot; nothing abnormal could be felt in the
rectum : some dark blood followed the digital examination ;
vomited six or eight times within half an hour ; enemas were
returned as fast as given. Poultice over the abdomen, and J
gr. ext. of conium in a teaspoonful of camphor mixture given
every four hours. No more blood passed, but the patient
always vomited after taking the breast ; convulsions came on
during the night, and at 9 a. m. a fit proved fatal. Post-
mortem Four intussusceptions of the small intestines, which
were easily reduced, were found over-lying the peritoneum,
which was slightly red. The lower part of the ileum was a
deep red color and intussuscepted in the ascending colon,
which latter was also swallowed within the transverse. The
appendix cseci was highly injected, and along with the ca?cum
occupied the upper part of the invagination. The colon below
the intussusception was of a dark bluish color.

Case XXX. A woman, aged 26, had obstinate vomiting-
after uneasy sensation in the stomach ; violent paroxysmal
screwing pain between the sternum and tjie umbilicus. Calo-
mel, jalap, castor oil, laudanum and the warm bath all useless.
Five days passed without a dejection ; the common bellows
was used, and as soon as the air entered the rectum the coun-
tenance lost its anxiety, and the patient was relieved. In a
minute she passed a stool, and complete recovery resulted.

Case XXXI. The symptoms were vomiting of a dark, fetid,
oily fluid, hiccough, severe pain about the navel, no motion
four days, when the bellows was used. Six dej ections followed
in the course of the dav, and the patient recovered. Med, Ch.
Rev. 1839.

Case XXXII. A woman, aged 25, had diarrhoea and occa-
sional colic for two months, with fits of vomiting. In the
second week of May, she was admitted into the hospital.
Firm, hard swelling in the ileo-coecal region ; not very sensi-
tive on pressure ; leeches to the swelling and anus without
benefit; obstinate constipation and vomiting, at first bilious,
then faecal. After other means had failed, a pill of croton oil
produced an evacuation and gave relief, which was, however,
only temporary, for on the following week all the distressing
symptoms returned, resisting croton oil and all other remedies.
Gastrotomy was now performed, as a last resort. An incision

18G0.] Tongue Removed by the lacraseur. 648

was made over the tumor, and a 1"*'}) of small intestine drawn
out and opened to the extenl of an inch and a half. A quan-
tity of faecal matter flowed out, with great relief to the patient.
The wound of the intestine Mas with some difficulty retained
in the external wound by ligature; light dressings were ap-
plied, and the patient put to bed. On the next day tin- con-
dition of the patient became rapidly worse, and she died that
evening. Post mortem- -General peritonitis in the last or pu-
rulent stage. The intestine which was opened proved to he
the ileum, eight or nine inches above the caput-coli. The
obstruction was found to be at the junction of the caecum
with the colon. The constriction was so great as barely to
allow of the passage of the little finger. The caecum rested
posteriorly on an indurated scirrhus-like mass, but the mucous
coat of the gut was uninjured. The rest of the intestinal
canal showed but slight signs of disease. 31. Monoid, Arch.
Gen.

Case XXXIII. A child six months old, put out to nurse
at three months; ailing, and troubled with colic and diarrhea
from that time. On the afternoon of August 10th, lie had a
small, natural motion, which was the last, although he lived
until the morning of the 14th. On the llthDr. B. was called
in ; found the napkins stained with blood; food and injections
were immediately rejected; great and continual uneasiness,
and progressive feebleness and emaciation up to the hour of
death. Post-mortem On slitting up the rectum, its impacted
contents were found to consist of the caecum, the greater por-
tion of the colon, and a small part of the ileum, with some
omentum. Dr. Buvfovd. London Lancet.

Tongue Removed by the Ecraseur.

In the Xew Orleans Medical Xcws and Hospital Gazette
for February, Dr. S. Choppin reports a case of removal of
the tongue, for cancer, with the ecraseur. The operation
lasted fifteen minutes, and was accompanied with no haem-
orrhage. This operation is usually accompanied with con-
siderable haemorrhage, and it is highly probable that the
ecraseur is, in such cases, a valuable surgical appliance.

Radical Cure of Hernia. Dr. Choppin, referred to, is an
earnest advocate of the Wurtzer plan of operating for the
radical cure of hernia. lie has operated many times with
success, and has demonstrated, by post-mortem examina
tions of subjects operated upon years before, that positive

f>44 Tongm Removed by the Eerasewr. [July?

occlusion of the canal had taken place; thereby rendering
the recurrence of the hernia impossible. The editors of the
Medical News and Hospital Gazette, referring to Dr. Chop-
pin's operations, and his lecture upon this subject in the
Charity Hospital, say, k- We have several times before called
attention to this most valuable operation, and offer no
apology for repeating our opinion, that it is one of the most
important surgical innovations of the age, if not absolutely
the most important." Several eminent surgeons have ridi-
culed this operation; but, really, we hope the views and
experiences of Prof. Choppin may be proved to be correct
by subsequent clinical observation.

Radical Cure of Hernia. In the Medical Press, for Feb-
ruary 11th, Dr. J. W. Posebrugh reports a case of hernia
apparently cured, after two operations after the plan of
Wurtzer. He says: "The inguinal canal was so large that
three good-sized ringers could be introduced into it." Hopes
of success were entertained after the first operation, but
after a month the patient felt something give way, and a
fold of intestine descended into the scrotum. On reducing
the hernia again, "the canal was found to be so small that
the point of one finger could scarcely be insinuated into it."
Encouraged by a partial success, the operation was repeated,
and three months after there is every prospect of a radical
cure.

Prof. J. C. Xott, of Alabama, writing from London to
the Xew Orleans Medical and Surgical Journal, and speak-
ing of this operation, says : "In Paris, I talked with Vel-
peau, the Xestor of French surgeons, with Xelaton, and
others, and they all say that AVurtzer's operation, or any
other on similar principles, cannot be relied on, the disease
returning in the great majority of instances. In fact, the op-
eration is scarcely performed at all now in Paris." Opposed
to these views, we may instance the following, as the most
recent, in addition to those previously referred to. One of
the editors of the Xew Orleans Medical Xews and Hospital
Gazette, in the February issue, says: "The fact that the
radical cure of hernia can be nearly always accomplished
by the method under consideration is no longer to be dis-
puted, and he who sneers at it is only furnishing a stick
with which to have his own head broken."

In the Charleston Medical Journal and Review for Jan-
uary, Dr. T. L. Ogier reports twelve successful operations
by Wurtzer's method, and he says he has performed nine-
teen other successful operations, not included in his report.

I860.] Induction of Prematim Labor, 545

Dr. Ogier concludes his report thus: " Recent cases, insub-
jects under forty years of age, arc always successful, and as
tar as my limited experience goes, quite free from danger."

In the paper of Dr. Etosenbrugh in the Medical Press, the
author says he was not aware that the operation of Wurtzer
had ever been repeated iii the same individual. Ill the
Medical Times and Gazette for August 6th, 1859, Dr. Red-
fern Davies reports forty cases of this operation, in five of
which the operation had to be repeated lie says: -* Where
the rings are very large, and relaxed, the operation is some-
times unsuccessful, and has to be repeated." Out of Dr.
Davies1 forty cases, "but two were complete failures, and
of these one was owing to supervention of small-pox."

If the operation for the radical cure of hernia is seldom
resorted to in Paris, as we are led to believe by reports, it
is frequently and successfully performed both in England
and America. Am. Med. Monthly.

Induction of Trematun Labor,

In the Louisville Medical .Journal for February, Prof.
Henry Miller has an article upon the induction of prema-
ture labor and abortion, with cases. We refer to it for the
purpose of quoting his method of using the uterince douche.
He says: "For this purpose an apparatus was constructed
according to the directions of the German professor, (Ki-
wisch,) with only a slight and important variation, consist-
ing of a tin box, ten inches square, holding about four
gallons, with an india-rubber tube, twelve feet long,
attached to the bottom of the tin box by a screw and nut,
and having a metallic tube, six inches long, affixed to its
other extremity the end of the metallic tube being fash-
ioned like the nozzle of the common enema syringe. In-
stead of arranging the apparatus to act on the principle cf
the siphon, as recommended by Kiwisch, a stop-cock was
adapted to the india-rubber tubing, about two feet from its
metallic end. To put the apparatus in operation, the box
must be suspended on a nail driven into the wall, near the
ceiling of the room, say nine or ten feet above the floor;
the india-rubber tubing must be screwed on, and the stop-
cock turned, so as to prevent the flow of the water till it is
wanted. The patient takes her seat on a stool placed in a
bath-tub to receive the water, the metallic nozzle is intro-
duced into the vagina, and in contact with the os uteri, and
35

546

Chloride of Zinc as a Caustic.

[July,

the tin box having been previously filled with water, the
stop-cock is turned, so as to pour a continuous stream upon
the os uteri until all the water in the box is discharged."
Prof. Miller uses the water warm at first, and, if need be,
subsequently alternates cold and warm. In the successful
case reported, the douche was used but once on the first day.
On the second, third and fourth days, it was used twice
each day. On the fifth and sixth days he used warm, and
then cold immediately after, using the warm and cold douche
each twice each day when labor set in.

The fact that the douche will sometimes fail in inducing
labor, and the number of times it has to be repeated before
success crowns the effort, will always operate against this
procedure. We prefer the separation of the membranes,
which can be done at one sitting, is usually safer when
properly performed, and is always successful. American
Med. Monthly.

n

Action of Chloride of Zinc as a Caustic. By Salmon and
Maunoury, Surgeons to Hotel Dieu, at Chartres.

Chloride of zinc, as compared with caustic potassa, is an
agent producing cauterization very slowly. It does not
dissolve tissues, but on the other hand, renders them harder
and more coriaceous ; under the microscope, one can recog-
nize very readily all the anatomical elements of which they
are composed. The cauterized surface prevents the ready
penetration of the fresh caustic, when it is desired to act at
a greater depth ; and then it is necessary to remove the
eschar, already produced, by caustic potassa, or to cut off
the same by the bistoury, or to await its removal, which
requires from six to eight days.

It is a caustic which does not spread under the following
conditions : 1st. When it is applied on moist or fungous
tissues, on a wound, &c. 2d. When the successive layers
of the tissue to which it is applied are all of like ready pen-
etrability. But if, under a tissue easily destroyed by the
cauterization, an aponeurotic expansion, muscular tissue,
&c, be found, it scarcely penetrates these, and spreads
through the tissue on which it has been applied, until it
doubles, or even triples, the size of the required eschar ;
hence it cannot, with justice, be said that chloride of zinc
destroys tissues like a punch.

It destroys cellular tissue more readily than cutaneous ;

! r

I860.] Cancer of the Breast

and the latter more readily than fibrous or muscular tissue,
fcc. Contrary to the assertion of Girouard, it attacks mor-
bid tissues, such as cancerous growths, with the same facility
that it penetrates fungous tissues. If the morbid mass be
enveloped with a fibrous covering, the zinc caustic can iso-
late this mass, hut this docs not imply the rapidity of its
penetration in the morbid tissue when deprived of its en-
velope. It coagulates the blood even in large vessels, but
does not prevent haemorrhages from following its employ-
ment, even when the arteries are only of medium size.
Eschars formed by it are soluble in potassa, and this property
can frequently be utilized with the view of hastening the
termination of cauterizations. Gazette Medicate de Paris.

Spontaneous Cure of Cancer of the Breast.

Guerdan, of Billigheim, having a female under treatment
for cancer of the left breast, with swelling- of the axillary
glands, sent her to Professor Chelius, who pronouced the
case not suited for operation. It was decided then to em-
ploy the hemlock plaster. The physician was sent for, one
evening, in great haste, and finding the patient bathed, as
it were, in a pool of arterial blood, he ordered, without any
great hopes as to the result, five drops of tinct. ferri. muriat.
jether. every half hour. On his seeing her again, she told
him that, after her return from the hospital, erysipelas had
appeared on the diseased breast, which surrounded the
tumor with a dark-red circle, for which she had employed
fomentations of cold water. After some days, the circle
changed its color from a bluish-red to a leaden hue : the
scirrhous breast was covered with sanies ; by degrees the
whole diseased mass was decomposed into a granulated
mass, analogous to a mixture of sanies and gluten, and, in
live months, the whole cancerous breast was removed,
leaving the pectoralis major exposed. Xot only did granu-
lations form a normal cicatrization, hut the axillary glands.
whose volume had diminished one-half during the suppura-
tion, continued to disappear, until it was difficult to detect
them by the touch. There remained nothing abnormal on
the cicatrix, except a horny crust, which was kept covered
with charpie and flannel. From that time, this person
enjoyed good health, presenting no trace of cancerous dis-
ease or diathesis, and died eight years after, of an acute
pleurisy. Echo Medical Suisse.

548 Belladona in Scarl t F> ver [July.

External Application of Belladona in Scarlet Fever. By J.
W. Benson, M. I).'
In twenty-five successive cases of this disease, which have

been latterly under my professional care, the treatment con-
sisted in inunction of the parotid and submaxillary regions
by an unguent composed of fifteen grains of the extract of
belladonna to an ounce of simple ointment. This was ap-
plied freely and frqnently as soon as the patient complained
of sore throat. A piece of flannel was afterwards applied,
and in no case was any other treatment adopted, except the
administration of small quantities of neutral mixture during
the day. In some cases of rapidly occurring tumefaction
of the throat, the prompt subsidence thereof under the
treatment, left no room for doubt as to its efficacy. I do
not pretend to offer this mode of treatment either as a
cure for scarlet fever, or as the sole means to be relied
upon in any case, but I do claim for it a controlling power
over the engorgement, and hence a prevention of those de-
structive ulcerations of the throat which are so much and so
justly dreaded. In some cases it has seemed to have a salu-
tary effect upon existing diarrhoea as soon as the system was
influenced by the remedy.

In one case only was I com} tell ed to discontinue its use
because of its constitutional effect. I will not here discuss
its modus operandi, but simply suggest that the experiments
of physiologists in reference to the influence of the organic
nerves upon glandular organs, coupled with an experience
of thirteen years in its use as a restraining remedy in saliva-
tion, and a more limited but somewhat extensive observa-
tion of its influence on the mammary gland, seemed to
justify, on purely rational and philosophical grounds, the
adoption of the course pursued.

During a discussion some months ago in the College of
Physicians and Surgeons upon the merits of belladonna
treatment in profuse lactation and mammary inflammation,
1 took the liberty of intimating that perhaps the contra-
dictory results of the observation of members might have
obtained from a failure to distinguish between the patho-
logical condition of the gland itself, and that of the areolar
structure in relation with it, for if my views of its action be
correct, it might not influence directly the latter condition,
but would prove potent in the former. Since the results
^\' the application as indicated were reported to the College,
some o\' my friends have adopted the same course, and with
the same results, viz., perfect success in every case.

I860.] Tttmor8ofthe Breast. 549

They, therefore, concur with me In attributing such re-
shits to something else than mere coincidences on negative
effects. They may noi be, but the application is a simple,
and, under judicious watchfulness, a harmless one, and I

will be as free to confess its inertness as 1 am now anxious
to press its claims to attention, so soon as my duty shall
seem to indicate such a course. Tjouisvilli M><L News.

Topical Applications for Tumors of the Breast.

There arc some benign tumors of the breast, resembling

cancer, which arc frequently extirpated. Dr. Chabrely lias
published some observations on certain forms of these
tumors, that can be cured without an operation, although
months of treatment are required, and frequent applications
of the following powder:

R- Ainvli. grammes 2.50

rul v. [odini, gramme 0.50 to gramme 1.

Morphhe muriatis, " 0.40

This powder is spread on some wadding, and then kept
in contact with the diseased part by means of a suspensory
hag. Bulletin Gcn.de Therapeutique.

Pulmonary Consumption A Prescription of Dr. Louis.
The Druggist copies the following from Champianiere's
Journal: " To support strength, to subdue the cough and
promote sleep, to diminish night-sweats, such arc the three-
fold indications which are met by the following prescription
of Mr. Louis, in the case of confirmed phthisis : 1. Take,
one hour before the principal meals, one pill of proto-iodide
of iron (Pilules de Blancard.) After ten days, increase the
dose to two pills, and drink immediately afterwards a small
tea-cupful of infusion of quassia, made with cold water, and
not sweetened ; 2. At night, or four hours after the last
meal, take a pill of extract of opium from one-sixth to a
half grain ; 3. If abundant perspiration be present, take at
bed-time one or two pills of two and a quarter grains of
white agaric ; 4. The diet should he generous, but not
stimulating."

550 Editorial. [July,

EDITORIAL AND MISCELLANEOUS.

American Medical Association Dr. Mott. We have, as vet,
received but fragmentary notices of the proceedings of the meeting just
closed at New Haven. We forbear, therefore, any attempt to present
our readers with the interesting minutes. There can be no doubt that
the anticipations of the most sanguine will be fully gratified in both the
interest and pleasure of the present reunion of the Profession. The
scientific interest must be greatly enhanced by the carrying out of the
plan so ably and judiciously perfected at the last meeting by Dr. J. IS.
Liiidsley, of Nashville. The Association, in consequence of these sug-
gestions, has become at once a truly scientific body for the discussion of
high questions in the various departments of medical science, and now.
more than ever, will its influence be felt throughout the length and
breadth of our country, and more than ever, too, will it command the
respect and consideration of scientific men in Europe.

We understand, from our exchanges, that it has been proposed to
elect Dr. Valentine Mott, of New York, President of the Association.
This is a happy and most appropriate idea. In ISoo, at the meeting in
the city of New York, the courtesy of the Profession in New York re-
signed Dr. Mott's claims to his distinguished cotemporary, Dr. Jonathan
Knight, of New7 Haven. The announcement of his election was received
with an enthusiasm which was abated, only by the reflection, that the
excellent and highly distinguished Dr. Mott, the Nestor of American
Surgery, had in all probability lost his last chance of occupying the
highest place in the gift of the l^rofession. Dr. Mott was old then he
is seven years older now, and being spared by an all-wise and gracious
Providence to meet his admiring brethren again under favorable circum-
stances, we earnestly hope that the Association and that New Haven
have honored themselves by honoring him, and paid the debt so justly
due to Dr. Mott and to New York.

The most youthful, it is true, may die at any moment, but we must
make haste, when we would do honor to the aged, or lose, perhaps for-
ever, the golden opportunity. Their journey is nearly travelled to the
end their battle of life fought almost through their endurance and
their heroism have won our admiration, their benevolence our warm
affection gratitude wells up from the heart but hesitates, unspoken, at

I860.] Editorial 561

the lips. Speak quickly, Bpeak plainly, for silence may bring i life-
fong, sclf-rcproachful regret ; even now, " they are gathering their robes
about them to depart," and another year or another day may find them
for beyond the sound of our voices, when our paltry tokens of honoring
respect, and our ungrateful neglects, are alike unheeded and forgotten.
Mott an<l Francis yet remain within the reach of our honoring recocni-
tion. May they both still live to preside each, in the national delibera-
tions of their Profession.

Vesico-Vaginal Fistula. One of the most complacent things wc
have seen lately, is reported in the Medical Times, as having occurred
recently at a meeting of the Medico-Chirurgical Society. Mr. Syiue, <>f
Edinburgh, it appears, read a paper before the Society, in which he
claimed to have established some new rule in surgery, the import of
which is not t'uil v stated, but which was, however, immediately proved,
by Messrs. Erichsen, Adams, Skey and Curling, who were present, to be
not new, but known everywhere to belong to Guthrie. But this, remark-
able as it may appear, is not what we designate as li very cool." In
this paper Mr. Syme took occasion, as is stated, to speak in very disre-
spectful terms of his colleague in the Edinburgh School, Mr. Simpson,
speaking of some of his suggestions a< ''nonsense/' referring to him a<
an " individual." as one who had " no notion of Surgery," that his
practice had no merit, and was only followed because it was supported
by the Times as " a bait to catch whales."

The Times then continues in the following strain : " We believe that
Mr. Spencer "Wells expressed the very general feeling of the Fellows
present when he pointed out that acupressure did in many cases offer
great advantages over the ligature that this mode of suppressing haem-
orrhage, might be applied in the case of varicose veins and of aneurism,
and that it was another of the gifts for which surgeons ought to be
thankful to the great discoverer of chloroform. Jealous detraction of
such a man appears very paltry. It is to his labors that the Edinburgh
School of Surgery now owes its chief reputation. Mr. Syme has ac-
quired considerable proficiency in the routine training of surgical
adolescents, and he has some real merit as a practical surgeon ; but his
revival of the perinatal section has not tended to enhance the reputation
of its performers, and it has certainly proved disastrous to many unfor-
tunate sufferers from stricture. To Simpson, every surgeon is indebted
for the discovery of the anaesthetic uses of chlorDform, the exposition of
the true value of metallic sutures, the simplification of the operation for
vesico-vaginal fistula, the operative treatment of coccyodynia, and the use

552 Editorial. [July,

of needles in compressing blood-vessels. Surgery has little else for which
to be thankful to Edinburgh since Liston's welcome to a wider field. It
was on what Simpson has done that the reputation of the Edinburgh
School of Surgery in the present century is founded, and on which it
must depend in future histories of our science."

Such language on the part of the Medical Times, in behalf of Mr.
Simpson, under the contemptuous language of his colleague, is in the
main, perhaps, sufficiently appropriate. What is said about chloroform is,
to a certain extent, correct, though Mr. Waldie, of Liverpool, it will be
remembered, suggested it as a substitute for Sulphuric Ether to Dr.
Simpson. His treatment of cocciodynia is 'probably entirely his own,
as also his rather dubiously useful suggestions of the needle-substitute
for ligatures. But when we come to consider Mr. Simpson's dealings
with the operations for the cure of vesico- vaginal fistula, the indignation
of every unbiased mind must be excited beyond all measure. Ever
since he witnessed the valuable operation of Dr Bozeman, he has been
trying all sorts of devices to make trivial alterations in it, which are far
from improvements, in order to gain a sort of second-hand credit in this
greatest achievement of modern surgery. He has substituted iron wire
for silver wire, claiming that in vesico-vaginal fistula it produces less irri-
tation than silver, while at the same time, he strongly recommends iron
wire for the cure of varicocele, because it docs produce irritation. He
has attempted to alter the construction of Boze man's admirable But-
ton, by making a sort of wire matting far inferior to it, and yet for which
he attempts to claim great superiority. It is really amusing to witness
the impotent efforts of several English surgeons to cover themselves with
the glory of the garment already worn by Sims and Bozeman. English
nor French surgeons have not even now, been able to keep up with their
rapid improvements in the operation for the cure of vesico-vaginal fistula,
much less, to reorganize the operation advantageously, and even less still,
to claim credit for its inauguration. To Sims and Bozeman, and to
them alone, is due the credit of making it generally available at first,
and now practicable in cases heretofore regarded as entirely hopeless.

Our List of Payments. Our subscribers will find the names of all
who have paid up to the first of June, published on our cover. We
thank them for their punctuality. To those who are still in arrears, their
bills have been enclosed in the present number. We are sorry to find
that, notwithstanding the enlargement of the Journal, which has made
it one of the largest, if not the very largest, medical monthly in the
United States, so many of our readers have neglected, as yet, to reward

1800.] Editorial. 553

the libera] publisher by the payment of hia well-earned dues. \V<i arc not
constrained to indite this "call to subscribers" from any fear of the ulti-
mate non-payment of their arrears, but only as a reminder to those who

have inadvertently procrastinated till now. Three dollars is certainly a
small amount to pay for ever nine hundred and >ixty pages, and we
knew full well that there is not a subscriber on our list who will n>
thankful rather than annoyed by being reminded ofhifl account. " Here
a little and there a little " withheld or paid over, can effect cither th
prosperity or the destruction of any enterprise whatever.

Pathological and Practical Observations on Diseases of the Ali-
mentary Canal, (Esophagus, Stomach, Caecum and Intestines.
By S. O. Habershon, M. D. Loudon, Fellow of the Royal College
of Physicians, &c, &c. Blanchard & Lea. Philadelphia. 1800. pp.
312. (For sale by T. Richards & Son, Augusta, Ga.)

Monographs arc the only books which thoroughly examine the sub-
jects of which they treat. The one before us, relating to diseases of the
alimentary canal, is certainly a valuable addition to the medical literature
of the United States. No class of diseases are more constantly presented
to the attention of the medical practitioner than those which pertain to
some portion of the digestive apparatus. They are as well the objects of
interest to the surgeon as to the general practitioner and the manifold
obscurity which often attaches to them, renders each new treatise on the
subject an object of great interest to every conscientious member of the
profession.

Dr. Habershon's work, although not so full nor so clear on all the
subjects of which it treats as is desirable, is still as a comprehensive mo-
nograph, on a group of diseases of every-day interest to the profession, a
most valuable work. The various subjects are presented in sixteen chap-
ters, in which they are discussed with much ability and practical common
sense. These are his heads : I. Introduction ; II. On Disease of the
(Esophagus ; III. On Organic Diseases of the Stomach ; IV. On Func-
tional Diseases of the Stomach Hncmatcmesis ; V. On Diseases of the
Duodenum ; VI. On Mueo-Enteritis and Enteritis ; VII. On Strumous
Disease of the Alimentary Canal ; VIII. On Disease of the Ccecum and
appendix Coeci ; IX. On Diarrhoea; X. On Colitis and Dysentery;
XI. On Typhoid Disease of the Intestine ; XII. On Colic; XIII. On
Constipation ; XIV. On Internal Strangulation Intussusception Car-
cinoma of the Intestine; XV. On Intestinal Worms ; XVI. On Per-
foration of Intestine from without Abscess in the Abdominal Parietes,
extending into the Intestine Faecal Absc

564 Editorial [July,

Throughout the work there are presented the records of over one hun-
dred and sixty cases, which the author makes the basis of his discussion
and indoctrination. The work cannot fail to interest and instruct all
who niny read it.

Lectures on the Diseases of Infancy and Childhood . By Charles
West, M. P., author of Lectures on Diseases of Women : Fellow of
the Royal College of Physicians, &c., &c. Third American Edition
from the Fourth Revised and Enlarged London Edition. Blanchard
& Lea. Philadelphia. 18(30. pp. 630. Octavo. (By T. Richards &
Son.)

"We have so frequently and so favorably noticed the previous editions
of this valuable work, that our commendation now will seem to most of
our readers a mere supercrrogation. Not so to those who may have pur-
chased and read this last edition of Dr. West's work. It is greatly en-
larged and improved. Since 1848, the work has rapidly run through
three editions in England, which evinces a popularity seldom enjoyed by
any medical writer. The lecture, form of communicating instruction so
popular at the present day, is adopted in the present work, and so suc-
cessfully that Dr, West, in the language of a distinguished Reviewer,
''stands second only to Watson, the Macaulay of medicine."

We cannot pretend to give even an analysis of the work, and refer to
our former reviews for our opinion. We heartily commend it to all.
Even those who have purchased and read the older editions, will not
find themselves the losers by replacing them by this last more complete
and more valuable new publication.

OBITUARY.

Death of Dr. Charles W. West. Just as our last pages are going
to press, we observe in the newspapers, the announcement of the sudden
death of Dr. Charles W. West, of Savannah. We receive the melan-
choly intelligence of the demise of this distinguished, worthy and useful
man with great sorrow. He was a graduate and formerly Professor of
Chemistry in the Medical College of Ceorgia, and more recently he
occupied the same chair in the Savannah Medical College. His death
will create a void in the Profession in Savannah and in the State at large,
not easily to be filled. He was a true-hearted, earnest christian gentle-
man.

Ophthalmic Hospitals have been established in Italy, at
Turin and Home.

I860.] Miscellaneous.

The Arsenic Eaters of Styria. lv Charles Ebisoh, Lec-
turer on Chemistry at the Middlesex Hospital. A1 the lasl
meeting of the Manchester Philosophical 9bciety i observe
thai Dr, Roscoc called attention to the arsenic eaters of
Styria. Having for the last two years been in <-<iiiiiiiiiii<*ii-
tion with the medical men and other residents in the dis-
tricts where this practice prevails, I shall feci obliged if yon
will allowme through your journal to make known the facts
I have at present collected. The information is derived
mainly from \h\ Lorenz, Imperial Professor of Natural His-
tory, formerly of Salzburg, from \h\ Carl Arbele, I'rofessor
of Anatomy in Salzburg, and Dr. Kottowitz, of Neuhaus,
besides several non-medical friends. I!' human testimony
be worth anything, the Tact of the existence of arsenic eaters
is placed beyond a doubt. Dr. Lorenz, to whom questions
were first addressed, at once stated that lie was aware of the
practice, but added, that it is generally difficult to get hold
of individual cases, as the obtaining of arsenic without a
doctor's certificate is contrary to law, and those who do so
are very anxious to conceal the fact, particularly from medi-
cal men and priests. Dr. Lorenz was, however, well ac-
quainted with one gentleman, an arsenic cater, with whom
he kindly put me in communication, and to whom I shall
refer again more particularly, lie also says that he knows
arsenic is commonly taken by the peasants in Styria, the
Tyrol, and the Salzkammergut, principally by huntsmen
and wood-cutters, to improve their wind and prevent fatigue,
lie gives the following particulars :

The arsenic is taken pure in some warm liquid, as coffee,
fasting, beginning with a bit the size of a pin's head, and
increasing to that of a pea. The complexion and general
appearance are much improved, and the parties using it sel-
dom look so old as they really are, but lie has never heard
of any case in which it was used to improve personal beauty,
though he cannot, say that it never is so used. The first
dose is always followed by slight symptoms of poisoning,
such as burning pain in the stomach and sickness, but not
very severe.

Once begun it can only be left off by very gradually di-
minishing the daily dose, as a sudden cessation causes sick-
ness, burning pains in the stomach, and other symptoms of
poisoning, very speedily followed by death.

As a rule, arsenic eaters are very long lived, and arc pe-
culiar}' exempt from infectious diseases, fevers, &c; but un-
less they gradually give up the practice invariably die sud-
denly at last.

556 Miscellaneous. [July,

In some arsenic works near Salzburg with which he is
acquainted, he says the only men who can stand the work
for any time arc those who swallow daily doses of arsenic,
the fames, &e., soon killing the others. The director of
these works, the gentleman before alluded to, sent me the
following particulars of his own case. (This gentleman's
name I suppress, as lie writes that he does not wish the only
thing known about him in England to be the fact that he
is an arsenic eater; but if any judicial inquiry should arise
which might render positive evidence of arsenic eating ne-
cessary, his name and testimony will be forthcoming.)

"At 17 years of age, while studying assaying, Iliad much
to do with arsenic, and was advised by my teacher, M.
Bonsch, Professor of Chemistry and Mineralogy atEisleben,
to begin the habit of arsenic eating. I quote the precise
words he addressed to me. 'If you wish to continue the
study of assaying, and become hereafter superintendent of
a factory, more especially of an arsenic factory, in which
position there are so few, and which is abandoned by so
many, and to preserve yourself from the fumes which injure
the lungs of most, if not of all, and to continue to enjoy your
customary health and spirits, and to attain a tolerably ad-
vanced age, I advise you nay, it is absolutely necessary,
that besides strictly abstaining from spirituous liquors, you
should learn to take arsenic ; but do not forget when you
have attained the age of 50 years gradually to decrease your
dose, till from the dose to which you have become accustomed,
you return to that which you began, or even less.' I have
made trial of my preceptor's prescriptions till now, the 45th
year of my age. The dose with which I began, and that
which I take at present, I enclose ; they are taken once a
day, early, in any warm liquid, such as coffee, but not in
any spirituous liquors." The doses sent were Xo. 1, original
dose, three grains; Xo. 2, present dose, twenty-three grains
of pure white arsenic in coarse powder. Dr. Arbele says
this gentleman's daily dose has been weighed there also,

and found as above. Mr. continues : "About an hour

after taking my first dose (I took the same quantity daily
for three months), there followed slight perspiration with
griping pains in the bowels, and after three or four hours a
loose evacuation ; this was followed by a keen appetite, and
a feeling of excitement. With the exception of the pain,
the same symptoms follow every increase of the dose. I
subjoin as a caution that it is not advisable to begin arsenic
eating before the age of twelve or after thirty years." In

1800.] Miscellaneous.

reply to my question, if any harm results from either inter-
rupting, or altogether discontinuing the practice, be replies,
"Evil consequences only ensue froma Long-continued inter-
ruption. From circumstances I am often obliged to leave

it otl" for two or three days, and 1 feel only slight languor

and loss of appetite, and I resume taking the arsenic in
somewhat smaller doses. On two occasions, at the earliesl
solicitations of my friends, I attempted entirely to leave off
the arsenic. The second time was in January, L855. I
-was induced to try it a second time from a belief that my
first illness mighl have arisen from some other cause. On
the third day of the second week, after leaving oft" the dose,
I was attacked with faintness, depression of spirits, mental
weakness, and a total loss of the little appetite I still had;
sleep also entirely deserted me. On the fourth day I had
violent palpitation of the heart, accompanied by profuse
perspiration. Inllammation of the lungs followed, and I
was laid up for nine weeks, the same as on the first occa-
sion of leaving off the arsenic. Had I not been bled I
should most likely have died of apoplexy. As a restorative,
I resumed the arsenic eating in smaller doses, and with a
firm determination never again to be seduced into leaving
it off, except as originally directed by my preceptor. The
results on both occasions were precisely the same, and death
would certainly have ensued had I not resumed arsenic eat-
ing." One of the most remarkable points in this narrative
is that this gentleman began with a dose which we' should
consider poisonous. This is the only case of which I have
been able to obtain such full particulars, but several others
have been mentioned to me by those who knew the parties
and can vouch for their truth, which I will briefly relate.

One gentleman, besides stating that he is well aware of
the existence of the practice, says he is well acquainted with
a brewer in Klagcnlurth, who has taken daily doses of ar-
senic for many years. lie is now past middle life, but as-
tonishes every one by his fresh juvenile appearance, he is
always exhorting other people to follow his example, and
says "Sec how strong and fresh I am, and what an advan-
tage I have over yon all ! In times of epidemic fever or
cholera, what a fright you are in, while I feel sure of never
taking infection."

Dr. Arbele writes "Mr. Curator Kursinger, (I presume
curator of some museum at Salzburg), notwithstanding his
long professional work in Lungau and Binzgau, knew only
two arsenic eaters one the gentlemen whose case has just

558 Miscellaneous. [July,

been related, the other the ranger of the hunting district in
Grossarl, named Trauner. Tins man was at the advanced
age of 81, still a keen chamois hunter, and an active climber
of mountains ; he met his death by a fall from a mountain
height, while engaged in his occupation. Mr. Kursinger
says lie always seemed very healthy, and cv^ry evening
regularly, after remaining a little too long over his glass, he
took a dose of arsenic, which enabled him to get up the
next morning perfectly sober and quite bright. Professor
Fenzl, of Vienna, was acquainted with this man, and made
a statement before some learned society concerning him, a
notice of which Mr. Kursinger saw in the Wii/xr Zeitung ;
but I have not been able to find the statement itself. Mr.
Krum, the pharmaceutist here, tells me that there is in
Sturzburg a well known arsenic eater, Mr. Schmid, who
now takes daily twelve and sometimes fifteen grains of ar-
senic, lie began taking arsenic from curiosity, and appears
very healthy, but always becomes sickly ami falls away if
he attempts to leave it off. The director of the arsenic fac-
tory before alluded to is also said to be very healthy, and
not to look so old as 45, which he really is. Phar. Jour.

Medical Colleges and Medical Students. From indications
in various quarters, as well as from the tone of the medical
press throughout the country, we are satisfied that a quiet and
much to be desired revolution is about to be effected in the
Medical Colleges of this country, in reference to the more
equal distribution of students among them.

Heretofore, enormously overgrown classes have annually
assembled in a few of our large cities, whilst institutions in
other localities, equally meritorious, and equally capable of
imparting a thorough medical education, have been hut thinly
attended. This Ave believe will not be case to so great an
extent hereafter.

The stampede among the medical Btudents of Philadelphia
last winter, has at least had the effect of directing the atten-
tion of Western and Southern young men to the uncalled for
neglect of home institutions, and of arousing a strong feeling
in favor of home education.

We have heretofore, on more occasions than one, expressed
the opinion, that the best interests of the profession would be
subserved, and the cause of medical education generally pro-
moted by a more equal distribution of students among our
various well organized medical colleges. This belief arises
not from a spirit of agrarianism, nor yet from any feeling of

I860.] Miscellaneous, 559

hostility or unkindness towards Eastern schools ; but from a
firm conviction that moderate size classes can be better in-
structed, and have far hotter anatomical and clinical advan-
tages, than where the number in attendance is so great a> to
cr>>\vd the wards of hospitals, however large, and preclude the
ibility of frequent dissections. Hence, we should rejoice
at the change suggested.

Of Course, those who have heretofore enjoyed a monopoly

in the business <>f medical teaching, and who have almosl
come to regard this monopoly as among their inherited and
prescriptive rights, will nor sympathize with these views; hut
we greatly mistake the tone of public Bentiment if the voice

of the profession will not pr<ve to be decidedly in favor of
smaller classes and more equal distribution. Time, however,
will show whether or not we have rightly judged in this
blatter. Si, Louis Med. <X' Surgical Journal.

JJnguentum Glycerini, C. A. Simon, in Berlin, has made
a preparation which consists of live parts of glycerine and one

part of starch, which he calls ungnentum glycerini; it forms
a buttery, translucent mass, which can be rubbed in with
great facility, and causes the comfortable and pleasant soft-
ness to the skin peculiar to the applications of glycerine. This
substance is quite inodorous, and chemically indifferent,
always of uniform consistency, temperature having no effect
upon it, and it preserves these properties for a great while
without alteration.

Posner has made an experiment by exposing a loosely cov-
ered vessel containing glycerine salve to an intense sun-heat
for several weeks without change. This compound has advan-
tages over all other salves: 1st. It is more elegant than any
other salve, free from all fat odor, the patient never objecting
to the use of it, and never causes, even upon the most sensi-
tive skin, erythema. 2d. It undergoes, neither by itself nor
in combination with other substances, any change; it can
therefore be stored up in large quantities not a small con-
sideration in field service, in clinics, and dispensaries. 3d. It
contains the additional extracts and soluble salts, not only
mechanically mixed with it, but in a dissolved state, render-
ing absorption very easy. 4th. It never runs over the place
of application, in consequence of its uniform consistency. 5th.
It can be removed with ease from bandages. M. Ccntr. Z.,
xxviii., 70.

The Number of Children a Woman can Bear. The question
of how many children a healthy woman can bear, during

560 MisceUam ous.

the child bearing period of her existence, is one of some
interest. If a couple live harmoniously together during a
long life, and marriage has taken place very early, it" is
quite possible that as many as 24 may have been horn to
the state, at intervals reasonably short, and without their
coming as twins or triplets. Amongst the poorer classes
this regularity is met with, although even amongst them a
pretty large number of children are born. On looking over
the Register of the St. Pancras Royal Dispensary since the
year 1853, six instances occur in which over 16 children
were born; thus, two patients, aged 42 and 46 years re-
spectively, were cadi confined of their seventeenth child;
one, aged 89, of her eighteenth; whilst three, aged respec-
tively 39, 40 and 50, were confined of their nineteenth.
The last patient, 50 years of age, besides her 19 children,
had 4 miscarriages. In most of these cases the births were
single, although occasionally twins were born. The great-
est age was 50. Dr. Gibb states that, on a careful exami-
nation of the Register for many years back, the age of 50
is the highest at which any patient was admitted, and as
the same patient did not present herself again, it is proba-
ble she ceased to bear children.

If the cessation of the catamenia determines the time at
which gestation ceases, then it must occur in some instances
as late as 55 or even 60 years ; for M. Brierre de Boismont,
who determined the critical period of life in 181 females,
found that it occurred in 21 between 51 and 55 years, and
in 5 between 55 and 60 years.

In considering the number of children a woman can bear,
we of course here exclude those cases of multiple births,
wherein from 2 to 6 children are born at one time, and
which thus will swell the number of children brought into
the world by one woman to as many as from 25 to 69.
Lancet, Sept 17.

Feet iff Sweating of flu Feet. Mr. Gaffard recommends as
a most effectual agent, the applying between the toes of a
few drops of the following liquid. An application once a
week is usually sufficient, but during summer it may some-
times be required to be made daily : Red oxide of lead 1 part,
and the liquor of the subacetate of lead, of the French
Codex, (3 parts of acetate, audi of lithrage, to 9 of distilled
water) 29 parts ; bruise the sesquioxide of lead in a porce-
lain mortar, and add the licpior gradually, directing the
bottle to be well shaken whenever it is used.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL

(new series.)

Vol. XVI. AUGUSTA. GEORGIA, AUGUST. 1M0. NO. 8

ORIGINAL AND ECLECTIC.

ARTICLE XX.

An Essay on Bloodletting, read before the Medical Association
of the Steite of Georgia, at their Annual Meeting, held at
Borne, April 11th, 1860. By Robert Soutiigate, A. M.,
M. D., of Augusta, Ga.*

[Continued from July Number, Page 505.]

Motto. Nil remedium, nisi tempestivo usu sit.

We come, now, to the Eruptive Fevers, upon three of
which Measles, Scarlet Fever, and Small Pox I will
make a few remarks. These we all know are composed of
two elements, the fehrile or inflammatory, and a specific
blood poisoning. I hope it will not he deemed presump-
tuous in me to suggest, that, at the present time, we direct
our attention to the last mentioned element, to the too great
exclusion of the first from our thoughts; and that we thereby
throw upon the system, the duty, often oppressive, not only
of eliminating the poison from the blood, but of overcoming
the sub-acute inflammations, that are so frequently attend-
ant upon them. Xo one can look upon a case of Measles,
without being convinced that the poison is an irritant of a
very decided character, expending its force, principally,
upon the mucous membrane of the air passages ; and that

* See also pamphlet published by the author.

36

562 Soutiigate. Essay on Blood-letting. [August,

the danger of the disease consists in the establishment of
irritation and inflammation in those structures. Hence the
physicians of the olden time did not hesitate to let hlood,
when the eruptive fever was high, and the pulmonary irri-
tation great ; for they knew, that when the latter was very
intense, it would interfere with the effloresence on the sur-
face, which is one of the natural, and if I may so express
myself healthy features of the disease. I had an opportu-
nity, a few weeks since, of witnessing the salutary influence
of what might he denied excessive purgation, during the
eruptive fever of Measles.

I was called to visit a young gentleman who was some-
what alarmed by the sudden appearance on his skin, of the
most vivid rash I had ever seen in a case of that disease.
Four days before it appeared, he had experienced chilly
sensations, followed by fever, hoarse cough, tender and
watery eyes, and all the other symptoms that lead us to
suspect the disease to be present in the system. Thinking
he had taken a severe cold, he administered to himself a
large dose of Epsom salts and rhubarb, (how he managed
to swallow such a dose, I cannot conceive,) which, for two
successive days, had produced frequent liquid evacuations
from the bowels. His pulse was 200, and soft ; he com-
plained of some rawness and soreness in the chest, which,
however, was less than it had been the preceding day.
Thinking the purging had continued quite long enough, I
prescribed a Dover's powder, and the use of slippery-elm
tea. This was all the treatment required. The disease
went through its stages, without calling for any interference.
During the disappearance of the rash, a moderate diarrhoea
set in, with which, as it was clearly carrying out of his sys-
tem the dregs of the disease, I did not interfere. It ceased
as soon as nature had completed her work in her own way.
He returned speedily to his business, without a remnant of
pulmonary irritation, and with scarcely an appreciable
diminution of his strength. Xow the sedation of the circu-
lating forces, by active purgation by the saline Cathartics,
is scarcely second to that produced by general blood-letting.

18G0.] Transactions Medical Association of <l<>. 568

Far from interfering with the eruption, it was more vivid
than any I had ever seen. I have qo doubt, that general
blood-letting would have had an equally salutary effect, and
with far loss inconvenience to the patient.

With respect to the Scarlet Fever, whilst it is very clear,
that the poison IS intensely irritant, there seems to be com-
bined with it a septic quality which makes the practical

man cautious, as to the use of active sedative treatment.
Experience has taught us, that cases commencing in a mild
manner, have suddenly assumed a gravity that calls for the
most devoted efforts of our skill. We sec in the same family,
children of equally good constitution and health, affected
very differently; some having the very mildest form of the
disease, whilst others may fall victims to putrid sore throat;
and the only satisfactory way Ave can account for it is, (for
a reasoning mind must have some explanation) by sup-
posing, that in these last, the peculiar poison of Scarlet
Fever, meets with some accidental element in the blood,
with which it forms a destructive compound. But whether
this be so or not, every practical man is cautious how he
proceeds, holding himself prepared for any emergency.

I was lately called to a case that gave me some anxiety,
more especially as it was the first time I had been sum-
moned to attend the family. A little girl, aged six years,
after some twelve hours of indisposition, complained of chil-
liness, which was followed by fever. Two spells of vomiting
had taken place, followed by three dark, watery, offensive
evacuations. I was summoned on the morning of the second
day of its sickness. I found it with a small, rapid pulse,
elevated temperature of surface, tongue slightly coated,
with here and there a red point showing itself; the fauces
were of a scarlet tint, and the breath exceedingly offensive;
there was some tenderness of the abdomen, on pressure. I
had no difficulty in diagnosing Scarlet Fever ; for in addi-
tion, there was a scarlet rash on the surface. The child had
had a dark, offensive evacuation, the morning of my first
visit. Thinking, from the character of the breath, and the
foetid evacuations, that nature might be expelling some

564 SoUTHG atk. Essay on Blood-letting. [August.

deleterious matter from the system, I determined not to
interfere with it. I directed a light warm poultice for the
abdomen, a mild sinapism for the throat, and toast-water
acidulated with lemon-juice, for a drink. At my evening-
visit, I found that, after three additional evacuations, the
diarrhoea had ceased ; the breath had lost its heavy and
offensive odor. The fever being high, and the child rest-
less, I prescribed a pleasant solution of the citrate ofpotassa,
which was continued through the night and following day.
On the morning of the third day of my attendance, finding
the pulse somewhat more feeble, a small ulcerated spot on
one tonsil, with enlargement of the lymphatic glands of the
neck, I prescribed, as an admirable unstimulating tonic,
one grain of quinine, in solution, with five drops of dilute
sulphuric acid, every fourth hour; a gently stimulating lin-
iment for the throat, and a solution of chlorate of potassa
with tincture of myrrh, as a gargle. But I will not tire you
with the details of the treatment. Suffice it to say, that the
child went safely through the disease ; a result which hardly
could have been expected, had I rashly checked the diar-
rhoea, through a puerile fear of debility, and resorted either
to a stimulating or actively sedative treatment.

Whilst, then, reason and experience teach us the propri-
ety of some such course as the above, there is not wanting
testimony to show that in the severe anginose forms, blood-
letting and other sedative treatment is successful. I quote
from Wardrop, the following case. The heroism of the
practice, although it was eminently successful, seems hardly
justifiable ; but it shows that there is not that great danger
from active depletion in Scarlet Fever which, in these latter
days, we are so much disposed to attribute to it:

"A gentleman, between fifty and sixty years of age, was
seized with shivering, succeeded by hot skin, and other
febrile symptoms. On the evening of the same day, I vis-
ited him. His mind was restless and excited; his skin hot
and burning; his tongue white and loaded; his pulse fre-
quent, and the action of his heart tumultuous. His coun-
tenance was Hushed, the tint of which, along with a slight

I860.] Transactions M Ileal 1- 'ationof 6a. 565

redness of the throat, made me suspicious, dial he had an
attack of Scarlet Fever. He was immediately bled from

the ami : al first the pulse rose, and a considerable quantity
of blood was abstracted, before he became faint Calomel,
combined with antimony, and a purgative medicine, were
then given alternately every two hours. Next morning, the
febrile Bymptoms were much subdued, but bis throat had
become very painful. Twenty-lour leeches were now ap-
plied to the external i'auees with relief. In a few hours
afterward, he was again bled from the arm, a slight return
of headache with fever having come on. These symptoms
never returned: a betid slough separated from the tonsils,
and be Avas rapidly restored to health. From the decided
sueeess of the treatment, doubts were entertained of its
having been really a ease of Scarlet Fever; those doubts
vanished, when that disease made its appearance, a few days
afterwards, in two children of his family."

We sometimes lose these anginose cases; is it because
the fear of debility deters us from the use of blood-letting ?

As regards Variola or Small Pox, we all know how terri-
ble was the loss of life, under the old heating and stimula-
ting system. A orcat fire occurred in London,, which
wrapped in flames the Small Pox hospital, rendering neces-
sary the hurried removal into the open air, during a cool
night, of the miserable inmates. Humanity shuddered at
the inevitable loss of life, it was thought, must necessarily
result from the exposure. But how short sighted is man !
that great tire taught a great lesson in therapeutics. The
poor festering wretches were mostly benefitted by the
change. Many recovered who, it was thought, must neces-
sarily die. Sydenham was there, a true disciple of the Coan
sage. He instantlv took the hint. General bleeding, cool-
ing cathartics, cold drinks and fresh air. were substituted
for the horrible system of aromatic confections, hot stimu-
lating drinks, red blankets and a hot stifling atmosphere,
which converted the body into a great manufactory of
poison, and hurried so many to the grave. Thanks to
Edward Jenner, that once great pestilence is shorn of its

5<jG Southgate. Essay on Blood-letting. [August,

power! and it is a lasting reproach to the profession, that
the 17th of May, the day of his birth, is not celebrated in
every city and town and village throughout the world. It
is a day, on which wealth and intelligence and refinement,
should assemble around the festive hoard, to do honor to his
memory. And female loveliness should he there, with its
consecrating presence ; for to Jenner, female loveliness
owes a debt of gratitude ! AVe have the record of a bloom-
ing young beauty, who a few weeks before, had stood
before the mirror, and smiled upon the reflection of her
lovely self, innocently conscious of "all those endearing
young charms," that had brought so many ardent young
lovers, prostrate suppliants at her feet ; a few weeks after
the pitiless malady had folded her in its embrace, presenting
herself before the same mirror, and beholding the scarred
and furrowed phantom of her former self, being instantly
changed into a howling, shrieking maniac. We should
read, now and then, the history of its ravages, its heartless
immolation, year after year, of thousands upon thousands ;
and when it did not kill, marring the human nice divine,
converting female loveliness into hideous deformity ; a pes-
tilence that called forth the exhibition of the best, as well
as the worst feelings of the human heart ; presenting, here,
the spectacle of the mother, pressing to her bosom the dying
child, and self-oblivious, inhaling from its expiring breath,
the vapor of her own destruction ; and there, the spectacle
of the heartless wretch, fleeing from the presence of those
who had brought him into the world, in a storm of agony
and distress, protected his helpless infancy, comforted him
in the sorrows and disappointments of childhood, guided
him gentlv, and affectionately, and forgivingly through the

1/ ' /

waywardness of youth, and finally led him up to manhood !
We should think of all this; and then Ave should turn our
thoughts to the village of Berkely in Gloucestershire, Eng-
land, and think of Edward Jenner, a modest, unpretending,
but most able country surgeon, beloved for the amiability
of his chaiacter, and admired for his unquestioned skill,
taking hold of a tradition, that had been floating, imme-

I860.] Transactions Medical Association of Ga* 567

mprially, around the stable yards and dairy farms of bis
native county, experimenting and proving and reasoning
upon it, month after month, and year after year, until he
was ready to publish to the world the greal generalization

falsified by any exceptional instance, I verily believe, only

through the criminal neglect of his successors that in vac-
cination we possessed a sure, sale and certain preventative,
against the contagion of Small Pox. In a letter that has
come down to us, he touchingly portrays the feelings, that
at times almost overpowered him, as returning from his
professional duties, lie mused upon the great central object
of his worldly thoughts, and the possibility of his being,
under the guidance of the " Great Physician," the instru-
ment of a mighty benefaction to his race ! What a temple
for the abode of true philosophy, was that man's soul !
Humble, reverent, full of calm, deep thought! and as if
nothing might be wanting, to invest his memory with in-
terest, the fragrant wreath of Poetry encircled his philo-
sophic brow ; his Address to the Pobin, and other pieces
that have come down to us, were the emanations from a
pure heart, instinct with the tenderest sensibility to all the
beauties of nature. I know }tou will excuse this digression ;
it is refreshing and profitable, to dwell upon the characters
of those who, in other days, illustrated the dignity and value
of our profession.

The only time I ever felt disposed to be seriously vexed
with Homoeopathy, wTas when one of its writers claimed the
great discovery, as an illustration of the Homoeopathic law.
"We see no shadow of a shade of philosophical analogy; to
countenance the idea. Let them take everything else from
us sweep from under our feet the foundations of the mag-
nificent fabric of Philosophical Medicine, and lay it pros-
trate in the dust in the midst of the ruins we will cling to
this ; for it was a revelation vouchsafed to the visions of
true genius and pure philosophy.

In acute Rheumatic Fever, with severe inflammation of
the joints, it used to be the practice to take blood from the
arm, not with the idea of curing the specific part of the

568 SouTHOATB. Essay on Blood-letting. [August,

disease by depiction, which is utterly impracticable, but
with the view of moderating the general excitement and
common inflammation associated with it, and preparing the
system to respond to the eliminating treatment the true
treatment of the disease. Now, we all know that it would
be worse than folly to attempt to cure Rheumatism by let-
ting blood ; that it would have a tendency to give a fixed-
ness to the disease. But seeing no good and satisfactory
reason why the turbulent movements of the circulation,
which must, by their continuance, lead to secondary pros-
tration, should not be moderated in this as well as in other
forms of morbid action, I cannot but regard the entire dis-
use of bleeding as a retrograde movement, even in the
therapeutics of Rheumatic Fever. Some years ago, in some
medical periodical, the use of large doses of quinine was
recommended as a royal road to the cure of the disease ; it
was tried, and some cases did get well after its use ; and
one medical gentleman who used it in full doses, did sup-
press, as it were, by magic, the articular inflammation, but
stood aghast at seeing his patient struck with horrible con-
vulsions, followed by coma and death. The proposer,
doubtless, thought he was recommending something new ;
whereas, it was nothing more than the treatment recom-
mended by a clear-headed English physician, by the name
of Haygarth, many years before the proposer was born, who
administered the Peruvian bark with a view to its invigo-
rating action upon the nerves, which he clearly saw were
implicated in the disease. But Haygarth, if I remember
aright, did not recommend its use during the febrile com-
motion of the first stage of Rheumatic Fever. It would be
interesting to know what may have been the condition of
the heart, two or three months after some of these marvel-
lous cures, by the suppressing power of large doses of
quinine; whether some of the patients felt as comfortable
in the cardiac region as before; whether thev could ascend
a flight of stairs with as little sense of palpitation and fatigue
as before the attack; whether, in a word, there were not
some symptoms indicating that a lesion of the central organ

I860,] Transactions Medical Association of Qa. 569

of the circulation might have been sustained. We musl be
well informed upon this point, before we can endorse any
such therapeutics.

The treatment by opium and t lie alkalies, &c, so ably
advocated by Dr. Todd, of London, commends itself to as,
as admirably adapted to its treatment, by its powerful ano-
dyne and diaphoretic action the cutaneous exhalents being
the great eliminating agents by which the blood is freed
from the acid elements with which it is charged. Preceded,
in robust and inflammatory habits, by bleeding, cathartics,
or other sedative treatment, I should think the system
would be placed in the best possible condition, to be thor-
oughly cleared, by a continuance of the eliminating treat-
ment, of those dregs of the disease that prove so vexatious
alike to physician and patient. Dr. Todd's lecture on
Rheumatic Fever will amply repay perusal ; for it is based
upon the clinical experience of a clear-headed and indepen-
dent thinker.

In many of the distressing symptoms of the pregnant
state, general bleeding used to be employed with marked
benefit. Many of us know bow intractable they sometimes
are, and how wretched the existence of many females be-
come, almost from the very moment of conception to the
end of gestation. I quote the following case from War-
drop, in illustration of the great benefit resulting from
venesection :

"A lady, in a state of pregnancy, had been greatly debil-
itated, having vomited every kind of food and drink she
had taken for upwards of twenty days. I sawT her at this
period. She was so emaciated and feeble that her recovery,
by those around her, was considered hopeless. She had
distinct tenderness, on pressure, in the epigastrium, and
her pulse, which at first gave the impression of great lan-
guor, on more minute examination, was very contracted,
feeling like a thread, and very incompressible, whilst the
heart's action was vigorous. This state of the vascular sys-
tem assured me that I should afford her relief by blood-
letting, which was immediately resorted to, though with

570 Soutiicatk. Essay on Blood-letting. [August,

hesitation, by her other medical attendants. Xo sooner had
a few ounces of blood flowed from the vein, than the pulse
began to rise and acquire volume, and upwards of twenty
ounces were abstracted before its vigor was subdued. The
result of this treatment was, that with very small doses of
the sulphate of magnesia, repeated at short intervals, the
stomach no longer rejected food, the alimentary canal was
unloaded, the patient's recovery was progressive, and she
was delivered of a healthy child, at the proper period."

Xow, when we reflect upon the formidable dimensions
that uterine pathology has assumed, within a few years past,
may not a reasonable suspicion be entertained, that it may
be partly due to the almost entire disuse of blood-letting,
in the distressing irritations, irregular determinations and
congestions of the pregnant state. In days long past, the
practice was common; and our mothers and grandmothers,
having fulfilled the duties of their holy mission, still live in
our midst, in the enjoyment of health, the objects of our
veneration, our admiration and our love. Bur*in these days,
scarcely is the young wife the second time a mother, when
she presents, too frequently, a wreck of her former self.
Intra-pelvic irritations and pains harrass her by day ; con-
gestions, inflammations, and ulcerations of the cervix uteri,
and their sympathetic accompaniments, destroy her bloom;
and we hear doctors boasting of how often they have leeched
and cauterized the delicate structures. "We know, from
experience, that these proceedings are sometimes absolutely
necessary; that after having relieved constitutional irrita-
tion and sympathetic suffering, as tar as medical treatment
will answer, we are compelled to conclude that some local
trouble exists, demanding local treatment. But what true-
hearted gentleman is there who docs not lament the sad
necessity ; and even when called to minister to one whose
purity is swallowed up in crime, who does not wish it might
be otherwise. We know that the gentlest and the sweetest
of the sex, whose heart is the throne of purity, having full
confidence in her medical adviser, will submit with resig-
nation to his judgment. But if he does not feel that it is

I860.] Transactions Medical Association of (>'>>. 571

an alternative to be, if possible, avoided if otherwise, much
to be lamented he is unworthy to minister to the infirmi-
ties of the sex. Now, may it be possible that much of this
distressing ill-health is due to the fact, thai we lei the suf-
ferer ffo through nine lone: months, with her headaches and
flushings, her febrile movements, her infra-pelvic pains, her
gastric irritations, her bloated limbs, and the other afflic-
tions of her most interesting state, when experience has
proved that the occasional loss of a few ounces of blood
from the arm would sooth her troubled system, into peace
and comfort. Passing by other morbid conditions, in which
blood-letting was formerly practiced, I come to the subject
of Inflammation, for which, in former times, it was consid-
ered, par excellence, the remedy.

A\ natcver theory we may adopt, to explain the process of
Inflammation, two or three positions respecting the state of
an inflamed part, have been universally admitted : First,
that it contains more blood than one in a natural condition;
second, that its vessels are distended, or dilated ; and third,
that minute branches, which previously only allowed en-
trance to a colorless fluid, now contain colored globules.
That there is some change in the nervous sensibility of a
part, anterior to all other phenomena, must likewise be
admitted; all the subsequent changes being, in some way
or other, related to this condition of things. The micro-
scope has revealed to us, "that the first change in the
application of a stimulus to a vascular tissue, is the momen-
tary contraction followed by the dilatation of the artery, the
flow of blood through it and the capillaries is accelerated,
retardation from congestion then ensues, and lastly, stag-
nation at points." Let us add to this, that there is, to every
inflamed part, a determination, and we have an abstract of
what is really known about the process. In the language of
Mr. Erichsen, "we have an increased size of the vessels, an
increase in the quantity and rapidity of the blood; but con-
joined with this, we have a tendency to its arrest, to its
stagnation at points:'' and as Nature is very uniform in

572 SOUTHGATE. EsSCUJ Oil BloOcl-ldtliKJ. [AllgUSt,

her processes, we have a right to infer, that in all internal
inflammations we have essentially the same phenomena.

Let ns now take a glance at the effects of general bleed-
ing, in a common sense way, and see whether it may he,

reasonably, brought into requisition against the pre
We open a vein, and abstract, say twenty ounces of blood.
As the blood flows away, the blood-vessels slowly adapt
themselves by a vital contraction, to their diminished eon-
tents; and we have the very best evidence, that this vital
diminution of size takes place throughout the whole sys-
tem the inflamed parts, as well as those in a healthy con-
dition. After the flow has continued for some time, we
witness manifestations of sedation of the circulating for
a diminution of the injecting power of the heart and arte-
ries, unless there has been oppression, when we find the
pulse to rise, indicating a more free and vigorous circula-
tion. I have sometimes thought, in reasoning upon the
subject, that the direction to take blood in a fall and bold
stream was faulty; except in obstetrical practice, where we
wish to relax the rigid and unyielding soft structures, or in
obstinate constipation, when Ave wish to relax spasm; the
delicate vessels being, as it were, taken by surprise, and not
so surely contracting on their contents, as when a more
gentle flow was established. Be this as it may, can we look
at the conditions of an inflamed part, as above described,
and then reflect upon the effects of general bleeding, with-
out being persuaded, that in it we possess an agent, admi-
rably adapted to overcome inflammation ? It must likewise
be remembered, that general bleeding leads, secondarily, to
a rapid absorption of effused fluids, which we know exist in
all inflamed tissues. Xow reverting, for a moment, to in-
flammation of the lungs, and reflecting upon the vast im-
portance of their functions, no less than the supply of duly
oxverenated blood to the nervous centers, without which
their functions must soon cease, and life become extinct: is
it not very reasonable to believe, that in abstaining from
general bleeding in Pneumonia, we arc depriving ourselves
of one of the most reliable means of saving the structures
from fatal disorganization ?

I860.] Iransactions Medical Association of Oa, 578

livery now and then, the voice of lamentation comes ap
from Borne of your plantations, thai fifteen or twenty valua-
ble negroes have been carried off by Pneumonia; aje we
sure that oppression has not, sometimes, been mistaken for
true debility ? Dr. Billing, in his admirable little work of
300 pages, which should be in the bands of cvtv young
practitioner, for his study by day and his meditation by
night, illustrates the Bubject of vital oppression in Typhus,
and severe inflammation of the lungs and bowels, by com-
paring the system, under such circumstances, "to a tired
horse in a loaded cart, reaching the foot of a hill, but unable
to ascend it. The stimulus of the whip may make him
struggle to the attempt, but if urged, he will at length sink.
If, however, some of the load be removed, he can ascend
the hill, and if some of the load of blood be withdrawn, the
pulse will rise, as is well known and admitted in its sunken
state, in severe inflammation of the lungs or bowels."

Can it be necessary, in addressing such an audience as
this, to extend the illustrations of my subject? Shall I still
farther trespass upon your attention, by picturing to you
the brain, the stomach, the liver, the intestines, or the kid-
neys in a state of inflammation; their tissues gorged with
blood, their delicate vessels distended to the bursting point,
their line network of nerves pressed upon and so irritated
that they appeal successfully to the entire system for sym-
pathy ; effusions taking place, points of stagnation forming,
and leading to still farther obstruction; every inflamed
point, a point of determination, to which there is an in-
creased flow; important functions interfered with or sus-
pended. "Will not this state of things, unless arrested, lead
to disorganization and death, or a lingering and crippled
convalescence? and has general bleeding no power against
the above described condition of things ? Can it not diminish
the amount of blood flowing in and to the organ, take off
the injecting power of the heart and arteries, and promote
the absorption of the fluids that have been effused ? Can
we doubt that it possesses these powers, and shall we give
it up without full and due reflection ?

574 Southgatb. Essay on Blood-Jetting. [August,

In dealing with an inflamed extremity, we place it on an
inclined plane; for what purpose? to take oft' the injecting
force of the vis a tergo, and promote the returning current
through the veins, and thereby relieve the limb of its excess
of blood ; this we cannot do in inflammation of internal
organs, but is it not equally important, that they should be
relieved of their excess of blood? We can cover the same
extremity with cloths, moistened with cold evaporating
lotions, and thereby constringe the dilated vessels, reduce
heat, and diminish the inflammation. We have no such
resource as this in internal inflammation; or we can ban-
dage the engored extremity and strap the inflamed testis,
and by mechanical force extinguish the inflammation. This
we cannot do with an inflamed lung or liver. In phleg-
monous Erysipelas we pursue the practice introduced by
Mr. Hutchinson, and endorsed by the high practical author-
ity of Mr. Lawrence, make incisions, let out the blood and
effused fluid, and save the limb from gangrene and death.
We cannot deal in this way with an inflamed lung or kid-
ney. But in general bleeding we have a remedy equal to
the emergency. Shall we lay it aside without at least a
deliberate reconsideration of its claims ?

And how perfectly under our control is the remedy!
With a finger on the pulse, and an eye directed to the
expression of the patient's countenance, we at once appre-
ciate the effect, and as quick as thought, can check the
flow or permit it to continue.

Other therapeutic agents will disappoint us general
blood-letting rarely will. Other agents take time to affect
the system; this is prompt. Guided, then, by reason,
observation and experience, I will, in defiance of statistics
and the infallible numerical method, open a vein, in the
early stages, be it remembered, of inflammation of vital or
delicate organs, when I find the pulse oppressed and smoth-
ered, or tense and vigorous, persuaded that I should, by
such proceeding, place the suffering organ most promptly
on the road to health.

And suppose it should produce some debility, what have

18G0.] Transactions Medical Association of Ga. 575

we to fear from it '.' [fall the spiritual bodies of those who
have departed this life since disease first attacked the race
could be summoned before us, and the countless throng
with one voice respond to the question What was it thai
prematurely separated you from those bodies which encased
you on earth, now commingled with the elements from
which they Bprang? Would the answer he debility? Would
it not rather be fever and inflammation?

Now, with reference to debility from loss of blood, will
not your experience sustain me when I assert, that in a large,
a very large, majority of instances, the recoveries after large
losses of the circulating fluid are remarkably prompt? Will
not the accoucheur bear witness to the fact? Wrill not the
surgeon confirm the testimony? Mr. Wardrop says, (and
his experience was very great) "That having generally ob-
served that the wounds of all those patients who had lost
much blood during an operation, healed most promptly by
adhesion ; he was in the habit, when he operated, of letting
a considerable quantity of blood flow from the smaller ves-
sels that were divided, and he never regretted the prac-
tice."

And Professor Dugas, a few weeks since, showed me a
case in which lie had performed the operation of Staphylo-
raphy the union of the lips of the wound being prompt
and perfect, although the patient, being of the hemorrhagic
diathesis, lost an amount of blood that gave the Professor
great anxiety. Is prompt, perfect and beautiful adhesion
of the lips of a wound, after a copious loss of blood, evi-
dence that the loss has seriously lowered the restorative
energies of the system? By one who is anxious to support
a foregone conclusion, it will, be at once objected, that the
prompt recovery from loss of blood, under the physiological
states I have referred to, cannot be considered a fair ex-
pression of the powers of the system under acute disease.
I might reply by demanding proof of the fact. Xow, I
believe every practical man will agree with me when I
assert that the states of the system that render blood-letting
expedient the state of vital oppression, as admirably

576

Southgate. Essay on Blood-lettuxj. [August,

described in the quotation from Sydenham, and that of
violent febrile re-action are eminently hostile to the recu-
perative movements of the system. Can any better proof
of the fact be needed than that presented by the change
that takes place in a wound when fever attacks the patient
under treatment ? AVe have been, perhaps, admiring ob-
servers, day after day, of the healing process in an extensive
solution of continuity. The patient is attacked with fever,
we remove the dressings, and find the lips of the wound
that had nearly united, gaping, and instead of the bland
cream-like fluid, that gave such maternal shelter to the del-
icate and florid granulations, we find a serous, unhealthy
fluid issuing from the surface. What course will the medi-
cal surgeon pursue under such circumstances? He will
remove the dressings, substitute, perhaps, the tepid water
dressing and use means to subdue the febrile excitement,
knowing that when that is relieved the wound will recom-
mence its process of repair. He must have been a very poor
observer who has not witnessed frequent illustrations of this
fact. And it will, doubdess, also be objected that when the
system is suffering from the influence of a blood poison, it>
power of repairing the loss of blood is lowered, and, there-
fore, the circulating fluid should not be abstracted.

Xow, is it not a truth that some of those blood poisons
are intense irritants, exciting high fevers and inflamma-
tions, and producing thereby prostration of power; and
shall we, through fear of their influence, leave these fevers
and inflammations to themseves; all our principles being
swallowed up in the single idea that there is a poison to be
eliminated, and that the powers of the system are to be sus-
tained and stimulated to that end. This idea of blood
poisoning is looming up into fearful proportions. It is a
wonderfully convenient thing to satisfy the friends of a
patient who is struggling through a long, tedious illness ;
its tediousness being cavalierly laid to the charge of a blood
poison, whilst the sub-acute inflammations and fever are
almost entirely lost sight of. Xow, upon any physician who,
in these days, should advocate exclusive solidism or exclu-

I860.] Transactions Medical Association of Ga. -"'77

sive humoralism, a commission ude lunatico inquirendo"

should be appointed. Look at. the human body every
microscopic point o\' the soft solids bathed in fluid, and

every atom of fluid bathed, if I may so express myself, in

sot't solids, and how can any rational man entertain exclu-
sive views! And then the nervous system seems at times
almost to be forgotten in the Quixotic hunt after the blood
poison ! The nervous system, whose great office it is to
receive and reflect all impressions ; the system that places
us in relation with the world and with ourselves, which
comparative anatomy and physiology tell us, becomes more
and more complex, as we rise from the lowest form of ani-
mal life, through its various progressions up to man. The
nervous system, that makes us just what we are, and which,
if I may venture into the field of physiological speculation,
is the material frame-work by which the spiritual body,
that shall exist hereafter, is placed in existing relations with
the present order of things. And as regards this blood
poisoning, there are some facts that make the reflecting
mind receive it with some reserve, as regards its primary
operation in producing disease. A man is struck instantly
dead by a stroke of lightning, or the shock of a powerful
galvanic battery ! We open the body and we find the brain,
lungs, liver, spleen, stomac it and bowels, loaded with blood,
with a great deficiency of it in the cavities of the heart.

Xow, in some of the worst forms of fever, that kill in a
few hours, we find just the same state of things ; and it is
. in these very fevers that the phenomena of the nervous
shocks are so intense ; requiring, in the first instance, the
most powerful stimuli to keep the patient alive. If my
memory serves me, I think it was Dr. Robert Jackson,
Deputy Inspector General of army hospitals in the British
West Indies, who described a form of fever in which senti-
nels, who, a short time previous, had been posted in perfect
health, were stricken down, as it were, by apoplexy, which,
if they rallied, was followed by the most intense febrile
reaction, requiring copious general bleeding to place them
in a state of safety. The nervous system, I cannot help
. 37

578 Southgatb. Essay on Bloodletting. [August,

regarding as the recipient of the first morbid impression

the starting point, from which proceed all the subsequent
phenomena of fevers. Now. do not suppose that I ignore
the pathology of blood poisons. I know there are some so
virulent that, under their influence, the whole system seems
ready to crumble into ruins, and that we dare not use low-
ering treatment. But when it takes such possession of the
mind as to prevent us from using sedative treatment in the
earlier stages of continued fevers, I cannot help regarding
it as exercising an influence out of all proportion to its
intrinsic importance. If the medical history of the past
teaches any truth in reference to the future there is a des-
tined reaction to take place in medical opinion. Another
petechial fever may break out, in which indirect will be
mistaken for direct debility. Another Easori, captivated
by the simplicity of the doctrine, will resort to stimulation,
and be awe-stricken by the frightful mortality. Is it not
the duty of each one of us to give this subject a thoughtful
reconsideration ?

The object of this paper is to encourage a review of the
subject of General Bleeding as a means of cure, and not to
thrust my views upon you as worthy of adoption. AVe have
met together for mutual improvement; and if each member
of the Association would, at each annual meeting, place his
offering on the altar, can we doubt that it would promote
the great end and object of our union. Let not the youngest
member withhold his contribution, through fear it might
not be received Avith fraternal consideration and respect.
Like the widow's mite, it might seemingly be the least of
offerings ; but flowing from heartfelt devotion to truth and
science, it might prove of more real value than all the rest:
like the grain of mustard seed, the least of all seed, it might
contain within itself the germ of a beautiful tree, under the
future shade of whose leaves and branches many a disease-
stricken sufferer may repose in peace and comfort.

I am well aware that, as general bleeding is an agent of
great power for good, so must it be for evil; and that it
should be used under the guidance of a sound discretion;

I860.] Transactions Medical Association of (1". 579

that age, and sex, and temperament, and previous state of
health, and prevailing epidemic influence should all be duly
weighed and estimated. Bu1 as there is a strong tendency
m the medical mind to run into extremes ; may ii not be
that we are verging to a point that may terminate in total
neglect of tin1 practice.

Our jn-tly placed confidence in the powers of quinine,
doubtless, has had something to do with the disuse of blood-
letting. No one sets a higher value ou it than I do. Ihave
jtested its powers from the great lakes of the Xorth to the
San Saba river in Texas, and from regions far beyond the
sissippi, to the shores of the Atlantic, and have been
rarely disappointed. As the great tonic and anti-periodic,
kow matchless are its powers ! Even in inflammations,
with what advantage may it be applied, when we detect a
paroxysmal increase of general excitement, which must re-
act unfavorably on the original disease.

Powerless, with a rare exception, to arrest the march of
a Continued Fever, how admirably docs it act in the latter
_vs of the disease, when administered in moderate doses
in solution, in a form acceptable to the stomach, and easy
of absorption ; being circulated to the organic nerves of the
delicate blood-vessels, (for I will not dishonor the remedy
by supposing that it lias an elective tendency to any other
than the nervous tissue,) giving them tone, and thereby
bringing back the languid capillaries to a state of health ;
co-operating with the silent yet ever-acting energies of the
system, in the direction of its health and safety. And
when administered in doses proportionate to the threatened
emergency of one of those terrible chills which sometimes
extinguish life, with what commanding power does it step
in, taking hold of the organic nervous system, as it were,
bodily, lifting it up to an elevation, at which the dreaded
sedation becomes well-nigh a vital impossibility, and hold-
ing it there, with a steady hand, until the great crisis has
passed! Yet, with all its power, can we rightly and justly
regard it as a substitute for blood-letting, in those terrible
inflammations, that threaten disorganization and death?

580 Bouthgate. Essay on BloocUeUing. [August,

And may we not have been somewhat influenced to its
almost total neglect, by the popular current against it, set
in motion by a learned but visionary German enthusiast ?
I do not mention the system of Hahnemann, to revile or
denounce it; the cause of truth never was advanced by such
a course. We should not judge of it, as professionally rep-
resented by many of those whose ignorance, arrogance and
pretension affect us with sentiments of loathing and disgust.
There are intelligent and worthy gentlemen who have pro-
fessed conversion to its faith ; and ordinary courtesy de-
mands that we should give them credit for honesty and
truth. We do not comprehend how it is possible that one,
thoroughly educated in the science of his profession, and
who has experienced the triumphs of its art, can abandon its
well-tried resources. Xo ! We have seen the flag of regu-
lar medicine floating triumphantly over too many battle-
fields, to lower it at any such bidding; but there may be
some truth in the system, and if so, is it not our duty to
examine, test, and find it, and when found, apply it for the
benefit of our race ? Acquainted as we are, with the natu-
ral history of disease ; cognizant of the restorative powers
of the system, witnesses at the bed-side, at which we have
sat, anxious yet patient, observers of the struggling system,
of sudden improvements, which, had they been preceded
by inert medication, a peurile logic would have attributed
to it; we surely are qualified to discern the true from the
false. It is our duty, then, to examine and test the system
in the spirit of candor, and if there be truth in it, to use it
for the relief of suffering. If we should so act, I think the
occupation of many would be gone ; for those with whom
we have smiled in the sunshine, and sympathized in the
cloud, from whom we have often received the tribute ol
grateful hearts, who have, perhaps, addressed to us the
touching appeal, "Doctor, we know that you have done all
that man can do, we know our child must die, but it will
he a comfort to us to have you near until the dreadful
agony is past," would hardly give us up for strangers, who
have no such claims upon their hearts.

18G0.] Transactions Medical Association of 0 . 581

There La an Impression on the medical mind, thai for
pome years past, we have been in a cycle of influence thai
has rendered the system intolerant of depletion. Ii'.->. will
it last always; have wo had any evidences that we are ap-
proaching the circumference of a differenl circle, during
the revolutions of which, a more anti-phlogistie medication
may be demanded? As faithful sentinels, is it not our duty
to he on the alert, so that we may not he surprised by a
ludden onset of the enemy ':

However this may he, the question I have so imperfectly
(discussed in your hearing, is worthy of calm consideration.
I lean to the opinion, that we are making a retrograde
movement in the growing tendency to give up general
bleeding in the treatment of disease. You may differ with
me, for honest differences of opinion will exist as long as
we are what we ought always to he, free and independent
thinkers. But there is one point on which we can unite in
full communion of spirit and feeling the advancement of
, our profession. Assembled together from different sections
of this great State: leaving behind our professional joys,
sorrows, hopes, and disappointments, and I trust all un-
worthy feelings ; let us register a common vow of future
devotion to its honor; and when we consider the precious
interests intrusted to our care, is it not worthy of our most
faithful study? Whenever we cease to realize the great
responsibility that rests upon us, we are worthy, no longer,
lo minister to its altars. Let us, then, for the future, so
study and practice our profession, that it may be exalted
in the estimation of the world, and be still more worthy of
the grateful tribute paid to it by the Roman orator, as it
was illustrated in the person of his physician and friend.

"Homines ad dcos nulla reproprius accedimt, <i>"im salutem
mominibus dando"

582 Ford. Operation of Staphytoravhy. [August,

ARTICLE xx.

A successful Operation of Stapkyloraphy. By Professor L.
A. Dugas. Reported by DeSaussure Ford, M. D., Pro-
sector to the Professor of Surgery in the Medical College
ol Georgia.

The operation of Staphyloraphy, for congenital division
of the soft palate, was first performed by Prof. Grrcfe, of
Berlin, in 1860 ; contemporaneously, or soon after, Prof.
Roux, of Paris, by his great success, and more efficient
mode, excited much interest in it throughout Europe, as
well as in this country. Though the honor of the first op-
eration is due to Prof. Grrefe, yet the profession is more in-
debted to Roux, of whom Dr. Mettaucr says : "Xo one
seems to have enjoyed such extended and ample opportuni-
ties for cultivating an acquaintance with it, or the infirmity
demanding it, as a means of relief, as must have fallen to
the lot of this distinguished operator, and, down to the
present period, it would seem that hev may still maintain a
decided pre-eminence, if we are to decide from the many
cases reported to have been treated by him, amounting to
fifty in number."* Dr. Diffenbach, of Berlin, conferred
great benefit by the introduction of the leaden suture in
place of the thread ligature, claiming that, by this means,
in the event of the contingency of tightening the ligatures,
it could be more readily accomplished. He also suggested
instruments for retaining the lips of the fissure while they
were denuded ; for a greater improvement in this latter re-
spect, however, greater facilities were added by Drs. AVar-
ren and Hosack, of our own country, the former claiming
precedence in operating in the V. S., which claims, how-
ever," are not fully established above those of Prof. Smith,
of Yale College.

Xo satisfactory causes have been ascertained for congeni-
tal cleft palate. "The infirmity may result from power act-
ing upon the foetus in utero, through the imagination or
feelings of the mother, or it may occur associated with cer-

*Amer. Jo urn. Med. Sciences, Vol. XXI, 1S37.

1S()0.] Operati vphyhraphy.

tain congenital and hereditary diseases in the relation of
cause and effect." --It. doubtless, Is the result of imperfect
development of the pari involved in the fissure, or of an ar-
!vm in the process, by which the organs are unfolded, and

as the causes <>f such arrest are only conjectural, all is hy-
pothesis both as to them and the palatine fissure itself."*

The soft palate being the septum immediately anterior to
the pharynx, and a guard to the posterior Dares, a priori
-reasoning would alone conceive in its total or even partial
obliteration exactly the abnormal states which exist, viz :
increasing the difficulty of speech, causing nasal articula-
tions, this more or less imperfect, in proportion to the diffi-
culty of closing the passage from the fauces, into the nasal
cavity, during the effort to enunciate ; and deglutition ia
much impaired, especially in infants, causing, in many in-
stances, death by inanition, and its attempts embarrassed
by accidents of the most disgusting nature, the solid food
lodging in the pharynx, causing most noxious and nausea-
ting emanations.

Dr. Mettauer, from whose valuable essay I have taken
many idea-, says : "The parts involved are disposed to ex-
cessive secretions of mucous, which, accumulating on the
surfaces, become thickened, adhesive, and finally niuco pu-
rulent, causing foetid breath and the expectoration of prodi-
gious quantities of tough mucous."

The infirmity may exist under three divisions -first, where
simply the uvula is divided ; second, by division of uvula and
soft palate : third, division of uvula, velum, palatine hone,
and often palatine process of maxillary bone, often laying
the floor of the nasal cavity entirely open ; in either of these
cases the patients are peculiarly prone to affections of the
throat, such as catarrh and inflammations about those parts.
For a more particular account of the last named variety. I
refer to the paper from which I have quoted.

A case of the second variety, the uvula and soft palate
alone implicated, the greatest width of the fissure heing

*Amer. Jour. Med. Sciences, Vol. XXL 1537.

584

Ford. Operation of Staphyloraphy. [August.

about three-fourths of an inch, presented itself February
27th, 18G0, to Prof. L. A. Dugas, of the Medical College of
Georgia, for operation. The roof of the mouth was unusu-
ally concave, with general deformity of the face, the lower
jaw protruding in front of the upper a half inch, with much
elongation of the head. The patient was of hemorrhagic
diathesis; as evidence of this, while a child his finger was
slightly cut, which healed, but fixo, days after profuse hem-
orrhage from the wound ensued ; a similar circumstance
ccurring after the extraction of a tooth.

The patient, Mr. H , aged 23, was placed in a sitting

osture, well supported and secured, a speculum ori then
ltroduced, pressing the tongue, and keeping the mouth ef-
fectually opened. The edge of the right side was supported
>y a double hook, and a sharp pointed bistoury plunged
ibove the angle of the fissure, and carried down to the ex-
tremity of the uvula ; the left side was denuded in a similar
manner. The hemorrhage was so profuse that some time
elapsed before the introduction of the sutures. Five thread
sutures were applied, as detailed in the operation of Dr.
Warren.* To one end of each of these was fastened small
silver wires, which were drawn through the edges of the
fissure and twisted by the serre noeud until the edges were
approximated, the remaining ends cut off some bleeding
continued six or eight hours. Five days after the operation
there was profuse bleeding for twenty-four hours consecu-
tively. The blood seemed to flow from the posterior sur-
face of the wound. Ligatures were applied to the superior
and inferior extremities. The patient suffered from this
alarming bleeding, was prostrated and reduced nearly to a
*tate of syncope, administered wine of ergot and tincture of
iron. In an attempt to inject water and tincture of iron,
violent sneezing ensued, threatening rupture of the parts.
The hemorrhage ceasing, lie was put upon gallic acid for a
few davs, and then a return to tincture of iron. On the

Smith's Operative Surgery, page 203.

I860.] /.- \tures on Rickets.

sixteenth day the sutures were removed, perfect union

throughout having been effected.
It will ho remarked that Prof. Dugas did no1 deem it ne-
sary to divide the levator palati and palato pharyngeus
muscles, as suggested by Mr. Ferguson ; also, thai the su-
tures were not introduced before denudation. Of this I>r.
Mettaner says : "We prefer denuding the margins of the
Lips before inserting the Ligatures, for several reasons, But
chiefly because, by that means, the possibility of dividing
them is precluded; the sutures maybe inserted at more
equable distances from the margins, and because the mosl
painful step of the operation is reserved for the conclusion
of it." "Hemorrhage, from the denuded margins, cannot
he adduced as an objection of any weight to this or the first
step of the operation, as it ceases in a few moments alter
the incisions are formed."

A Scries of three Lectures on Rickets, delivered at the Hos-
pital for Sick Children, in December, 1859, and January,
1860. By Wm. Jbnner, M. J)., Physician to University
College Hospital, and to the Hospital for Sick Children.

LECTURE II.

Summary : The Thoracic Deformity in Rickets due to Atmospheric Pressure
Elasticity of the Lung merely retard? the entrance of the Air Oval Chest in
Tubercle etc Deformities of the Pelvis in Rickets Circumstanres which de-
termine the Differences in the Form of the Pelvis Deformities of the Head in
Rickets, and their Causes Mistake to suppose the Tibiae are invariably bent
in Rickets Bones suffer as if one Organ Arrest of Growth Late Dentition
White Patches on the Heart Evidence afforded by Rickety Subjects of the
Truth of the Attrition Theory Pulmonary Vesicular Emphysema and Col-
lapse of the Lung both due in Rickets to a Common cause, and not related to
each other as Cause and Effect Mechanism of their Production Most Com-
mon Cause of Emaciation in Rickets. Albuminoid Infiltration of Lymphatic-
Glands. Spleen, etc. Anatomical Characters of the Lymphatic Glands and
Spleen when the Seat of Albuminoid-Infiltration.

Gentlemen, At the conclusion of my last Lecture I was
endeavoring to prove to you that the deformity of the chest
in rickets, of which we have so many specimens on the
table, is produced immediately by atmospheric pressure

the seat of the circular groove being determined, not by the
contraction of the diaphragm, but by the position of the
upper margin of the liver, stomach, and spleen ; the seat of

:,st;

res on RkkeU

[August,

the vertical groove being determined, not by the loss of
power of the respiratory muscles attached to the outside of
the ribs, but by the softness and want of resilience of the
ribs themseh

That atmospheric pressure is the immediate cause of the
thoracic deformity seem- to me to be farther shown by the
following experiment : Apply to the abdomen of a child
having a rickety thorax pressure so directed as to retard
very decidedly the rapidity of the descent of the diaphragm
during inspiration : the result is, even though the child in-
spires deeply, that the recession of the chest walls is very
considerably diminished ; remove the pressure, and cause
the diaphragm to act suddenly and rapidly, and then the
recession of the chest walls is not only greater than it was
when you retarded the descent of the diaphragm, but
greater than it is in ordinary inspiration. Again, if any
cause impedes the free passage of air into the lungs. as,
for example, narrowing of the glottis, the recession of the
chest walls during inspiration is enormously increased.
Under these latter circumstances, you will note that the in-
spiratory muscles attached to the ribs are called powerfully
into play : they put forth all their force, and yet the vertical
groove is deeper than it is when the orifice of the glottis is
of proper size and the inspiratory muscles are acting nor-
mally. As to the part played by the elasticity of the lung
in producing the thoracic deformity: In ordinary respira-
tion the elasticity of the lung has to be overcome before tlie
air can enter its substance. The elasticity of the lung is
the same in the rickety as in the healthy child. The elas-
ticity of the lung aids then in the production of the thoracic
deformity only by the normal impediment which it offers to
the ingress of air, and consequently to the rapid dilation of
the thorax. Lateral curvature of the spine will considera-
bly modify the shape of the posterior part of the thorax,
causing the side to which the convexity is directed to bulge ;
but it lias little effect in modifying the special deformity of
which I have been speaking.

It is interesting to compare the shape of the thorax in ex-
treme rickets, with that which it presents in a non-rickety
child, when the free entrance of air into the lungs is impe-
ded for a considerable time, as from tubercular bronchial
glands compressing the trachea or the largest bronchial
tunes, or from chronic laryngitis, or chronic spasm or pa-
ralysis of the larynx. There is a boy in the Hospital at the
present time, suffering from long continued laryngeal spasm.

I860.] Lcctur, s on Rickets.

depending, I believe, on tuberculisation of the bronchial
glands, who illustrates the poinl in question. In the rickety
child, the ribs are softer than their cartilages; in the healthy,

and still more so in the tubercular chilli, the cartilages are
Bofter than the ribs. The consequence is, that when any
chronic impediment to the entrance of the air into the lungs
-is in the healthy or tubercular child, the thorax obtains
a very oval form; the anteroposterior diameter being Less
than in health, the lateral diameter greater. Lf the impedi-
ment he very considerable, or the cartilages softerthan natu-
ral, the sternum may he forced by the atmospheric pressure
backwards, BO far as to he placed on a level lower than the
point of junction of the ribs with the cartilages.

In the majority o\' cases where this deformity of the tho-
rax lias been produced during childhood, it is said in after
life to have been congenital. I doubt altogether the exist-
ence of such congenital deformity of the chest.

The rickety thorax is constant in shape, not BO the rickety
pelvis. It has been said, that while the pelvis of mollities
oseium is triangular, that of rickets is oval ; hut in fact, the
pelvis in rickety children is much more frequently triangu-
lar than oval. Its form will vary, first, according to the di-
rection in which it is compressed by the spine, and its su-
perincumbent parts, on the one side, and the heads of the
thigh bones on the other side, and the direction will vary
as the child is the greater part of its time lying, sitting,
crawling on all-fours, walking, or shuffling alonir on the
floor; and secondly, according to the age at which the com-
pressing forces are brought to hear on the walls of the
pelvis, and the consequent differences in the degree of ossi-
fication of the pelvic bones. The cartilages being in the
pelvis of the rickety, as we have seen they are in the thorax,
less yielding than the bones.

The rickety head is distinguished,

1st. By the length of time the anterior fontanelle remains
open. In the healthy child it closes completely before the
expiration of the second year. In the rickety child it is
often widely open at that period.

2ndly. By thickening of the bones. This is usually most
perceptible just outside the sutures, the situation of the
sutures being indicated by deep furrows.

3rdlv. By the relative length of the antcro-posterior
diameter.

4thly. By the height, squareness, and projection of the
forehead.

588 Lectures on Rickets. [August,

The two first of these peculiarities of the rickety head are
the result of the affection of the bones; the two last are
due chiefly to disease of the cerebrum.

In consequence of the arrest of growth of the bones of the
face and the sinuses, the forehead, as mentioned by Mr.
Shaw, in his most able papers on rickets, seems to project
more than it really does. Guerin supposed that the rickety
deformities were developed from below upwards, e. g. that
the inferior extremities always suffered before the trunk.
But they are not so. If a child is the subject of rickets he-
fore it Avalks, the ribs, clavicles, and upper extremities,
certainly become deformed; while the tibia1, unless the
child sit so as to press on them, escape bowing. It must
be borne in mind, that if a very heavy child be placed on
its legs at too early an age, the tibiae may bend a little, be
a little more bowed outwards than natural, though there be
no reason to suppose the child to be the subject of rickets.
A child then, may be, nay, often is, rickety in the highest
degree its ribs softened so as to endanger life, its clavicles
bent at an acute angle, its wrist swollen so as to measure as
much in circumference as the length of the forearm, and
yet its tibiae be as straight as in health; and again, as I
have just observed, the legs may be slightly bowed out-
wards, and the child not be rickety.

The enlargement of the ends of the long bones, and the
softening of the bones, do not always proceed in an equal
degree the softening being very often out of proportion to
the enlargement; the enlargement being sometimes out of
proportion to the softening.

It is not uncommon to see the thoracic deformity lessen
at the time the legs are bending. I think this is due to the
disease having greatly diminished, and the muscular power
increased so as to permit of the child walking before the
bones of the leg are strong enough to bear the weight of the
body.

Rickets being a general disease, the bones are affected as
one organ, just as the arterial system is in the degeneration
of age; the consequence of this is, that no one bone is ever
affected without all suffering, and that whether the disease
manifest itself chiefly by enlargement of the ends of the
bones, or by softening of the bones, or by both in a porpor-
tionate degree.

I have described the deformities that result from the
severest form of rickets, a form which is very common
among the poor, and not so uncommon as has been sup-

I860.] /. s on Rickets.

posed among the rich. We see, however, all degrees of
softening, from thai in which the ribs only yields to extra-
ordinary pressure, as during bronchitis, and then only suf-
ficiently to flatten the anterolateral surfaces, to that in
which they yield at every inspiration, as was the rase in the
child from whom this model was taken. We see all degrees
of enlargement <>t* the ends of the ribs, and of the other long
bones, from that where one might maintain the enlarge-
ment was only that proper to the child, to that in which
the projections ow the anterior wall of the thorax and the
enlargement of the wrist would strike the most careless
observer.

Arrest of growth of the hones and of the parts in relation
with them, is a very important consequence of rickets. This
arrest of growth commences during the progress of rickets,
hnt it continues after the general disease has terminated.
Hence, not only arc children stunted in growth while the
subject of the disease, but they never grow into ordinary-
sized" adults.

All the hones in the adult whose skeleton shows the
effects of rickets are diminished in length ; hut the lower
limbs, including the pelvis, are, according to Mr. Shaw's
researches, disproportionately diminished in size, and the
face is small in proportion to the skull.

I must refer you to Mr. Shaw's most ahle papers for fur-
ther details on the arrest of growth of the hones (a).

When speaking of the deformity of the head in rickets, I
mentioned one important consequence of the arrest of
growth viz : the late closure of the anterior fontanel le.
There is another most important consequence of the arrest
of growth in rickets, which, though it is well known, does
not appear to me to exert sufficient influence on practice
I mean the late period at which rickety children cut their
teeth.

Healthy children commence teething pretty constantly
between the seventh and eighth month, and cut the last of
the first set of teeth between the twenty-fourth and twenty-
fifth month. As a rule, children brought up by hand, sup-
posing them not to be rickety, and children the subjects of
tuherculosis, cut their teeth early.

If a child pass over the ninth month without teeth, you
should carefully inquire for the cause. It may he, that an
acute illness has retarded dentition. It may be, hut this is

(a) Medico-Chirurgical Transactions, vols xvii. and xxvi.

590 Lectures on Rickets. [August,

very rare, that there is some condition of the gum which
interferes with the advance of the teeth. It may he, and

this is infinitely the most common cause of late dentition,
that the child is rickety; fail not, then, when called to a
child in whom the teeth are late in appearing, to look if it
he rickety, for if you do fail to look for rickets, you will
most likely attribute to the irritation of teething symptoms
which are the consequence of the rickety diathesis; the late
dentition in rickets being itself merely a symptom of the
general disorder.

The rickety deformities may be very trifling, and yet the
teeth considerably retarded in their development,

You are familiar with the " white patches" so common
on the visceral pericardium in the adult. These " white
patches" are not common in children. The more ad-
vanced the age of the subject, the more frequently are they
found (b).

I use this term "white patch" to signify circumscribed
opacity of the pericardium itself, and patches, limited in
size, of organized lymph, seated on the surface of the peri-
cardium. In some cases the patch is composed of a thin,
smooth layer, of more or less perfect fibrous tissue, in oth-
ers it is highly villous the interior of the villi being per-
fectly formed fibrous tissue, containing vessels ; the exterior
a layer of epithelium. (Drawing microscope, etc., on
table.)

We find every stage between the opalescent spot due to a
little thickening of the pericardium, and the most shaggy
growth from its surface.

Two theories have been advanced to explain the origin of
the "white patch."

According to the pathological anatomists whose opinions
have the greatest weight in this country, white patches are
produced, in the vast majority of cases at least, by inflam-
mation of the pericardium.

Dr. Hodgkin is said to have advanced the second theory.
He attributes the origin of white patches to "pressure,
aided by the movements of the heart." (c) Dr. Wilkes, in

(b) Bizot examined sixteen male subjects under 17 years of age without find-
ing in a single case a white patch on the heart; while one-third of twenty-four
male subjects, between the ages of IS and 30, had white patches on the heart,
and three-fourths of thirty-two subjects between the ages of 40 and 79.

(c) Lectures on the Morbid Anatomy of the Serous Membranes. 1836, p- 98.
Five-and-twenty years before the Lectures on the Serous Membranes were pub-
lished, Corvisart wrote: "On a attribue la formation de ces plaques blanches a

18G0.] Lectures on Rickets. 591

his recently published valuable Lectures on Pathological

Anatomy, lias termed this the w* Attrition Theory." Now.
[told you a little while since, thai " white patches " are
not very common in children, speaking generally. They
are, hbwever, very cpmmon in children whose chests are
deformed from rickets. But, while in those advanced in
years by far the most common seat of the while patch is
about the centre i)\' the anterior surface of the righl ventri-
cle, in children with rickety chests the chosen seat of the
'"white patch" is on the left ventricle, a little above its
apex; in tact, just as the spot which impinges against the
tilth rib where it projects or knuckles inwards.

The white patch is here evidently produced by attrition ;
and these cases form important links in the chain of facts
which unite the white patches and friction to each other as
cause and effect and the}7 afford the strongest grounds for
believing that circumscribed opacity of the pericardium, the
smooth, thin layer of fibrous tissue on the pericardium, and
the villons-looking tuft, are mere varieties of one pathologi-
cal state, and due to one and the same cause that cause
being, I believe, friction of the spot where the white patch
is found against some hard, resisting substance.

You may say," " But how comes the apex of the heart so
far to the left in the young child as the junction of the fifth
rib with the cartilage, seeing that in the healthy child, as
in the adult, the apex of the heart impinges inside the nip-
ple?" The answer is, that the sternum of the rickety tho-
rax being forced forward, the relative positions of the chest-
walls and of the heart, are no longer those of health; and
the apex usually strikes outside the nipple.

Unless you bear this in mind you may suppose in such a
case, as I once did, from the apex impinging outside the
nipple, that the left ventricle of the heart is dilated; and
this mistake is favored by the chest-walls in the rickety
thorax being pressed so closely in contact with the apex of
the heart that the force of the impulse seems to be greater
than natural.

In children whose chests are oval, the anteroposterior

1' impression des parois de la poitrine sur le cceur, quand sa contraction le porte
vers les cotes.7' Essai sur les Maladies du Cocur. Par J. N. Corvisart. Second
Edition : 1811, p. 4'2. Corvisart recognizes the pathological identity of the white
patches on the heart with the white patches found on the liver, lungs, arachnoid,
etc. He doubts their origin being inflammation "Le mot inflammation doit-il
meme etre prononce pour donner un air de verite a Implication de ce phenom-
ene. dont la cause, je avoue, me parait absolument inconnue ? P. 44.

Lectures on Rich is. [August,

diameter being small, you may often, by moderate pressure
with the stethoscope, force the sternum far enough back-
wards to compress the pulmonary artery; and thus you may
produce a systolic basic murmur. In consequence of the
length of the antero-posterior diameter of the chest of the
rickety child, you cannot by any amount of pressure on its
sternum produce a basic systolic murmur.

In children whose chests are greatly deformed by rickets,
we sometimes find a white patch on the spleen, identical in
structure with those which are found on the heart. In such
cases the'w7hite patch on the spleen owes its origin to the
same cause as the white patch on the heart, viz : friction
against one or more ribs projecting inwards the spleen
rising and falling, you know, with the inspiration and expi-
ration.

There are two lesions of the lungs constantly present when
the thorax is deformed from rickets, and which are, in fact,
direct consequences of the softened state of the ribs, and the
deformity which accompanies it. These two lesions are
emphysema and collapse.

I need Scarcely remind you that pulmonary vesicular em-
physema has been considered by some to be always secon-
dary to collapse of lung-tissue; and the frequent conjunction
of the two lesions in the rickety thorax, at first sight seems
to lend support to the theory; for when found conjoined it
has been pretty generally admitted that the emphysema is
related to. the collapse as effect to cause.

A careful study, however, of the lungs and thorax of a
child who has died while the subject of extreme rickety
deformity of the thorax, proves that the two lesions may co-
exist in the same lung without having any such relation to
each other.

With the abnormity of the thorax to which I have referred,
there is, I say, always conjoined as consequences, pulmonary
vesicular emphysema and collapse of lung-tissue. The em-
physema is that variety which has been termed insufflation.
It is mere over-distension with air of the vesicular tissue of
the lung. It invariably occupies the same situation in the
lungs of the rickety child, viz: the whole length of the
anterior border of both lungs, extending backwards for
about three-quarters of an inch from the frov margins. The
emphysematous portion is separated from the healthy part
of the lung by a groove formed by collapsed lung/ The
groove of collapsed tissue corresponds to those projections

I860.] / tares on Rickets. 593

of tlio ribs inwards, which are situated at the points where
they unite with their cartilages.

On the table, illustrating these lads, are a wax model of
flie inside of a thorax ; a wax model of one of the lungs
from the same thorax ; and the thorax and lungs from which
tho models were made, The mecKanism of the production
pfthe lesions in question is as follows: The softened ribs,
instead i^t' being drawn outwards at eaeh inspiration, are
forced inwards by atmospheric pressure; the consequence
is that not only are the lobules of lung beneath not expan-
ded, but they arc compressed. The compression of the
lung, aided by its elasticity, causes the collapse.

The common cause of collapse of lung-tissue is undoubt-
edly obstruction of the bronchial tubes leading to the col-
lapsed portions ; it has been confidently affirmed that it is
the sole cause. The facts I have brought before you refute
the assertion.

The emphysema of the anterior border is produced thus :
The lateral diameter of the thorax is diminished at the part
corresponding to the line formed by the junction of the ribs
and cartilages. Here, as we have seen, at each inspiration
the ribs recede ; but in proportion as the ribs at this part
are forced inwards, the sternum must be thrust forward :
and just as less air, or no air, enters into the tissue under
the receding ends of the ribs, bo an excess of air is drawn,
as we commonly call it, into the lung-tissue subjacent to the
abnorniallv-advancin^ sternum and cartilages of the ribs.
; The collapse is directly consequent on the recession of the
ends of the ribs during inspiration; the emphysema is
directly consequent on the thrusting forward during inspi-
ration of the sternum.

The groove of collapsed lung-substance, and the border
of emphysematous tissue, are all the lesions of the lungs
invariably present in the rickety thorax. But we so often
find a very large portion of one or of both lungs collapsed,
and that collapse is so directly connected with the defective
mechanism of the inspiratory power of the rickety thorax,
and is so very, very often the cause of death in rickets, that
I must here especially direct your attention to it.

The collapse of the lung, of which I am, now about to
speak, occupies especially those parts of the lungs which
are the seats of bronchitis i. c, the posterior and interior
portions, now and then the greater portion of the inferior
lobes of one or of both lungs, and. some part of the superior
lobes.
38

594 Lectures on Rickets. [August,

If we call to mind the mechanism of the process by which
we expel mucus from the bronchial tubes, we readily com-
prehend why a child with a rickety thorax, when the subject
of bronchitis, is sure to suffer, and must often die, from col-
lapse of the lung. When we desire to expel mucus from
our bronchial tubes, we inspire deeply, and so fill the pul-
monary tissue with air to the utmost ; we then close the
glottis, compress, by the aid of the muscles of expiration,
the air contained in the lung; when the compression has
reached a certain point, we open the glottis. The air is, of
course, driven from the vesicular tissue of the lung with a
force proportionate to the compression it was experiencing
at the instant the glottis was opened. The greater the force
with which the air is driven along the bronchial tubes, the
more certainly, other things being equal, are they cleared
from their secretions.

Mucus in the bronchial tubes, when in any quantity, im-
pedes the entrance of the air into the vesicular structure of
the lung. But the free entrance of the air into the vesicu-
lar structure of the lung is essential for the expulsion of the
mucus from the bronchial tubes ; hence the violent inspi-
ratory efforts made when an adult or a child is the subject
of bronchitis. "Watch an adult or child, past infancy, the
subject of severe bronchitis; note how every muscle of
inspiration is brought into play. He sits upright, he catches
hold of the arms of his chair ; he takes instinctively the
position that enables his muscles of inspiration to act with
the greatest results. ]>7ow one can reason why the healthy-
formed young child so frequently dies from bronchitis, is
the flexibility of the lower part of its thoracic parietes, and
the consequent mechanical difficulty under which it labors
in overcoming the resistance to the entrance of the air into
the pulmonary tissues of the lower lobes, when mucus is
secreted in quantity into its bronchial tubes.

If the flexibility of the chest-walls in the young child
normally built, has this influence on the termination of
bronchitis, what must be the influence of the extraordina-
rily flexible chest-walls of the rickety ? Eecluce the human
chest-walls to a membranous state, and the diaphragm
would be as useless as a muscle of inspiration to a man as
to a frog. In extreme rickets, the chest-walls have more
resisting power than have those of the frog, but they have
infinitely less than those of the healthy child. Observe a
child the subject of extreme rickets, but otherwise healthy.
See the business it is to him to breathe. The chief occupa-

/.

tiou of his li by effoi

fcir-cella oi' his ! liable bim to li

ruction in fclie i
r all hie efforts u
Be has bronchitis; you Btrip bim, and

\ alls which accompanied
bronchitis are doubled in d
annot be drawn in1
.
muc

domina] mi
belL rom the defect in the inspiratory appa-

ratus.

Id not Bay, in thesi
child di

y of that which causes death, vii: the wai
r in the inspiratory apparatus to than-

impediment to the enfc offered by

muc L\al tube of power whicb

[ration expei ' mmon v. ith thos

rally, in rickets, inc
difficulty rcoming th<

pf the air. This ws y power, and tin

bronchial tubes, affords
xplanation of the extraordinary mortality of meae

nd in din
to which i
I on the constitute
Whoe "ii the largi

\
ed, othert ai fvith

liat they mi . if

! a baby-show.
. lit that the ted children we

such was not the case. I

- in
ble, and

I of this 1 !

<l : imd

is almo

id infilti

596 Lectures on Rickets. [August,

lymphatic glands and spleen are the chief seats of the dis-
ease ; but I have not unfrequcntly seen the liver, kidney,
brain, heart and thymus suffer in a high degree.

I strongly incline to the opinion that in rickets this exu-
dation is never limited to one or two organs, but that in all
cases every organ, and may be every tissue, is more or less
its seat. The lymphatic glands are, in regard of albuminoid
infiltration, to be regarded as one organ -just as I told you
the bones in rickets are to be regarded as one organ. And
as in the osseous system we never find one bone only affect-
ed with softening, and the other lesions characteristic of
rickets, so in the lymphatic system we never find one gland
only, or one set of glands only, the seat of albuminoid infil-
tration. The knowledge of the oneness, so to say, of the
glandular system^ in reference to albuminoid disease, is of
much practical importance ; inasmuch as we can readily
ascertain the state of the lymphatic glands in the groin,
axilla?, and neck, while it is difficult to determine by the
eye or touch during life the condition of the mesenteric and
other internal glands.

During life we feel the lymphatic glands, if they be infil-
trated with albuminoid lymph in the groins, axilla?, and
neck, varying in size from that of a large pin-head to that
of a sweet-pea, hard, and very moveable. The skin over
them is natural in color. There is no sign of inflammation.
On examining the -body after death in such a case, we find
the deep glands of the neck, the mesenteric, the lumbar, the
bronchial, etc., resembling those seated in the superficial
regions. The cut surface of the glands is singularly pale
and transparent, compact, smooth, tolerably moist, and, to
the unaided eye, uniform in appearance. The substance is
tough, and the gland heavy in proportion to its size. In
rare cases, instead of being pale, the glands may be purplish
in color.

I have never examined a rickety subject after death in
which the lymphatic glands were the seat of this albuminoid
disease without finding the spleen more or less extensively
infiltrated with the same substance (d).

As to the size the spleen may attain when the subject of
albuminoid infiltration, it may be that the organ is only just
perceptible to touch when the child inspires i. e. when the

(d) It is a point of interest that the spleen, the lymphatic glands, and Peyers
patches experience decided atrophy about the same period of life, and that dis-
eases of the spleen, of the lymphatic glands, and of Peyer's patches are infinitely
more common in the child than in the adult.

I860.] 597

diaphragm descends and detrudes somewhat the spleen;
it may be thai it reaches nearly to the middle line jus!
below the umbilicus, and downwards to the crest of the
ilium.

1 have never seen this extreme enlargement of the spleen
in the child as the consequence of a deposit of the tubercle
in its substance ; it has always, in my experience, depended
on albuminoid infiltration. And albuminoid infiltration of
such a degree as to cause very great enlargement of the
spleen in children is rarely Been except in those of the
rickety diatl Sometimes the bono disease is extreme,

in others, as in the two cases to which I have befor referred,
the bone disease is moderate, or even trifling in degree.
One oi* those children certainly, and the other probably, had
the bone disease developed after their spleen : lymphatic
glands, etc., were the seats ot' albuminoid infiltratioi

The albuminoid spleen of ricketty children presents after
death the following characters : It is increased in size; the
increase may be trifling or extreme. Thus 1 have seen it
little larger than in health, and I have seen it measure as
much as eight inches from above downwards, over its con-
vex surface, and four inches from side t<> side. It is n<
adherent to the parts adjacent, as a spleen containing
tubercle- often is, and its capsule generally is scarcely, if at
all, thickened. In anterior border is pretty sharp;
firm to the touch, and smooth on the Burface; its weight,
1 being had t<> it< size, strikes one as considerable.

Th nee i< tough, but elastic, and the thinnest s<

i be cm with facility. The cut surface is remarka-
bly smooth and transparent It is not unlike <>ne mi
Buppose would be its appearance it' tin- w 1
infiltrated with glue. Only a little pale bl
d from the cut suri

Usually the organ i- pale red, but is dark

purple. The more transparent any given i i he paler

= : the most transparent parts are almost colorli

The spleenic c imetimes more readily -

than in a healtl a : they may be mistals

tubercles. I 1:; .. in the spleen of rickety

children the sago-like little masfi - >ften present in the

who die of phthisis.

(e) Feb: 360;] have now under m .

only, -whose spfe< ./ the level of the

ing from catarrh. There are no gigi

598 Correlation of Forces. [August,

The parts of the spleens of the hoys II. and F., now on the
table, afforded, when recent, good specimens of the disease.
They have now lost much of their transparency, still they
preserve many of their characters, e. g, hardness, elasticity,
smoothness: I have never seen this disease conjoined with
ascites. Medical Time* and Gazette.

The Correlation of Physical* Chemical and Vital Force, and
the Conservation of Force in Vital Phenomena. By Jo-
seph LeConte, Professor of Geol. and Chem. in the South
Carolina College, Columbia. Bead before the American
Association for the Advancement of Science, at the Spring-
field Meeting, August, 1359.

Matter constantly changes its form but is itself indestructi-
ble except by the same power which called it into being. The
same quantity of matter exists in the universe at all times.
So also force changes its form constantly, but is itself inde-
structible, incapable of increase or diminution, and the same
absolute amount offeree exists in the universe at all times and
forever. The mutual convertibility of the various forms of
force is called "correlation of forces." The invariability of
the absolute amount in the midst of constant change is called
"conservation of force." This principle of correlation and
conservation of force must be looked upon as one of the grand-
est generalizations in modern science, a principle startling at
first, but when clearly understood and u'rmly grasped, almost
axiomatic. It must be considered a necessary truth, and as
such is a legitimate basis of deductive reasoning.

The correlation of physical forces is universally recognized
as a principle in science, and not only so but has already been
productive of many beautiful and useful results but the cor-
relation of physical and vital forces while generally recognized
as a probable fact lias only been speculated on in a vague and
as yet unfruitful manner. The science of life is scarcely yet
ripe for the legitimate extension of this principle over its do-
main. The most elaborate attempt of this kind which I have
seen, is contained in the very remarkable and suggestive papej
of Dr. Carpenter entitled "mutual relation of physical and
vital forces," and published in Phil. Trans, for the year 1S50

In the present paper I wish simply to present a few thoughts,
which have originated in my own mind, in the course of re-
flection on this subject, in the hope that they may prove sug-
gestive to others. They have at least the merit of being un

I860.] 0

influenced by the writings of others- and therefore perhaps
of presenting the Bubject in a somewhat new light. I sincerely
wish I could present the matter in a more definite form, but

certain that where a subject is not perfectly understood,
the n our ideas more denniteness also makes

them more questionable. We are obliged to be content with
a certain vagueness, in the hope that by the use of right
methods a clearness will come after. We must gratefully ac-
cept the twilight in the hope that it marks the approach of
the full light of day.

There are four plane- of material existence which may be
regarded as being raised one above the other. The first ami
lowest is the plane of elementary existence, the second the
plane of chemical compounds, or mineral kingdom, third, the
plane of vegetable existence, and fourth, of animal existence.

. it is apparently impossible for any known force in nature
to raise matter through all these grades at once. On the con-
trary there is a special force adapted for the elevation of mat-
ter from each plane tQ the plane above. It is tin.- special
function of chemical affinity to raise matter from plane No. 1
No. 2. All the changes too which take place upon plane
N" '2 by the mutual reactions of bodies situated on that plane
are under the guidance and control of this force, [t is the

:ial prerogative of the force of vegetation of vegetable
life, to lift matter from No. 2 to No. 3, i.e. from the condition
of mineral matter to the higher condition of vegetable matter.
All the changes which take place upon this plane, the laws of
which constitute vegetable physiology, are under the guidance
. Finally, the force of animal life and that alone
the privilege of lifting matter still higher into the 4th

e. i. o. the plane of animal existence. No forcein nature
can lift from No. 1 to No. 3, or from No. 2 to No. 4. Plants
cannot feed entirely upon elementary matter, nor can animals

, upon mineral matter. The reason of this will be sc< n in

3e_quel. Thu ns that after matter is raised from

elementary to the mineral condition, it requires an additional
another and peculiar kind t" into the \< _

kingdom, and again, another accession of fori
into the animal kingdom. These kingdoms are, therefore,
tin! nted as successive plane.- raised o e the

N< Kingdom,

\ .. ::. Vegi taJbU Kingdom.
No. ~. Mim ral Kingdom.

600 Correlation of Fore [August,

If then it be admitted that this ie the relative position of
these planes that it requires a greater and greater expendi-
ture of force to maintain matter upon each successive plane,
then it follows that any amount of math r n turning to a lower
plane by decomposition must a t fr< or develop a force which
may, und\ r favorable circumstances^ raise oth> r matter from a
lower to a higher condition. Or to express it by a mechani-
cal illustration, a given amount of matter falling from one
plane to any plane below, develops a force sufficient to raise
an equal quantity of matter an equal height. Thus, decompo-
sition must in every case a\ velop force, which force may take
the form of heat as in combustion, or electricity as in electro-
lysis, or may expend itself in forming chemical compounds or
i in organizing matter.

Again, in the same manner as matter may be arranged in
several distinct and graduated kingdoms, so it seems to me
the forces of nature may also be properly divided into distinct
groups arranged in a similar manner one above the other.
These are the physical, the chemical and the vital forces.
And as in the case of matter, so also in the case of force, it is
impossible to pass directly from the lowest to the highest
group without passing through the intermediate group. The
conversion of physical into vital force seems impossible
without passing through the intermediate condition of chemical
force.

These are the simple principles upon which are based all
that follows principles which may possibly seem fanciful to
some unfamiliar with the principle of conservation of force,
but the number of phenomena which they consistently explain
will I hope entitle them to serious thought.

1st. It is well known that chemical elements, in what is
called the '; nascent condition'' i. e. at the moment of liber-
ation from previous combination, exhibit a peculiar energy of
chemical affinity not exhibited under other circumstances. It
seems to me that this is readily explicable on the principle of
conservation of force. At the moment of decomposition the
chemical affinity which bound the elements together and
which was before satisfied is suddenly left unsatisfied. There
is an attraction set fra which was before disguised a force
liberated which was before latent. If conditions favorable
are present this force may preserve the form of chemical
affinity, and expend itself in forming other chemical com-
pounds ; or even as we shall see hereafter in organising mat-
ter. But if favorable conditions arc not present, then it may
take some other form of force, e. g. heat or electricity, and
tJu rcfore no longer exist as chemical affinity. The chemical

I860.] Correlation of Forces. 601

affinity is said to be lost. To return to the mechanical illus-
tration used above, Matter falling from plane No. 2 to plane
No. I develops force sufficient to raise other matter from plane
No. 1 to No. 2, but which in the absence of Buch matter may
expend itself in heat or electricity or some other form of
physical force.

2nd. It is a fact, now well established, thai the seed in
germination forms carbonic acid, and in doing so loses weight.
That is, the organized matter of the seed is partially decom-
posed, a portion of its carbon uniting with the oxygen of the
air to form carbonic acid. Now it ie this decomposition which
develops the force by which germination is effected. A por-
tion of the organic matter of the seed is decomposed. This
decomposition sets free a force which suffices to organize the
rest. The force necessary, and therefore the amount of decom-
position necessary in this case, is small, because the work t<>
be accomplished is simply the change from one form of
organic matter t> another, <>r rather from organic to organized
matter to recur again to the former illustration, merely shift-
ing a certain quantity of matter from one place to another
upon the plane No. 3. " But how," it may be asked, "is this
decomposition brought about 8" This seems to be effected by
the heat, and perhaps, (according to Hunt) by the actinic
rays of the sun." Heat and actinic rays have been spoken of
by many writers, e. g., by Carpenter and by Robert Hunt, as
the physical force which is changed into organizing force, by
means of the "substratum of an organized structure:" but the
peculiarity of the view which I now present, is that this con-
version does not take place immediately, but only through the
mediation of another force more nearly allied to the vital, viz :
chemical force. The food is laid up in the seed mostly in the
form of starch. In the act of germination this starch is
changed into sugar. Starch, as is well known, differs from
sugar in two important respects, viz: it is insoluble and it is
more highly carbonized.^ Now according to the ordinary
view, the only object of the partial decomposition is to change
the food from an insoluble to a soluble form and this can be
done only by elimination of a portion of the carbon, in the
form of carbonic acid. According to the view which I now
present, the food is always laid up in a more highly carbon ized
condition than is wanted, in order that force may he stt free
by elimination of superfluous carbon. According to the ordi-

*See Report by Robert Hunt on the growth of Plant?, Rep. Brit- Assoc . 1846,
p. 33, 1847, p. 30.

f Robert Hunt. Rep. Brit. Ass., is 17, p. 20-22- Carpenter, Comp. Phys , p.
288. Mulder, Chem. An. and Veg. Phys., pp. 208, 230.

G02

Correlati n of /'

[Angus]

nary view, it' an insoluble food could be found, caj
conversion into the soluble form, without loss of carbon, tli
germination of tlie seed might take place without Iose
weight, by the direct conversion of heat into viral forc<
According to my view, deconvposition} and therefore loss
Wi ight, is absolutely , y to ,]< v . Ingforc]

the loss of weight being in fact ti. measure of thai

force.

3rd. As soon as the plant develops gr< n leaves^ a completj
change takes place in its mode of development. It no longei
loses weight, but increases in weight. It not only d
but grows. The reason of this is, that the organizing force ii
no longer developed by decomposition of food laid up witlii:
its own tissues, but by the decomposition of food rakei
vtern-o. Sunlight Is universally admitted to be the phyi
cal force concerned in this decomposition. Farther, it v.
generally supposed that there is a direct and immediate
conversion of light into vital force in the green leaves of ph
But evidently this is impossible, since the work done by the ligM
is the separation of the two elements carbon and oxygen\
Light is therefore converted into motion. It is therefore tin
chemical affinity thus set free which is the force immediately
converted into vital force. The food of plams consists
carbonic acid, water and ammonia, (CO, HO and NH) or, i
some cases, according to M. Yille, of CO, HO and N".* Sun
light, acting through the medium of the green leaves of plants]
has the remarkable power of decomposing CO. The fore
tJais set free from a latent condition, or the chemical amnit;
of carbon in a nascent condition, is the force by mean- i
which C, 1:1, O and N are raised to the organic condition.
To return to my former illustration, matter (oxygen) Tallin,
from the second to the first plane, develops force sufficient
to raise other matter from the second to the third plane]
Thus it is evidently impossible on thejn incijde of conservaiu
of force that plants should fed entirely >,. nenta\

matter ; whereas, according to the ordinary view of the din
conversion of light into organizing force, there is no reaso

*See review of the controversy between Boussingault and Ville on this subject
Bib. Univ. Arch, des Sci., vol. 30, p. 305. Also Phil. Mag., 4th ser., vol. 13, p
497. Ann. des Sci., 4th series, vol. 2, p. 357. Am. Jour. Science, vol. 10. p-
100. Bib Univ. Arch, des Sci,. vol. 28, p. 335. Ann. des Sci., 1th series,
vol. 7, p. 5.

t Ammonia is also probably decomposed in the tissues of the leaves of plants-
carpenter, correlation of physical and vital forces, Phil. Trans. 1^-30, p. 732,
See also Morren, Bib. Univ. Arch des Sci., new period, vol. 5, p. S I.) This would
of course produce additional organizing i'ov

I860.] I ;

why plai ntirely on i I ept that

one of them, c is insoluble.

4th, There are ma i r phenomena of vegetable life

which r ready explanation on this theory. 1 have

said thai sunlighl lias the power of decomposing carbonicacid
only in tl of plants. Pale plants, Buch as the

Fungi among crypl and the M ; a among ;

nogams, have no power to decompose CO. These plants,
therefore, upon chemical compounds mineral

matter. The; I upon o atter, which organic

matter ti wnished th< force neces-

o, then this decomposition, a
i attended with the elimina
of CO. Both of these are known to be tact?. Pale plants
gaiiic ma I do evolve CO. The n<

sary connect] liese facts with one another, and with the

principle of conservation of force, is now for the first time, as
far as I know, brought out. The phenomena of nutrition in
these plants, is similar to that of seeds in germination, except
that the hitter contains the organic matter already laid up
within its <wn tissues, while the former derives it from decay-
ing vegetable or animal matter taken db externo into its
In this case, too, as in germination, heat is apparently
the physical force which effects the decomposition of the
organic food., and which, is therefore converted indirectly
through chemical into vital force. Light is actually unfavora-
ble to this process, for light tends to decompose, not to form
CO. in both cases, therefore, the conditions favorable for
nutrition are first, abundai >lnble organic matter, second,

- ence of heat. This is then apparently
the true reason why germinating plants and pale plants avoid
the light. These plants grow by the ooeydation of carbon and
formation of CO. Light dec CO, and must therefore

be antagonistic to its formation, and consequently to the
growth of these plants. Whether or not this property of light
is entirely limited by the condition of its acting through an
organic tissue, is a question yet undetermined. Heat we
know is favorable to the oxydation of carbon, (combustion,
fermentation, putrefaction, &c.) under all circumstances.
Has light an opposite property also under all circumstances,
- this opposite property of light limited to the ion of

its acting through the medium of an organism \ I hope the
experiments already commenced, and still in progress, by my
brother, Prof. John LeConte, and published in the last pro-
ceedings, and in the American Journal of Science and Arts,
vol. 24, p. 317, will eventually furnish the means of solving

604 relation of /' [August,

this very important problem. I do not wish to anticipate the
final results of these experiments, but it seems to me that the
negative results thus far obtained, rather support the view
that the action of light is not thus limited. In all experiments
on this Bubject, the light and heat of the sun have been com-
bined. Now heat we know is favorable to combustion. The
fact, then, that combined light and heat produced no effect,
would seem to indicate that light counteracted the effect of
the heat of the snn.

5th. Etiolated plants, or plants artificially blanched by ex-
clusion of light, exhibit the same phenomena, and for the
same reason. These plants cannot receive their organizing
force through the decomposition of CO by sunlight : there
they are obliged to obtain it from decomposition of organic
matter. Hence these plants require organic food, hence, also,
they evolve CO instead of oxygen. In this case, also, decom-
position of organic matter, with a separation of a portion of
the carbon in the form of CO, furnishes the organizing force.
In the absence of any external organic matter in the form of
humus or manure, etiolated plants, like germinating se
will feed for awhile upon organic matter, previously accumu-
lated in their tissues in the form of starch, and actually
weight of solid matter.*

6th. In a most interesting and BUggestive article in the
Bibliotheque-Universelle (Archive des Sciences,*)*) on the sub-
ject of humus, M. Risler shows in the most conclusive manner
that organic matter in a soluble condition (soluble humus is
taken up by almost allj/Jants. This fact had been previously
proved experimentally by Th. de Saussure. but having been
denied by Liebig, it has been very generally neglected by
vegetable physiologists. The doctrine of Liebig and of phys-
iologists generally, is that, except in case of pale plants,
ganic matter is decomposed into CO, IIO and XII, i. e. must
fall into the mineral kingdom before it can be absorbed and
assimilated by plants, ami therefore that organic manures only
supply the same substances, and in exactly the same form,
which are already supplied, but in insufficient quantities, by
the atmosphere. But M. Risler repeats with great care the
experiments of de Saussure, and confirms the accuracy of his
conclusions. Hyacinths and other bulbs were placed with
their roots suspended in water colored with soluble extract of
humus. When these plants were placed in the sun, the water
became rap-idly decolorized. Other such as carrots,

1 'arpenter, Comp. Phys. p. 2S3.
f Bib. T'n. Arch- des. Sci. new period, vol. 1, p. "!0-''>.

I860.] ' of Force*. 605

also germinating grains of wheat, were observed to produce
the same effects. An extract of humus was exposed at a
Bomewhat elevated temperature to sunlight under a bell glass.
Microscopic plants developed in great abundance. As Ion
these plants continued to develop the Infusion was transparent
and did not putrefy In the slightest degree; and yet there wat
a constant evolution of ( N > as Bnown by analysis of the air In
the bell glass. "Now the cellules formed in the Liquid con-
tained carbon. This carbon did not come from the I < *
of the air, For the liquid, far from absorbing, disengaged CO.
Therefore the soluble humus must have furnished the carbon
directly to the vegetable cells." It could not have furnished
it indirectly in the form of 00 derived from decomposition of
the organic matter, otherwise oxygen instead of CO would
have been eliminated. M. Risler thinks moreover that the
embryo in germination take- up soluble organic matter in the
form of humus in addition to the soluble organic matter con-
tained within the cotyledons, and that the evolution of CO by
germinating seeds is due in part also to the oxydation of hu-
mus. Finally, according to the same anther, the formation of
roots in all plant.-, but particularly those containing much
starch or sugar, is due to the direct absorption of humus, and
not, as is generally supposed, by the fixation of carbon by
means of light. "In order," says he, "that CO of the air
should form these substances, it is necessary, in the beet and
the potatoe, that there should be a descending sap which there
is not." Moreover if the carbon was taken from the soil in
the form of CO, there should be elimination of oxygen instead
of evolution of CO ; but the converse is the fact as has been
proved in the most indisputable manner by dc Saussure and
Boussingault.*

Mulder is equally explicit in affirming that plants absorb
soluble organic matter which is converted in the roots, by
elimination of a portion of the carbon, into starch and sugar.
Mulder, pp. 620, 60-i, 682. Thus according to these authors
sap is actually elaborah dby the roots from organic manures.

Now, according to the theory which I propose, this change
from humus into starch, sugar or cellulose, furnishes an addi-
tional life-force. Humus is a more highly carbonized sub-
stance than either starch or cellulose. By the partial decom-
position of humus in the tissues of the plant, with the elimi-
nation of a portion of its carbon (removed by oxydation)
a chemical force is set free which serves to assimilate the
remainder. Hence, this process of evolution in CO as we

* Bib. Un. Arch, des Sciences, new series, vol. 1, p. 5.

1)06 ( [Au_

have itl. ight but favored by

darkm sand heat. Light favors the formation of chlorophyll,
of woody fibre,* ial oils, . c; darkness, heal

aic ma; . &c.

Hence the explai Ltion iy cover-

iip the lower plants b ing earth

around them, many buds which would other

Hence ai th
the equally well known fact that the

grow most rapidly in the n of most abundant food, If

the sap is elaporated entirely in the leave - lifficult to un-

derstand why the descending sap should flow in greater abun-
dance in one direction than anotl aborated
in t/> to see

the direction of most abundant manure. It is easy to
why roots avoid the light : sir.ee light decomj i
therefore must be unfavorable to the formation
substance.

7th. h is a well known fa $1 that the so-called n
of plants consists of two dis parently opp<

3, 1st, the absorption i f ( !< I by the leaves and i

lution by the roots, the decomposition of this CO by
means of light with the fixation of the carbon and the
elimination of the . : 2nd, the ion and

evolution .of CO. The mdoubtedly

takes place in the leaves, but where the recomposition of
CO takes place is not bo well a$ ed. It is exhaled,

however, like the oxygen, from the I The proces

decomposition oi only during the <[-:y as Lighl

is absolutely . ry for this process. The

of CO takes pla .r and day. although its ex;.

according to vers, seems to e abundant

during the night. The process of d CO is

well und< >sition, our knowh

is very imperfect. M. Risler's explanation of this latter
proc< probable. Plai . un-

doubtedly absorb soluble humus.

Humus. >w, is a mor

than ccb >re oxydi

in the roots and interior of the trunk, away from light, by
also abs by the roots, and thus forms

C< '. This CO then cir exhale.

>r perhaps to be again . by sunlight

in tliis organ. In tl ' Light, the whole is exhaled

composed. Thi- readily accounts for the apparently

[8G i

. latiou of ( ( > during the night,
well conducted experiments would tesl the truth
fiew. i e should be a relation between the

richness of the soil in organic manures and the amoui
CO exhaled. For a given amount of growth, the amount
of ( -t I exhaled i lount of food taken

up in the form of organic matter, and the amount of 0x3
exhaled is the measure of the amount of food taken in
form of mineral matter. Or if the exhaled CO is decom-
1 in the leaves during the day, then of course the dif-
ference between the amount exhaled during the night and
day would enter as an clement in the calculation. Also it
would seem that those plants, especially, which frequ

shady spot 1 exhale proportionally more CO

and less oxygen, than those loving thin soils and sunny

In plants, then, there mx- > nizing force, the

relative proportion of which varies infinitely, according to
the amount of lig :olor of the plant andnchness

the soil in organic matters. The two i&reimmedi

the decomposition (^\' <'>';. 2nd, the decomposition of
ble highly carbonized organic matter ; r . '.

light and heat. In plants which first take pos-
>n of desert spots, bare rocl theirs/ is the only

In pale plants and fungi the second is the only
source ; but in most plants the two are combined in vai

must of be coi the

t fundamental and i - vidently

supplementary. The decomposition of C< I by sunlight may

be consider _ I source of all vegetation, but in

the higher order of plants, the of nutrition

by the re-absorptio ire it

in returns to the condition of O >. HO and 1VII.

gg during incubation, al xyLivn. evoh

CO, and probably HO, and loses weight. As the result of
this evolution of CO, we find tl ?. What it

w what ' urce

: It evidently hears a direct relation

hen, we hav< I a\ -

A portion of the

tter, falling from the organic to the mineral

plai . - which raises the remaining poi

into a slightly higher condition. Heat is evidently the

phy which is transformed, not

but '/, through chemical affinity, into vital force. In

608 Correlation of Forces. [August,

other words, heat is the agent which effects the necessary
decomposition. The phenomena of development of the
is, therefore, very similar to that of the seed.

9th. After the hatching of the egg, the animal no longer
loses weight; because recomposition of food taken ad externc
proceeds pari passu with decomposition. But in this c
also, decomposition supplies the force by which recomposition is
effected, and growth and development carried on. As this
is an important point, I will attempt to explain it more
fully.

It is well known that in the animal body there are, going
on constantly, two distinct and apparently opposite pro-
cesses, viz., decomposition and recomposition of the tissues ;
and that the energy of the life is exactly in proportion to
the rapidity of these processes. Xow, according to the or-
dinary view, the animal body must he looked upon as the
scene of continual strife between antagonistic forces chemical
and vital; the former constantly tearing down and destroy-
ing, the latter as constantly building up and repairing the
breach. In this unnatural warfare the chemical forces are
constantly victorious, so that the vital forces are driven to
the necessity of contenting themselves Avith the simple work
of reparation. As cell after cell is destroyed by chemical
forces, others are put in their place by vital forces, until
finally the vital forces give up the unequal contest and death
is the result. I do not know if this view is held by the best
scientific minds at the present day, as a fact, but it certainly
is generally regarded as the most convenient method of
representing all the phenomena of animal life, and as such
has passed into the best literature of the age. Certain it is,
however, that the usual belief, even among the best physi-
ologists, is that the animal tissue is in a state of unstable
equilibrium; that constant decomposition is the result of
this instability, and that this decomposition, and this alone,
creaks the necessity of recomposition in other words, creates
the necessity of food. But according to the view which 1
now propose, decomposition is necessary to develop the force
by which organization of food or nutrition i> effected, and
by which the various purely animal functions of the body
are carried on that decomposition not only creates the
necessity, but at the same time furnishes the force of recom-
position.

But it will no doubt be objected that according to the
principle of conservation of force, decomposition of a given
amount of matter can only effect the recomposition of an

I860.] rrdation of /

equal amount that a given quantity of n
given height, can only raise an equal quantity an equal
height : the whole force developed by decompo
to be expended in maintaining the body at a given position.
I Low, then, can growth and animal activity go on ': The an-
swer to this question is obvious enough when we recollect
the nature 01 the food of animals. Animals, it is well
known, cannot feed upon mineral matter, but only on food
already organized, at least up to the vegetable condition.
But when decomposition takes place, th d matter re-

turns no Longer to the vegetable condition from which it
was immediately raised, but to the mineral condition. It is
decomposed into CO, HO and urea. This last substance,
though not strictly a mineral substance, is far below the
condition of vegetable matter. Thus :, Ident that a

ffing downfli/m t ! f animal

to that of mineral matter^ i. e., from the 4th to the 2d plane,

to lift a larg iy of matter

from the veg\ table to the- animal condition* i. e., from the 3rd to
the 4th plane, and yet perhaps leave much residual force
unexpended. Thus it is possible, and not only possible, but
certain, on the principle of conservation of force, that
decomposition of animal tissues should set free, a force, a
part of which is consumed in the recomposition of a larger
amount of new matter, and thus maintaining growth; a- part
in animal heat, and a part in animal activity of all zon^.
In this view of the case, we see at once the absolute neces-
sity that the food of animals should be organized. Upon
the principle of conservation of force, growth and animal
activity, in a word, animal life, would otherwise
impossible.

It follows also from the above, that the higher the organi-
zation of the food, the smaller the amount of force necessary
to effect assimilation, and therefore the larger the amount
of residual force to be expended in animal heat and animal
activity. In this we find a ready explanation of the supe-
rior activity of carnivorous animals, and the loss of animal
activity which results in a state of domestication from the
use of vegetable diet; also of the supposed superior activity
of men fed upon meat diet.

10th. I have spoken thus far of only one source of vital
force in animals, viz., the decomposition of the tissues. I have
attempted to show how, upon the principle of conservation
of force, this is sufficient to carry on the growth and the
activity of the animal organism. But decomposition of the
39

010 Corn lotion of Forces. [August,

tissues, though the fundamental source the source charac-
teristic of and peculiar to animals of immediate and uni-
versal necessity in this kingdom, and in many cases sufficient
of itself, is not the only somree. There is also in animals
as in plants a supplemental source, viz., the decomposition of
food.

It is well known that the food of animals consists of two
kinds, the nitrogenous, such as albumen, fibrin, casein, &c,
and the non-nitrogenous, such as fat, starch, sugar, gum,
&c. According to all physiologists since Liebig, the nitro-
genous alone are used in the repair and growth of the
tissues. The non-nitrogenous are either quickly consumed
in respiration, or else are laid up in the form of fat for future
consumption in the same way. Xow there can b'e no doubt
that animals may live entirely on nitrogenous food; in which
case the whole vital force, whether for assimilation of food
or for animal heat and animal activity, is derived from the
decomposition of the tissues. This is the case also, appa-
rently, in the starving animal, particularly if lean. But in
almost ail cases, much food in the form of fat, starch, sugar,
&c, (non-nitrogenous) is never transformed at all into
tissues, but is taken into the blood, gradually decomposed,
oxydized in the course of the' circulation, changed into CO
and HO, and finally removed by exhalation, from the lungs.
ISTow what is the object of the non-nitrogenous food, since
these do not form any part of the tissues, but are again
decomposed and thrown out of the system ? The answer
usually given is, that such food is used in the animal
economy solely as fuel to keep up the animal heat. On
this view it is difficult to see why this class of food should
be used at all, especially in warm climates. But according
to the view which I propose, we have here an additional
f vital force. The decomposition of these ternary
compounds sets free a force which is used in organizing
and assimilating other matter, (nitrogenous.) and in pro-
ducing animal activity and animal heat. As in plants,
although the decomposition of CO by sunlight, is all that is
absolutely necessary \\>v growth and development, yet the
decomposition of organic food supplies an additional force
which greatly increases the vigor and rapidity of vegetation ;
bo in animals, although n of tht tissues is all that

is absolutely necessary to furnish the force of growth and
the phenomena of animal life generally, yet the decomposi-
tion of non-nitrogenous organic food furnishes additional
force by which growth and animal activity may be main-
tained without too great expenditure of the tissues.

I860.] Correlation of Ford 61 1

11th. In what, then, consists the essential difference between
animals ami plants? There can be no doubt that it consists,
generally, in their relation to one another and to the mineral
kingdom. Plants occupy a middle ground between the mine-
ral and animal kingdom a necessary baiting place for matter
in its upward struggles. But when we attempt to define this
relation more accurately, the problem becomes much more
difficult. It is indeed probable that no single distinction will
be found free from objection. The commonly received, and,
to a certain extent, very correct idea is, that the essential dis-
tinction consists in their relation to CO. Plants ^compose
and animals rdcompose CO. The beautiful manner in which
the two kingdoms stand related to each other through these
converse processes, is familiar to all. But it is well known
that most plants carry on both of these processes at the same
time, while some, as fungi, pale plants, &c, only recompose
CO like animals. It seems to me that at least an equally good
fundamental distinction may be found in this, that in plants
the fundamental and necessary source of vital force is the de-
composition of its mineral food; while in animals the funda-
mental source of vital force is the decomposition of its tissu, ,s.
It is true that iu what I have called the supplementary source
oi' vital force, they seem to meet on common ground, viz., the
decomposition of organic food / but even here there is this
essential difference, that in plants this decomposition of organic
food is only partial, and therefore furnishes not only force but
material for organization ; whale in animals the decomposition
is complete and therefore furnishes only forct .

As a necessary result of the above, it would seem that the
"vortex" of Cuvier is characteristic of animals. There seems
no reason to believe that a tissue once formed in plants is ever
decomposed and regenerated, as is the case in animals. When
plant-cells decompose, the tissue dies. Hence the absolute
necessity of continuous growtJi in plants. In this kingdom
lift is synonymous with growth. There is no . possibility of
life without growth. There is no such thing as determinate
size, shape or duration. There is no such thing as maturity,
or if so, death takes place at the same instant. As cell life is
necessarily of short duration, and as there is no regeneration
of tissues in plants, it is evident that the life of the tissues
must be equally short. Thus plant life can only be maintain-
ed by the continual formation of new tissue and a constant
travelling of the vital force from the old to the new. h\
exogenous plants the direction of travel is from the interior to
the exterior ; in endogens from exterior to interior, and still
more from below upwards by the continual addition of new

612 Correlation i >. [August,

matter at the apex. In fungi where there is no Buch superpo-
sition of new tissue upon the old. where growth takes place by
multiplication of cells throughout the whole plant m other
words, a true instertitl.il growth as in animals since there is
no ri tion of tissues, the duration of the life of the "plant

is limited by the duration of cell-life.

Tlu- respiration of animals, also, differs essentially from that
of plants. At one time the absorption of CO and exhalation
of O was called the respiration of plants. It is universally ad-
mitted now, however, that this is rather a process of assimila-
tion than of respiration. The recomposition and exhalation of
CO as soon as discovered, was very naturally likened to ani-
mal respiration, and is in fact looked upon by many, as for
example the physiologist Carpenter, as a true respiration.
But there is an essential difference between this and animal
respiration, which I have already pointed out. Its very sig-
nificance is radically different. The essential object of animal
respiration is the removal of poisonous decomposed matters
from the organism. The so-called respiration of plants, on the
contrary, is rather a process of assimilation, since by it the too
highly carbonized organic food, by the elimination of a portion
of its carbon, is brought into a proper condition for organiza-
tion. A true respiration is necessarily connected with a
change of the matter of the tissues with the vortex of
Cnvier which has never been shown to exist in plants It is
true the exhalation of CO has been looked upon by some
physiologists as indicative of a regeneration of tissues, but 1
have already shown that this is probably not the case, but on
l he contrary that the CO is formed by the partial decomposi-
tion of highly carbonized organic food.

12th. The most natural condition of matter is evidently that
of chemical compounds, i. e., the mineral kingdom. Mattel-
separated from force would exist, of course, only as elementary
matter or on the first plane; but united with force, it is
thereby raised into the second plane and continues to exist
most naturally there. The third plant is supplied from the
second, and the fourth from the third. Thus it is evident that
the quantity of matter is greatest on the second and least on
. he tourth plane. Thus nature may be likened to* a pyramid, of
which the mineral kingdom forms the base and the animal
lorn the apex. The absolute necessity of this arrange-
ment on the principle of the conservation of force may be thus
expressed. Matte r, force and energy are related to one another
in physical and organic science somewhat in the same manner
as matte \ velocity and momentum in mechanics. The whole
energy remaining ' constant, the greater the intensity of the

I860.] The Adulteration of 613

force (the elevation in the Bcale of existence) tlio

quantity of matter. Thus necessarily results wha I
called the pyramid of nature, upon which organic forces work
upwards and physical and chemica inwards.

13th. As the matter of organisms is not created by th<
but is only so much matter withdrawn, borrow ere,

tVoni the common fund of matter, to be restored at death ; so
also organic forces cannol be created by organism?, but must
be regarded as bo much force abstracted from the common
fund offorce, to be again restored, the whole of it, at death.*
It', then, vital force is only transformed physical force, is it not
possible, it will be asked, that physical forces may gene]
organisms <? novo f Do not the views presented above, sup-
port the doctrines of t% equivocal generation," and of the oi
nal creation of species by physical forces? I answer that the
question of the origination of species is left exactly where it
was found and where it must always remain, viz., utterly be-
yond the limits of human science. But although we can
never .hope by the light of science to know how organisms
originated, still all that we do know of the laws of the organic
ana inorganic world seem to negative the idea that physical
or chemical forces acting upon inorganic matter can produce
them. Vital force is transformed physical force, true, but the
necessary men him of this transformation is an organi
fabric ; the necessary condition of the existence of vital force
is therefore the previous existence oi an organism. As the
existence of physical forces cannot even be conceived without
the previous existence of matter as its necessary substrai
so the existence of vital force is inconceivable without the
previous existence of an organized structure as its necess
py substratum. In the words of Dr. Carpenter, "It is tjie
speciality of the material substratum, thus furnishing
medium or instrument of the metamorphosis which esfabu
and must ever maintain a well marked boundary line between
physical and vital forces. Starting with the abstract notion of
force as emanating at once from the Divine will, we might
say that this force, operating through inorganic mailer, mani-
fests itself as electricity, magnetism, li
affinity and mechanical motion ; but that when directed
through organized structures the opera

growth, development and chemico-vital transform

The Adulteration of Tea, Dr. Eassall has d< large

quantities of the faeces of the silk worm in an inferior quality
of tea. ^^

*Carpcnter, Phil. Trans. ISoO. p. 755.

614 Blood -hit in (j in Disease. [August

Bh \od- Letting in Disease. Dr. Mak kea m .

The author, apologizing iov the wideness of the subject,
drew u complete distinction between the effects of local de-
traction of blood from an inflamed part, and the effects of

venesection upon it. Local abstraction of blood, as by
leeches applied to an inflamed joint, generally reduces the
chief characteristics of the inflammation the pain, the heat,
the redness and swelling. But venesection has no such
influence over those inflamed parts, nor any influence at all,
except such as is always manifested when large quantities
of blood are taken. Now, if these facts be true of external
inflammation, he urges they must, by strict analogy, be
true of internal inflammations, and, therefore, local ab-
straction of blood is useful in all those cases of internal
inflammation in which there is a distinct vascular connexion
between the skin and the inflamed part beneath it, as, for
instance, in pleuritis and peritonitis. He contends, how-
ever, from what we see of its action in external inflamma-
tion, that it has no beneficial influence over internal
inflammations. How comes it, then, that the wisest of our
profession have in all ages deemed the remedy so useful in
all such internal inflammations ? Are we to believe they
have all been mistaken ? The author answers this in a
decided negative, and thus solves the difficulty. He calls
attention to the fact, that the chief (and only) battle-field in
which the blood-letting controversy has ever been fought, is
pneumonia. This, then, is the disease in which the benefits
of bleeding must have been most beneficially exemplified,
and the practice may have been right, though the theory
may have been wrong. Men thought that bleeding had a
directly beneficial influence over the progress of the local
inflammation in the lung; but it was not so; it simply
relieved the pulmonary and the cardiac congestion, which
necessarily arises, in a greatei or less degre, as a complica-
tion of pneumonia. This is the only relief it gives ; it frees
the partially arrested pulmonary and cardiac circulation,
and gives intense relief. Its benefits, therefore, are great
and immediate, and its dangers all lie in the future. The
greater the extent of the inflammation, the greater the
asphyxiating congestion, and the more urgent the necessity
for venesection; but, unfortunately, the greater also is the
danger of the practice. Recollect, the lungs are the chief
blood-making organs of the body, and this all-important
function is arrested in proportion to the extent of the

1 860.] Physiology of Digestion. 6 i

inflammation. The loss of blood is, therefore, under such
circumstances, an irreparable loss. He ridicules the fear
which many have of large losses of blood, and asserts t]
the body will Lose such with, mpunity, provided the Lui
remain unaffected by disease i. e., so long as the In
can make fresh blood from the food to supply the wear and
tear o{' the tissues. As a striking proof of this fact,
instanced the large haemorrhage borne by women in child-
bed by fever patients with abdominal symptoms. As a
corrollary of his views of the indirect uses of venes*
follows that it is an excellent remedy in all those disea
whatever their nature, which occasion a congestive condi-
tion ot' heart and lungs, as in pneumonia ; and he instanced
diseases of the heart, peritonitis, and injuries of the head, m
cases in which this condition of the pulmonary circulation
obtains, and which require venesection. The author con-
cluded by stating, that if his views of the effects of venesec-
tion are accepted viz., that it has no beneficial influence
over the inflammation per se, but only in those cases in
which pulmonary and cardiac congestion arises, it must
generally follow that a very different signification from
that generally adopted, must he attached to the remedy.
It also follows, he thinks, that the remedy is now-a-days
much less frequently resorted to than sane therapeutics
require. The change of type-of-disease theory in no way
affects the position he here assumes as to the uses of bleed-
ing. Whether that theory he true or false, the action oi
bleeding in disease, be it good or be it bad, must be phy-
siologically1 the same. That theory can only affect the
necessity or otherwise of our resorting to the remedy in
given cases ; it cannot alter its mode of action. Tie there-
fore thinks the discussion unnecessary. London Lana t.

On the Physiology of Digestion.

Professor Busch, of Bonn, has had the opporunity of
making experiments on digestion upon a woman who had
been tossed by a bull, and presented, in consequence of the
accident, a fistulous opening communication with the small
intestines. The fistula was so complete that the bowel was
divided in two perfectly distinct halves. The upper por-
tion consisted of the stomach, the duodenum, and of a pro-
bably minute piece of small intestine; the lower portion
was composed of the remaining part of the small intestine,

616 Physiology of Digestion. [August,

the colon and rectum. Through the upper half, the food
introduced into the stomach, as well as the digestive fluids
of the latter organ, the liver and the pancreas, escaped, no
part of them finding their way into the lower half. This
state of things was therefore favorable to the study of the
action of the stomach, of the biliary and pancreatic secre-
tions, and also of intestinal secretions independently of the
liquids just named.

One of the first effects of the pathological state of this
woman was a considerable loss of flesh, as observed when
she came into the hospital six weeks after the accident.
Her appetite was, however, insatiable, though she was as
weak as those animals in whom artificial fistula? are made.
She was also very drowsy and cold ; but this low tempera-
ture was merely objective, for a thermometer intioduced
into the intestine marked a normal heat. All these symp-
toms disappeared when the patient recovered a little
strength, in consequence of a generous diet.

She used to swallow an enormous quantity of food with-
out feeling satisfied ; but by thus eating largely she felt
better, though still hungry. When the stomach was empty
she felt ill! The woman was so thin that the coils of intes-
tines could be seen through the parietes of the abdomen ;
and it was observed that their peristalic movements were
as energetic as those of that portion of the intestine situated
above the fistula and open to view.

As the intestinal secretion of juice was perfectly pure and
tnmixei with any chyme, which latter all escaped by the
fistula, a good opportunity was offered fur studying the
nature of that juice. Professor Busch found the quantity
always small, and tried its effects upon protein compounds,
starch and cane-sugar, these being the first experiments of
the kind ever made. The patient was at the same time fed
by the introduction into the lower part of the intestine,
through the fistula, of beef tea, beer, soups with flour,
meat, hard-boiled eggs. a.'. Soon arter these injections
were resorted to, she had numerous stools, a circumstance
which had not been observed since the accident. Tin;
The evacuations had a well-marked smell of putrefaction,
without any undigested portions of meat or hard-boiled
^^s being noticed in them ; this being a clear proof that
the intestinal juice acted as a Bolvent upon the food passing
through the canal.

M. Busch used to wrap the various substances introduced
in a piece of muslin, after having carefully weighed them.

I860.] Physiology of D 617

in order to observe the action of the intestinal juice. Ee
noticed that it was principally apon starch thai this juice
exerted an energetic Bolvent pow<

An interesting point was to find out what would become
of fatty matter without the assistance of bile ^v pancreatic
juice. According bo expectation, fatty substances pai
without being absorbed, or at leapt but a very small quart
titv of them disappeared.

ML Busch also examined the Btate of the substances
-which escaped by the upper portion namely, those which
had been subjected to the action of saliva, the gastric juice,
bile and the pancreatic juice. A very extraordinary fact
observed, was the rapidity with which the alimentary sub-
stances escaped. In from fifteen to thirty minutes after the
ingestion of the l'ood by the mouth, it was observed to
escape by the fistula ; hard-boiled eggs appeared in from
twenty to twenty-six and thirty-five minutes ; cabbage took
from fifteen to nineteen minutes : meat from twenty to
thirty minutes ; potatoes fifteen minutes. When the meal
was plentiful, complete digestion required from three to
four minutes.

The substances which escaped by the upper end of the
divided canal, seemed at first sight to have undergone but
little change ; they were, however, considerably softened.
and the meat presented both longitudinal and transverse
cracks or slits. M. Busch thinks that the fluid in which
these substances were suspended contained no longer any
saliva.

We add a lew of the propositions which the author con-
siders as proved by the experiments above enumerated:

1. The peristaltic movements of the intestines are as
vigorous when the bowels are covered by skin as when they
are exposed to the air; they withstand the pressure of :,
column of water two feet high.

2. The intestinal tube has periods of rest and motion.
The intestinal juice is secreted in small quantity; its

reaction is always alkaline; and it contains, on an average,
")-47 per cent, of solid matter.

4. It decomposes starch and protein compounds.

5. It changes starch into grape-sugar.

0. It dec a protein compounds with the phenomena

of putreiaetion.

7. It .Iocs not change cane-sugar into grape sugar.

. Cane-sugar, when wholly absorbed, does not re-appear
in the urine.

618 Two Cases of Tracheotomy \ [August,

9. Fat which has not. been brought in contact with the
bile or pancreatic juice, IS cither not absorbed, or, if so, in
in very small quantities.

10. The first portions of the food introduced into the
stomach reach the first third of the small intestine, on an
average, in from fifteen to thirty minul

11. Cane Sugar held in solution disappears almost entirely
at the beginning of the intestinal canal; any such cane
sugar which reaches the small intestine is changed into
grape-sugar.

12. Unboiled wlpte-of-egg is absorbed in the stomach or
the first part of the intestine; the portion which goes be-
yond has not undergone any change.

13. Grum is not changed into sugar; it passes into the
intestine without alteration.

14. Gelatine becomes dissolved, and loses the faculty of
coagulation.

15. Traces of casein in solution are found in the intestine
after the ingestion of milk.

16. Fat forms an emulsion with the fluids which find
their way into the small intestine, when these fluids have
an alkaline reaction; the emulsion is incomplete when they
are acid.

17. The mixture of juices in the small intestine has a
digestive action on protein compounds.

18. The minimum of the digestive juices, which reach
the upper part of the small intestine in twenty-four hours,
weighs more than one-seventeenth of the whole body.
Archiv. far Path. HeilL <f Gaz. Med de Paris.

Two Cases of Tracheotomy for the Removal of a Foreign Bodi
from the Trachea.

Case I. August 11, 1858, I was called to visit a child o*
Mr. Inman, about two years old, who had, it was supposed,
on the day before got a watermelon-seed into the air-pas-
sages. On the following day I visited the patient, win
lived at a distance of about twenty -live miles. I found, oi
arriving, that she was about her play as usual. Whei
quiet, there was very little disturbance. A little exercise at
play, however, produced shortness of breath and wheezim
respiration, which could be distinctly heard at some dis
tance. There was no difference in the respiratory murmui
on the two sides of the chest. There had been but little

I860.] Two Casi s f Tracheotomy. 619

bough. The mother informed me that, while playing with
Borne watermelon seeds, Bhe was suddenly seized with greal
dyspnoea and coughing, which lasted for half an hour, and
that during the paroxysm the face was livid. 'As it wa
late in the evening when 1 arrived, no interference was pro-
posed until the following morning. The child slept well
through the night. I advised tracheotomy, which after
some hesitation on the part of the parents, was assented to.
Having thoroughly etherized the patient, I opened the
trachea in the usual manner. A watermelon-seed was im-
mediately coughed out with considerable force. The wound
healed rapidly, scarcely abridging the amusements or 6on-
venience of the patient. Dr. A. Newman, of Lawrence,
Kan

Case IT. On Saturday, tlic seventh of January last, hap-
pening to be in the neighborhood, I was called in to see a
child of Nathan Hackett, a boy about three years of age,
who, 1 was told, was suffering from a foreign body in the
trachea, or in. one of the bronchi. I found him sitting in
his mother's arms, emaciated, and in a very feeble condi-
tion, not being able to walk a step, or even stand. The
circumstances, as related to me, were as follows:

At about the middle of last October, while amusing him-
self with his sister about the house, he got at some " burnt
coffee " which had been set away to cool, and, crying with
his mouth full, accidentally drew into the air passages one
of the grains as was supposed at the time which threw
him into violent paroxysms of coughing and choking,
accompanied by the usual phenomena attending the presence
of a foreign body in the larynx and trachea. After a short
time, however, he got easier, and in a few days was about
his play as usual, though still suffering more or less from
cough, and a peculiar wheezing when at play. Nearly two
months thus passed away, during which time there was
considerable failing of the general health. About the
month of December, he became worse, and the family phy-
sician was called, who pronounced his disease pneumonia.
This lasted about two weeks, and was said to have been
very severe.

On the seventh of January, as before stated, the case first
came under my observation, when I made a careful exami-
nation of the chesl by auscultation and percussion. The
lungs appeared healthy excepting the lower two-thirds of
the right, on its anterior aspect, where there was almost
entire absence of the respiratory murmur, without dulness

320 Tv:o Cases of Tracheotomy. [August.

on percussion, save over a small space just beneath the]
fourth rib. At this point a blowing sound eould he dis-
tinctly heard, which proceeded, I had no doubt, from sonic
obstruction in the right bronchus or some of its subdivisions.!
After expressing my convictions touching the ease, I took]
my leave.

The next day (Sunday) at about two o'clock, P. M., I was1
summoned in haste, and found Dr. Barker, the family phy-
sician, in attendance the case having assumed a much
more serious and alarming aspect. The child was thrown
into the most violent paryoxysms of coughing, of a peculiar
ringing and croupy nature, together with most distressing
efforts to breathe : in short, it seemed that life could be
maintained but a little while longer. These alarming
symptoms, however, lasted but a short time, when suddenly
respiration became easier, and the patient gradually sank
into a quiet slumber. It was now dark, and I left, pro-
mising to return the next morning.

Monday, January 9th. Returned in company with Dr.
Albert Xewman, of this eity ; found Dr. B. present, and the
patient much worse than when I left him he having had I
two or three severe paryoxysms during the night : cough
frequent and croupy; respiration labored and difficult:
voice hoarse ; pulse frequent and feeble : lips livid and skin
cool ; in short, all the symptoms indicative of a speedy un-
favorable termination. Tracheotomy was urged as afford-
ing the only chance of recovery, and was performed at
about V2 o'clock, Drs. Xewman and Barker assisting. We
attempted to produce anaesthesia with a mixture of one pari
of chloroform to three of sulphuric ether, but owing to
the dyspnoea, tins, not acting favorably, was abandoned.
Upon opening the trachea, a violent paroxysm of coughing
ejected first a tcaspoonful or more of muco-purulent matter,
followed by a whole "coffee-grain" of ordinary size, appar-
ently in as good state of preservation as when tak< n in.

This wa.s followed with a very little relief, so extensive
and scriou> was the disease oi' the larynx and trachea left
behind.

Tuesday. 5 o'clock, A. M. Dyspnoea and lividity in-
creased ; all the symptoms of croup, in its last stages, pre-
sent. I now hastily constructed two hooks by bending two
pieces of common iron wire into suitable shape, which I
applied to the wound, and bending them round on each
side, secured them on the back of the neck, and in this
manner very effectually and safely established respiration

i860.] i /' Tracheotomy. 621

through this new channel, it being now almost entirely cut
off by the larynx. The breathing immediately became free
and easy, and all the symptoms rapidly improved.

L2 o'clock Patient doing well : in a gentle and quiel
Bleep, breathing easily and freely, 40 times per minute.
Blood now perfectly aerated ; pulse L32. An attendant is
constantly sitting by, with a small piece of sponge to keep
the opening in the trachea clear of mucus which is ejected
in the act of coughing. One grain of calomel was ordered
to be taken every tour hours, and beef tea from time to
Erne.

Wednesday, 11th. Had a comfortable night; slept at
one time lour hours ; has paroxysms oi coughing every two
or three hour.-. The mucus coughed during- some of the
paroxysms lias been a little bloody. The treatment of yes-
terday to be continued.

12th. Pulse this morning 100, regular and full ; respira-
tion 40. and easy as through the natural channel. At
about 8 o'clock, patient became quite restless and uneasy,
indicating the cause as well as well as he could (not being
able to speak) to be pain in the bowels, which were hard
and tympanitic. Hot fomentations were applied to the
bowels, and stimulating anodynes taken by the mouth ; but,
notwithstanding our best endeavors, there was more or less
Buffering for some two hours, when, after several alvine
discharges, it passed away and gave us no further trouble.
This afternoon, considerable irritation and much more
swelling than usual about the wound in the trachea, which
caused some narrowing, and consequently more or less
difficulty of breathing ; but by changing the position of the
hooks, and carefully removing some lumps of dried mucus
adhering to the bottom and sides of the opening, the respi-
ration was relieved, and the irritation and swelling soon
began to subside. The pulse at this time rose to 120.
Calomel to be omitted.

loth. Patient comfortable ; wound looks better, but no
air yet passes by the glottis; any' attempt to close the arti-
ficial opening causes intense suffering. Pulse 96 to 104.

Removed hooks from trachea, which remains open with-
out them. Patient breathes a little through the nostrils,
and, on closing the wound, is able to articulate a word or
two, for the first time since Tuesday.

loth. Doing finely; calling often for food. Takes beef
tea and broth with crackers, also a little milk. Respiration
nearly re-established ; voice yet hoarse, and cough rather
ti&ht and ringing.

G22 ( lot of Blood in the Pons Varolii [August.

17tli. Closed wound with adhesive strips, when respira-
tion was easily performed through the glottis.

20th. Wound nearly healed ; appetite good, and patient
gaining strength rapidly; some irritation and cough re-
main. Dismissed the case, but have heard from patient
from time to time up to the present date, (March 9th,)
when he is in perfect health.

It should he home in mind that this case was treated
under the most unfavorable circumstances. On the night
after the operation, the weather turned suddenly cold and
windy. Our patient was in a "log cabin" with hut one
room, in the heart of Kansas Territory, which, though as
comfortable as Kansas farm-houses generally, would hardly
compare with the poorest of Xew England tenements. The
cold wind whistled through its many crevices, and with the
hottest fire that could be kept, one could not possibly keep
both sides warm at the same time. Hence, anything like
a uniform temperature was out of the question. Xo
tracheal tube could be obtained, but the apparatus used,
though not as elegant, was, I think, quite as convenient and
efficient ; and were I to treat another case of the same kind,
I believe I should use the hooks instead of the canula,
though each were alike at hand. L. C. Tolles, of Lavm
Kansas.

Lawrence, March 14th, 1860.

Pathological Society of London. Clot of Blood in the Pons
Varolii. Mr. Fergusson in the Chair.

The following history was given : On the night of Oct.
21, Mr. AV. left his mother, aged 66, in her usual health,
alone, cleaning her house. On his return in an hour he
found her lying on the floor insensible, with a large quan-
tity of green bilious matter beside her, which she had
vomited. She vomited also after his return. She was
carried to bed. She did not move during the night. She
had had more than one severe bilious attack, of which this
was supposed to be a repetition. The following morning
Mr. Nunneley saw her. She was lying in an easy position,
with the countenance calm and natural, as though in a very
dee]) sleep, breathing regularly, quietly and naturally. The
pupils were both equally and completely contracted. They
were also insensible to light, and continued so during the
whole time she lived. It was impossible to rouse her.

I860.] Typhus F< 628

Both sides of the body were equally powerless. Only on
taking a small portion of skin between the nails and using
piuch force, did she give an} signs of perception. In a
basin beside the bed was a quantity oi green bilious matter
which she had thrown up the previous night. The head
was rather warm, other parts of the body natural. She
lived sixty-six hours after the seizure, without any altera-
tion in the symptoms, except that the entire surface of the
body became hot. On examination o\' the head forty-eight
hours after death, the scalp was [\)uu(\ dry and bloodless.
The veins of the dura mater full. The blood-vessels of the
pia mater wore congested. The cerebrum and cerebellum
were firm and healthy, except dark from congestion. In
the centre of the pons varolii, perhaps rather more to the
left than the right side, "but not showing itself upon either
of the surfaces, was a clot of blood, filling a broken-down
space of the size of half a walnut. Medical Times.

Pathology und Therapt "tics of Typhus Fever.

The No. of the Glasgow Medical Journal for January,
1860, contains an interesting paper on this subject by Dr.
,)o. Bell, one of the physicians to the Glasgow Infirmary.
The following are his concluding propositions :

1. That in numerous cases of typhus, about the fifth,
sixth or seventh day of the attack, the impulse and systolic
sound of the heart becomes feeble and ultimately imper-
ceptible.

2. That these symptoms indicate a morbid alteration in
the structure of the muscular tissue of the heart, especially
in the walls of the left ventricle.

3. That this alteration resembles the usual changes which
result from congestion and inflammation of the muscular
structure.

4. That the nature of this pathological change requires
further examination and research, because the evidences
on which the doctrine of its non-inflammatory origin rest,
are not conclusive ; the circumstances on which Louis and
Stokes have placed reliance, not being uniformly present.

5. That the beneficial influence of stimulants docs not
prove the non-inflammatory nature of the morbid change,
because in asthenic inflammatian a stimulating treatment is
always necessary.

6. That whether or not the pathological alteration be

624 Tubercular Consumption. [August,

owing to inflammation, the softening must be regarded as
one of the secondary effects of typhus.

7. That the proper treatment is to maintain the action of

the heart by stimulants.

8. Thai in cases of cerebral and pulmonary disturbance
arising in connection with the symptoms of cardiac soften-
ing, ji stimulating plan of treatment is indicated.

9. That the presence or absence of the physical symptoms
diagnostic of softened heart, may be relied on as affording
trustworthy evidence, by which the sthenic or asthenic
nature of these cerebral and pulmonary affections can be
determined.

From these propositions, it follows as a corollary, that it
is the duty of the physician to devote the strictest attention
to the action of the heart, especially as regards its impulse
and sounds, throughout the course of every case of typhus.
Am. Jour. Med. JSci.

(hi the Importance of the Functions of the Skin, in the Pathology
and Treatment of Tubercular Consumption. By A. Toub
min, Esq., (St. Leonard's.)

The author commenced by offering as the proximate
cause of tubercle in all cases, the breathing of impure air,
and air in so small a quantity as to render it impure, espe-
cially during the night. Wherever this was the continuous
state of existence, the result must be a deficiency of oxygen
in the red corpuscles of the blood, and as the consequence
of this, the deposition of plastic fibrin e in an incomplete
state of oxygenation, and therefore of organization, and
thus incapable of being ultimately got rid of by change of
matter. It consequently remained as an extraneous adven-
titious substance in the system offering to the observe]" all
the characteristics of tubercle.

To explain the discrepancy which appears in the rich
(who have no want of oxygen in the air the}7 breathe,) being
equally subject to phthisis with the poor, he drew attention
to the importance of the respiratory functions of the skin,
as proved by the almost instant death that occurs on closing
the cutaneous pores by artificial means, as by varnishing
and gilding the skin of rabbits and other animals ; and he
observed that, in consequence of the coldness of our climate
and other causes, the better classes of society were certainly
not in the habit, of making the washing the whole surface

L860.] % Tubercular Consumption. >_!.">

of the body a part of their daily toilet ; and consequently
that the exuvise momentarily forming od the surface of the
skin the joint production of the sordes from within, com-
bined with the debris oi the cuticle soon became more or
less impervious, although the individual might he in the
habit of changing his Linen daily.

As an illustration of this state of skin, the author referred
to acne so frequently seen on the face, as being in reality
the general state o\' the skin of a Large proportion of society
especially in the earlier periods of Life, when phthisis gen-
erally shows itself. The free entrance of air, as well as the
exit of carbonid acid through the skin, beingthus impeded,
the same imperfect oxygenation of the blood ensued, as was
produced in the poorer classes, by breathing mephitic
air. For the removal of this state of the skin, the
only means of cure were to he found in the instituting a
fall and five diaphoresis by the aid of artificial heat ; the
result of which in first softening and then expelling large
quantities of inspissated sebaceous matter, after the surface
of the body had keen washed clean with soap and water,
was most surprising.

The use of hot air bath, as a therapeutic agent, was no
innovation on the established practice of the profession, as
it was the mode of bathing practiced by Hippocrates.
Galen and Celsus ; and the universality of the practice was
shown by the tact that the remains of such baths had been
found in every colony of the Roman empire.

If tubercle be imperfectly organized fibrine, then it
should be looked upon as a blood disease; and, seeing
it is found in other parts besides the lungs, without
destroying life, its deposition in them should not be con-
sidered as disease either of the lungs or air-tubes, but as an
accidental circumstance, killing mechanically, by its ulcera-
tion extending to the surrounding lung tissue. The author
called in question the propriety of sending consumptive
patients abroad to a warm climate during any stage of the
disease; as although in the later stages of the complaint,
when the air tubes sympathized with the tubercular irrita-
tion, a warm atmosphere seemed more congenial to the
patient's feelings: still in the earlier stages, when a cure
was practicable, the breathing the open air of our winter,
(at least on the south side of the island,) was most important.
lie instanced, as proof that the breathing cold air did not
cause the complaint, the fact that tubercular consumption
is not to be met with in high northern latitudes.
40

626 Chhrodyne. [August,

The treatment of phthisis was considered under its

hygienic and medical aspects. CFnderthe former, and par-
ticularly in the earlier stages, the patient was recommended

bo live in a high, dry and marine atmosphere, on the
Downs, rather than under them; to be as much as possible

in the open air; to use all sorts of athletic exercises, (avoid-
ing such as accelerate the pulmonic circulation) suitable to
the strength and sex of the patients, by which a more rapid
change of matter is effected, together with absorption of
already deposited tubercle : as well as the deposition of
naore healthy L <., of more highly organized matter.
Medically, the treatment was comprised in a few short
aphorisms, which were : 1. The keeping the functions of
the skin in healthy action by means of the hot air bath.
'1. The annointing the whole surface of the skin dailv with
some oleaginous matter. 3. The keeping a local ulceration
always patent by means of an issue or seton; and 4. The
use of some one or more of a large variety of tonic and
antiseptic medicines: all admirable adjuvants in improving
the general health, (if selected in conformity with the func-
tion most sympathising with and reacting on the disease,)
but powerless in arresting the specific lesion in ipiestion,
without the previous " Open Sesame," of the hot air bath,
followed by aspersion of cold or tepid water. Brid Med.
Journal.

Ch hrodyn e Hi* A > i // .

Chlorodyne was invented in the year 184S, by Dr.
Browne, while officiating in his medical capacity duringthe
prevalence of cholera and diarrhoea among the English
troops in India, and was introduced to the notice of the
faculty in England by him as "a combination of perchloric
acid with a new alkaloid."

Preparation. From Dr. Ogden's analysis, it appears to
be composed as follows: "Chloroform, six drams ; tincture
of capsicum, half a dram ; oil of peppermint, three drops ;
muriate of morphia, eight grains: perchloric acid, twenty
drops; Sheele's hydrocianic acid, twelve drops: tincture of
Indian hemp, one dram : treacle, one dram. Dissolve the
morphia in the perchloric acid : then add the tincture of
hemp, capsicum, peppermint ami chloroform, and lastly,
the treacle and prussic acid."

I860.] Ghlorodyne. ;^7

Properties. Chlorodyne is a volatile Liquid, possessing
pungent Bmell and taste. It is soluble in alcohol, hut
insoluble in water: but may be conveniently administered
in that liquid by suspending it in a little mucilage. The

alkalies and alkaline salts decompose it. In color it is dark
brown ; and in weight, it is equal to twice its hulk of water.
If i> anodyne, sedative, diaphoretic, astringent, antispas-
modic, diuretic, etc Unlike the preparations ^\' opium it
does not produce headache, giddiness, prostration of
strength, nor stupor; but in large doses, and for a consti
pated state of the bowels, it is liable to produce nausea,
which, in the former case, may he relieved by a small dose
of sal volatile, and in the latter by recourse to aperients.

77(( /<(/>< utic Kfn cts. The changes produced by this prepa-
ration on the system, are 1st, a gentle heat at the stomach,
followed by a general glow and total absence of pain ; 2d,
a calm and refreshing sleep; and 3d, an increase in the
pulse from a small, weak, thready, hurried or hounding one
to a full, yielding, elastic, natural sort of one, decreasing in
frequency of heats as well as resistance, to a healthy condi-
tion." ( )f its powers in the cure of consumption, Dr. Stone-
house remarks: "The cases (among others) in which 1
have employed it, have been twelve cases of phthisis ; eight
of these patients had been examined by other medical men,
and had heen regarded as genuine cases of consumption, so
that the nature of the disease does not rest upon my testi-
mony alone. Ihey were all well-marked cases; for I do
not mention several others in an incipient stage. Two of
the cases were in the last stage i. e., cavities had formed
in the lungs; two others were bordering upon this stage.
i The remaining eight were in the second stage, that of
softening ; in live of these haemoptysis was a prominent
symptom. All these cases have done or are doing exceed-
ingly well. Five of them have quite recovered; the others,
with one exception, are in a fair way towards recovery."

Doses. The dose of this preparation must he regulated
according to the nature of the. complaint. As an anodyne
for febrile, inflammatory or neuralgic affections, the dose is
from ten to thirty drops; diaphoretic in eases of coughs,
cold, etc., ten to twenty drops; sedative in consumption,
etc., twenty to fifty drops; antispasmodic in gout, rheuma-
tism, etc., twenty to forty drops; astringent in cholera,
diarrhoea, etc., fifty to one hundred drops. It is best ad-
ministered on lump sugar, and given at intervals from
every half hour to every four hours. Chemist and Druggist,

628 Editorial [August,

EDITORIAL AND MISCELLANEOUS.

Caffeine in Opium-Coma. The Second Case of the Injection of
Caffeine, by the Rectum, in Extreme Narcotism of Opium. By
Henry F. Campbell.

In the May number of the Southern Medical and Surgical Jour-
nal, of the present year, we reported the particulars of a case of Opium-
Coma, of a very grave character, in which twenty grains of Caffeine,
injected into the rectum, produced the most surprising and satisfactory
results. At the close of that former paper, we expressed the wish that
some member of the Profession would repeat the treatment applied by
us in that case, and either confirm or disprove our confidence in the
remedy. The various medical journals of the country have commented
upon the paper, and have generally approved the rationality of the
measure, but, as yet, we have not been gratified by observing the report
of any second trial of Caffeine under the circumstances, or any additional
evidence in support of our favorable conviction in regard to the antidote.
A case which occurred to us on the 10th of July instant, affords us the
privilege of being able to report the second case of the application of
Caffeine for Opium-Coma. Although the following case was not attended
by the same happy results as that reported in our May number, we
think that the details of the phenomena, so far from weakening our con-
fidence in the remedy, will go far to confirm it.

July 10th, 1800, 3 o'clock, P. M., called in haste to the U.S. Hotel, in
this city, to visit a gentleman, said to have been found in a dying condition
in one of the rooms. The patient was Mr. Moses Pike, a Jew, aged about
28 years, of good constitution apparently, and well developed corporeally.
( )n entering the room, we found him in the following condition : He was
entirely unconscious ; face of a dark purple hue ; hands and feet also
purple from congestion ; nails on fingers and toes of an indigo color.
There were also patches of venous congestion, presenting a darkened hue
all over the surface. His respiration was fearfully slow when counted,
not quite four to the minute. The attendants were slapping and
shaking him each time between the inspirations, to excite him to breathe.
\\\< respiration seemed greatly obstructed by the accumulation of mucus.
Palse very feeble, and about 100 per minute. The muscular system

l.siiO.] Editorial 629

was completely relaxed, bo that bis bead would fall about by its own
weight, ami his arms ami legs obeyed only the influence of gravity.

[mmediately on our arrival, a paper was found, on which the unfortu-
nate man had recorded the fact that he had taken laudanum at I -o'clock
the night previous, with the intention of Belf-destruction. Two empty
vials, labelled laudanum, one of 2 ounce capacity, the other of 1 ounce,
was found on the table. One of these vials had the neck knocked off,
apparently with the view of opening it hastily and some of the lauda-
num had escaped so as to leave a stain upon the label. It is probable,
therefore, that the entire three ounces had not been taken. Once or
twice during the morning, the servant stated, that he had approached and
tried the door, with the view of entcriug, but had desisted when he heard
the occupant snoring deeply, as he did not wish to disturb him. Some
what after 3 o'clock, P. M., the servant became alarmed and looked into
the room through the transom-light from a chair, and observing his con-
dition, called for assistance.

From the above circumstances, as well as from the written statement
of the patient, it was highly probable that near 3 ounces of laudanum
had been in his system nearly fifteen hours that so large an amount
had not produced death in so long a time, is truly unaccountable.

The condition of the patient, the necessity of constantly provoking
respiration, and also the little probability that any laudanum yet remained
in the stomach, caused us to abandon the idea of using the stomach-pump.
Emetics of course were out of the question, and we at once resorted to
the application of ice to the scalp, and pouring ice-water, from a distance,
upon the head, while we sent for a drachm of Caffeine, and a small
syringe. As soon as these arrived, we poured out in the palm of the
hand what we supposed to be about twenty grains of Caffeine, dissolved
it in two ounces of cold water, and introduced it into the rectum by
means of the syringe. The syringe being small, three applications were
made at short intervals. The whole of the alkaloid was not dissolved.
By an estimate made subsequently, calculating what had been lost, the
patient had taken near twenty-five grains of Caffeine in the three
applications.

The Caffeine was administered at twenty minutes before four o'clock,
at which time, as we have said, the respiration of the patient was
scarcely four to the minute, and constant efforts were necessary, in the
way of slapping and shaking to provoke him to inspire. At fifteen
minutes after four, (35 minutes after the injection) his respiration was
found to be effected with less effort and more regularly and, on count-

H30 Editorial [Attguat*

ing it by the watch, it numbered eight to the minute. The skin, even
now, began to present less of the cerulean tint. In one hour after, the
respiration had risen to twelve, and shortly rose to sixteen to the minute,
when the skin was nearly of the natural hue, though the nails on both
hands and feet remained still of a purplish cast.

Slight spasmodic movements in the fingers were now observed, and
also some occasional subsultus in the muscles of the forearm the under
lip, which before was hanging, now became elevated and slightly com-
pressed against the teeth. When the hand of the patient was held, and
an attempt made to extend the arm at the elbow, decided muscular resis-
tance was observed. The lid of the left eve was also observed to be
raised and let down rapidly once or twice.

The pulse had now become full and somewhat resisting, and the action
of the heart, as observed at the chest, tumultuous. On being raised, the
patient, once, made a noise slightly resembling a groan, but, from the
beginning to the end, he did not once manifest the least consciousness.

For a short time after the improvement in the respiration began, the
mucous rale seemed somewhat to diminish, and his breathing, were it not
for a certain jerking, resembled very nearly a man in deep, healthy
sleep. The rale now, however, (^ past 7 o'clock) became more and
more obstructive, the gurgling reaching up into the throat and threaten-
ing momentarily to strangle the patient. It was now plain that he could
not survive, and, on turning him upon the right side, a bloody mucus
bubbled out of the nostrils. The number of the respirations was at this
time twenty to the minute, when counted by the watch. The entire
surface of the body was intensely hot and remained so to the time of the
patient's death, which took place at 15 minutes before nine o'clock, P.
M. He seemed to die from the accumulation of the bloody mucus, in
the bronchial tubes and larynx. During the whole time, from the first
moment of our seeing him till the time of his death, the application of
ice was made constantly to the head of the patient, and also mustard
plasters were applied to the spine and to the extremities.

A superficial glance at the foregoing case might perhaps impress the
reader with the conviction that the confidence which we expressed, in our
former report, in Caffeine as an antidote in Opium-Coma, was somewluit
hasty and misplaced. A more deliberate consideration, however, will
remove such an impression. When we reflect on the amount of the
opium taken, the length of time during which the patient had been left
to its toxic influence, and the destructive ravages which had been made
during that time, we certainly, on the other hand, must feel great sur-

L860,] Editorial. -;i

prise at the amount of modification the Caffeine was Been t. produce
under sueh disadvantageous oiroumstances. The respiration, in o space
of time, leas than one hoar, was raised from four to sixteen In the
minute. The color of the >kin, under its influence, was ohanged from an
almost indigo hue, to that of the natural complexion, and the muscular
relaxation was replaced by n fair degree of tonicity accompanied h\
occasional twitohings. The mode of death, too, wan not such as iaseen
in the demise from the unmodified effects of opium, when the respiration

becomes gradually slower and slower till it ceases altogether, but at the
time of our patient's death, his respiration numbered twenty per minute,
and he died apparently drowned by the accumulation of the viscid
mucus in the air-passages, doubtless the result of the long-enduring pul-
monary congestion occurring previous to the administration of the
Caffeine.

In conelusiou. we feel confident in saying that we feel greatly encour-
aged bv the developments of this second case, and shall use the remedy
hereafter, with even more confidence than before. We again express
the hope that some of our professional brethren will add their published
testimony to ours so as to establish the true amount of value that should
be attached to Caffeine as an antidote in Opium-Coma.

We intend shortly reporting the results of experiments, with the two
drugs, Opium and Caffeine, as made by us, on the lower animals '

Proceedings of tiie American Medic-ax s^ssoccation.
Not being among the privileged number who attended the meeting at
New Haven, we transfer from our valued exchange, the Mart/land and
'Virginia Medical Journal the following Proceedings. The space
occupied by them excludes our Editorial, and much interesting matter.
We must also defer our comments upon certain important measures
adopted by the Association. This last meeting must certainly have been
one of the most interesting since the foundation of the Society :

*In the above case, at no time, did we find it necessary to resort to artificial
respiration. The patient could always be incited to inspire naturally by shak-
ing or pushing against his shoulder- The mode of artificial respiration described
in our own report of the former case, has been supposed by some (our friend.
l>r. E. Bland, of Edgefield) to be identical \\\\k\ that described by Dr. Sylv<
and reported in Braithwaite's Retrospect for 1859. We had not then seen Dr.
Sylvester's method ; we now admit that the mode of procedure is nearly similar
in both, but his involved the horizontal position, -while ours presented the ad-
vantage of being applicable in the sitting posture, where the weight of the
patients body was made subservient in effecting the vacuum to cause the ingress
ot air into the lungs. As we have heretofore promised, we will hereafter give a
full description of both methods, when the reader will be able to recognize the
peculiarities of each.

632 Miscellaneous. [August,

Thirteenth Annual Meeting ofth. American Medical Association.

FIRST DAY.

The Convention met in the College Chapel, and at 11 o'clock was
called to order President Dr. Henry Miller, of Kentucky, in the Chair.

Prof Fisher, of Yale College, opened the Convention with prayer.

Dr. ('has. Hooker moved the Committee on Reception report. J)r.
Knight, as chairman of the committee, made a most felicitous salutatory
to the Convention, and was received with considerable applause. He
spoke ably, and showed the lofty character of such a Convention. His
remarks on the advance in remedial agents, and the progress of medi-
cine, and especially of the art of surgery, were received with marked at-
tention. He reviewed with his remarkable liveliness and interesting
manner the more wonderful improvements, such as the ligature of the
greater arteries, the introduction of anaesthetic agents in the greater
operations, thus relieving that stinging pain and great anguish to which
patients were formerly subjected. He closed by welcoming the profes-
sion here, describing most graphically our city attraction by way of lite-
rary institutions, etc., and welcoming them all to our open homes and
hearts.

Dr. Chas. Hooker then followed in a welcoming address, and was fre-
quently applauded. He spoke as follows :

Mr P resident and Gentlemeyi of the American Medical Associa-
tion : It is with unwonted gratification that the Committee of Arrange-
ments welcome you to the city of New Haven. And we only bespeak
the common feeling of our fellow-citizens in saying that we are delighted
nay proud to receive you as our guests. We feel that any city is
highly honored to become the chosen place of meeting of the American
Medical Association a select delegated national Congress, representa-
tive of forty thousand members of a learned and humane profession. As
a city, we appreciate this honor, and should be ungrateful did we not
receive you with a generous and cordial welcome. You meet, gentle-
men, for a great and noble object for the promotion of a science vitally
linked with the interests of humanity. Your meetings have a most
happy influence in strengthening those ties by which the great fraternity
of medicine are bound in social compact. Another salutary incidental
benefit of your meetings, results from their affoiding an annual period
for relaxation and social enjoyment.

Too many physicians prematurely break down in their career of use-
fulness, in consequence of unremitted and arduous application to their
professional duties ; and many of you now present, whose exhausted
physical and mental energies need recruiting, could hardly have been
drawn away from your routine of toil and care had, but for your sense of
bounden duty to aid in the great object of this Association. "VYe con-
gratulate you, therefore, brethren, on this annual recurrence of our
national medical jubilee. In behalf of the faculty of Yale, we welcome
you to the halls of this ancient seat of learning, in which you are invited
to hold your - and in behalf of the citizens generally of New

Haven, we tender you the hospitalities of out city.

I860.] Miscellaneous.

We hope that to all of you this meeting will be o Boason of pleasant
social intercourse long to be remembered for the many friendships hero
formed; and we trust that the harmony and wisdom of your counsels
will efficiently promote the great benevolent objects of our organization."

The President ordered as the next business the calling of the roll.
This occupied some half an hour, which tho galleries and the Convention
to wme extent used as a recess. 4

Tho whole number of delegates who answered to their names was be-
tween 275 ami .'itHt. When all are present tho whole number of dele-
gates will probably exceed the last figure. Twenty-seven Slates and
tin* District of Columbia are represented in the Convention. There arc
also a few from the United States Navy.

Dr. Charles Hooker here gave notice of the five divisions and their
respective rooms, as follows :

1st, Anatomy and Physiology, President's Lecture Room.

2d, Surgery, Geological Cabinet.

3d, General Medicine, Geological Cabinet.

4th. Chemistry and Materia Mediea, Chemical Laboratory.

5th, Meteorology, Chemical Laboratory.

Dr. .lames Iladley, of Mass., moved that if any surgeons or physicians
from the navy be present, they be invited to take scats on the floor of
the Convention ; carried.

Dr. John Bronson asked if seats had been reserved for the ladies at
tending the Convention with their husbands; also, for ladies in general

Dr. Charles Hooker stated that a committee was formed from the
State and city medical societies to make themselves useful to the ladies
also that the galleries of the college chapel would be open every morning
at S o'clock, and the delegates could be present at college prayers who
so wished. The President stated that the committee on parliamentary
rules were ready to report ; ordered.

Report was read.

Dr. Brodic moved, before the resolutions be acted on, they be printed-

Dr. Cox moved an amendment that 500 copies be printed. Amended
again by the motiou that 1,000 copies be printed.

Here an exciting discussion took place in regard to the necessity of
having them printed, merely for acting upon, and after an indiscriminate
debate urging the T/evalcnce of pet motions and amendments, a motion
to lay tha-=^k,cm'air on the table prevailed by a small majority.

A molion for a recess often minutes was then carried, the object being
to give each State an opportunity to choose its member of the nominating
committee.

At a quarter before one o'clock, the Convention re-assembled, when
the nominating committee was declared.

A motion was made and carried, inviting the Legislature to be prc-
Bent at the opening of the Convention in the afternoon to listen to the
address of the President, as it would have gome reference to medico-
legal topics.

634 Miscellaneous. [Auguat>

AFTERNOON SESSION.

At 3 o'clock the Convention came together, and notwithstanding the
unpleasant weather, the galleries were filled, including quite a number of
ladies.

Convention called to order.

Gov. Buckingham and Lt. Gov. Catlin appeared on the stage, and
were introduced to the Convention amidst applause.

The Secretary, Dr. Bemis, of Kentucky, then gave the names of the
Committee on Credentials.

When the House had become still, President Henry Miller was intro-
duced and delivered his Valedictory Address. Quite a number of the
members of the Legislature were present. Most of it was a bold exposi-
tion of personal opinions regarding the moderate and limited standard of
medical education. We could see, as he advanced his views regarding
preliminary instruction and the duties of Medical Colleges in raising
their standards of requirements, that he had the cordial support of the
Convention by the earnest attention and frequent applause attending his
suggestions.

The Nominating Committee here reported the names of officers for
the Convention, as follows :

V resident Eli Ives, Conn.

Vice Presidents Wilson Jewell, Pa.; A.P. Palmer, Mich.; Joseph
P. Logan, Ga.; I. N. McDowell, Mo.

Secretaries Not reported.

Treasurer Caspar Wistar, Pa.

The various Committees were then appointed to wait upon the differ-
ent grades of officers to the stage.

Several invitations to visit prominent public places and factories of
the city were read and times set apart for such visits. At 5 o'clock,
this (Wednesday) afternoon, the Convention will visit Messrs. G. <fc D.
Cook & Co.'s carriage factory.

Motions were made of acceptance of the invitations, &c,

Motion made to suspend business and receive the officers just elected.
They were received with great and prolonged applause.

President Dr. Ives made a very short address, of which the following
is nearly a verbatim report :

"All he had, all he was, owed to his profession. He loved it. He
had two sons in the profession, also a grandson : and he, like a very
distinguished physician of the present century, could say he would visit
the sick as long as he could go, and when he was unable, he would be
carried to the bedside."

He was followed by first Vice President, Dr. Wilson Jewell, who will
preside over the deliberations of the Convention.

Dr. Davis, of Indiana, offered a series of resolutions to the specific
business of morning and afternoon sessions, as follows :

Resolved ', That the general meetings of the association after this day,
shall be restricted to the morning sessions, and the afternoon sessions,
commencing at 3 o'clock, shall be devoted to the hearing of papers and
discussions in the several sections.

I860.] Miscellaneous. 686

Resolved, That each section shall ohoose its owd officers and make
its own rules of order.

There wew other resolutions of this same series which are not report-
ed, because not finally acted upon. The third one, relative to the refer-
ring of public essays, addresses, iV<\. to their respective Bections, caused
a long and exciting debate, in which Drs. Watson, Reese, Miller and
Palmer figured conspicuously. After the discussion had run over an
hour, without seeming to come to any mutual understanding in the mat-.
ter. a motion to table this section of the resolution was almost unani-
mously carried, with tin1 proviso that Dr. Davis should have an opportu-
nity to revise it, ami at his own time to bring it again before the
Convention.

Dr. Little, of California, was then announced, and, although not a
regular delegate, was invited to a scat on the floor of the Convention,
there being no delegate from California.

A committee on Voluntary Communications was then appointed, viz :
Drs. E. D. Force, of Kentucky ; T. W. Blatchford, of New York; N.
S. Davis, of Illinois; R. LaRoche, of Pennsylvania ; Rochester, of New
York.

At his own request, Dr. LaRoche was excused from serviug on this
committee.

Dr. Ruschenbergcr, of Pennsylvania, was appointed in his stead.

The report of the Treasurer was then called for, read and adopted,
then referred to Committee on Publication.

The Committee on Publication then reported. Report accepted.

Committee on Prize Essays was called on to report, but failed to do
so through absence.

Adjourned.

SECOND DAY WEDNESDAY.

The Convention was called to order by the first Vice-President, Dr.
Wilson Jewell, of Penn.

The minutes of the Convention of yesterday were read and approved.

The President announced that the subscription list for the publication
of the Sydenham Society was on the Secretary's table.

An opportunity was now given for delegates to name physicians from
States not represented, also from the Army and Navy, as members by
invitation.

Dr. Gardner moved that the rules of order be suspended for Dr.
Logan, of Ga., to tender his resignation as Vice-President. Resignation
accepted.

Committee on Education reported Dr. Reese chairman.

This was far the most lengthy and deep-studied report yet made, being
a most able exposition of the necessities of our Medical Colleges. We
hope to give this in full hereafter. He ably supported his argument in
favor of lengthened terms of study, with a less number of lectures per
day four being the maximum.

Dr. Bodie moved that the report and resolutions connected with it be
received and referred to the Committee on Publication. Received.

636 Miscellaneous. [August,

On motion, the House went into a Committee of the Whole on the
resolutions H. P. Askew, M. D., in the Chair.

Dr. McDowell, of Mo., spoke against the first resolution, and immedi-
ately the galleries were densely crowded, and every effort made to get
a sight of the witty and wiry Missourian. Almost every sentence drew
forth roars of laughter. He was loudly cheered and often interrupted by
the repetition of applause.
. Dr. Henry Miller, of Ky., replied.

Dr. Palmer, of Mich., continued the discussion.

Motion made that the whole subject be laid on the table.

Motion made and carried that the committee rise, report progress, and
sit again.

Committee on Medical Literature called upon.

The Committee on Nominations reported that the Convention will
meet at Chicago on the 1st Tuesday in June, 1861. Amendment
offered that it be changed to the 1st Tuesday in May.

Dr. Davis, of Illinois, spoke for the Illinois delegation, urging June as
the proper month furthermore, he welcomed the Convention to the
hospitalities of the citizens of Chicago.

Motion made to change the time to the 2d Tuesday of June. Uncon-
stitutional.

The whole list of officers was not reported yesterday. The Committee
on Nomination here concluded their report, as follows :

In place of third Vice-President, Dr Logan, of Georgia, resigned, Dr
R. D. Arnold, of Georgia.

Secretaries S. G. Hubbard, Conn.; H. A. Johnson, 111.

Committee of Arra?igcments N. S. Davis, G. W. Freer, Dr.
Laski Miller, E. Andrews, H. W. Jones, Thomas Bevan, J. Bloodgood,
all of Illinois.

Prize Essays Daniel Brainard, 111.; D. L. McGugin, Iowa; M. L.
Seaton, Mo.; John Evans, 111., A. S. McArthur, 111.

Committee on Publication. S. G Smith, Penn.; Caspar Wistar,
Penn.; S.* G. Hubbard, Conn.; R. J. Breckenridge, Ky.; Ed. Harts-
horne, Penn.; H. F. Askew, Del.

Dr. Davis, of 111., called for a suspension of the rules, that he might
reintroduce his resolution laid upon the table yesterday. Carried. The
resolution having been revised was reported and carried.

Report of Committee on Prize Essays was called for. Prof. Worth-
ington Hooker, of Conn., Chairman. Three essays had been handed in,
two of which had considerable merit, and showed much research. The
Committee had concluded not to award any prizes this year. Report
accepted.

Moved a suspension of the rules to give Dr. "Wilbur, of New York,
an opportunity to report ihe protest of Dr. Ignatius Langcr, of Iowa,
against the action of the Committee of Arrangements in not accepting
his credentials as a delegate. The President stated he held in his hand
a letter stating that Dr. Langcr had been expelled from the Scott Coun-
ty Medical Society of Iowa, and, therefore, the rules of the Socicty
would not permit his acceptance as a delegate here.

I860.] Miscellaneous. 637

Motion to .suspend lost, almost unanimously.

Beportt of Special Committees were then called for and disposed of in

various ways.

One o'clock, the hour of adjournment, having arrived, a motion to
continue five minutes longer, prevailed. A little general business was
then transacted, and the Convention adjourned.

AFTERNOON SESSI

The Convention was called to order by the chairman at o o'clock.
- According to the resolution carried the day previous, the Convention
adjourned to the various sections as follows :

Anatomy and Physiology President Woolscy's Lecture Room.

Chemistry and Materia Mcdica Chemical Laboratory.

Practical Medicine and Obstetrics Geological Cabinet.

Surgery Geological Cabinet.

Meteorology Chemical Laboratory.

THIRD DAT.

The Association was called to order at 9 A. M. by the President, Dr.
Eli Ives : afterwards, Dr. Jewell, of Philadelphia, presided.

The minutes of the previous day's proceedings were read by the first
Secretary, Dr. S. G. Hubbard, of New Haven.

A list of newly registered delegates was read, making the number
over five hundred.

On motion of Dr. Arnold, of Georgia, it was resolved that no commu-
nication read before the Association should occupy more than ten minutes
in its reading, and no speaker should occupy the floor longer than ten
minutes.

On motion of Dr. Shattuck. of Massachusetts, the rules of order were
suspended, in order to allow Dr. Bowditch, chairman of the committee
appointed to take into consideration the propriety of contributing in the
erection of a suitable memorial to John Hunter, in Westminister
Abbey, to present his report. On motion, it was resolved that the
Committee on Nomination be requested to consider the report and reso-
lutions attached to it, and report thereupon, presenting the names of one
from each State represented, who shall be empowered to take such action
in the matter as may be hereafter agreed upon by the Association.

The Committee of Conference appointed to confer with the Committee
of Medical Teachers reported through their chairman that they had had
several meetings in New York and New Haven, during which the sub-
ject of medical education had been fully discussed.

The Committee offered the following resolutions for adoption :

Resolved, That it is the duty of medical colleges to require of every
candidate for the degree of Doc-tor of Medicine, certificates of study
during the full period of three years, under the direction of a regular
practitioner of medicine, recognized by the American Medical Associa-
tion, who shall certify, under his own hand, as to an attendance on two
fall courses of lectures, with an interval of at least three months between
the termination of the first and the commencement of the second course.

638 Miscellaneous, [August,

Resolved, That every medical college .shall keep a volume, in which
every medical student presenting himself, shall enter his name, his age,
the period of his commencing the study of medicine, any diploma he may
have received in evidence of previous education, with the name of the
college or school from which he received such diploma ; and the name of
the preceptor with whom lie has been studying.

Resolved, That hospital clinical instruction constitutes a necessary
part of medical education, and every candidate should be required to
nave attended such instruction regularly for a period of not less than four
months.

Resolved, That the professors of every medical college should recom-
mend to their trustees, or board of managers, the adoption of a rule
authorizing them to allow the attendance of two or three delegates, from
the State Medical Society, at all examination of candidates for the degree
of the doctorate, and accord to these delegates a vote on the question of
recommending such candidates for a degree.

Resolved' That every State Society be recommended to choose
proper delegates at its annual meeting, to atteud ihe examination of can-
didates for the degree of M. D., at all the medical colleges within their
respective States.

Resolved^ That this Association will not recognize as a regular organi-
zation, any college which does not require evidence of suitable prelimi-
nary education from all applicants for collegiate medical instruction.

Resolved, That we commend the use of all proper efforts, by which
the attention of persons of means and liberal disposition, as well as legis-
lative bodies, shall be directed to the propriety of endowing such medical
colleges, and professorships thereof, as shall be recognized by the
ciation.

Resolved, That this Association recognize as a regularly organized
medical college, one which has been represented at any meeting of
this association, and which complies with the preceding rules and direc-
tions.

Resolved, That this Association recognize as regular practitioners of
medicine, all who have been members of this Association, atid have not
forfeited their rights and privileges, and all members of State and county
Societies, ia full standing.

The report was received and taken up by sections. When the first
resolution came up, a motion was made to amend, by striking out that
part requiring an interval of three months to clapse between the termi-
nation of the first course and the commencement of the second ; the ob-
jection being that the resolution, if adopted as offered, would do an
injustice to summer schools, whose sessions would have to begin three
months after the closure of the winter sessions, in order to graduate
students, thus throwing the session into July, August and September,
and crowding upon the next winter session ; and that such a course
would drive students altogether from the summer schools.

Dr. McDowell, of Missouri, spoke in strong terms against the amend
ment. He despised the plan of some professors, who, teaching at a
winter school in the Soutji, immediately the winter session closes, bring

I860.] Miscellaneous. 689

their half fledged brood to b Northern Bummer school, and there deliver-
ing a Beoond oonrae of lectures, foist their hastily hatched Btudenta apon
the medical profession. I To was entirely opposed to the practice of
pushing ami forcing, which was becoming bo rampant.

The discussion was further participated in bv Drs. Shattook, of Boston,
Austin Flint, of N. V.. Brodie, of Sich., Palmer, of Mich., .Morse, of
Me.. Atlee, of Pa., McCaw, of Virginia, and ethers, and the resolutions
were finally adopted and referred to the Committee on Publication, for
publication in the forthcoming volume of Transactions.

The fifth resolution gave rise to a good deal of discussion as to the
propriety and the right of placing medical schools under the censorship

of the State Medical Societies.

Dr. Timothy Childs, of Berkshire, Mass., stated that forty years ago
be called for a board of examiners to be present at all examinations for
a degree, and that he had never ceased to urge the propriety for so doing.
He had never passed a .student without such a supervision.

I to stated that he was the first man to introduce into medical colleges
a Professorship on Pathology, and he was always in favor of enhancing
the dignity and worth of his profession, and as long as he was able to
raise his voice, he would oppose to the utmost all those who attempt to
lower the standard of medical excellence, regardless of the motives that
prompt them to do so.

Dr. Worthington Hooker, of New Haven. Ct., explained, that Yale
College, further back than forty years ago, had, of its own accord,
adopted the plan contained in the resolution under consideration, and
cjuring his connection with the College, there had not been one whisper
of disapprobation regarding it. There was harmony between the State
Medical Society and the institution, which feels the genial effects of that
harmony, which gives it its strength and position.

He thought that all medical colleges should be closely watched by the
State Medical Societies of their respective States.

The Committee on Nomination then reported the following appoint-
ments on Standing and Special Committees, which was received and
adopted, and the nominations accepted :

Committee on Medical Literature Frank H. Hamilton, N. Y.,
Chairman.

Committee on Medical Education L. S. Joynes, Va., Chairman.

On the Surgical Treatment of Strictures of the Urethra James
Bryan, Pa.

On Drainage and Sewerage of Large Cities their influence on public
health A. J. Semmes, La.

On Puerperal Tetanus its statistics, pathology and treatment D. L.
McCrurgiu, Iowa.

On Anaemia and Chlorosis A. P. Ayres. Ind.

On Alcohol and its Relations to Man J. W. Dunbar, Md.

On Milk Sickness Kobert Thompson.

On Microscopic Observations on Cancer Cells G. W. Norris, Pa.

On Blood Corpuscles A. Sager, Mich.

On the Hygenic relations of air C. C. Cox, Md.

040 MisctUarwox

On Quarantine D. D. Clark. Pa.

On Medical Ethics Paul F. Eve, Tenn.

On Tracheotomy in Membranous Croup A. N. Dougherty, N. J.

On the effect of Perineal Operations for Urinary Calculi upon Pro-
creation in the Male J. S. White, Tenn.

On Mercurial Fumigations in Syphilis D. W. Yandell, Ky.

On the Cause and Increase of Crime, and its Mode of Punishment
W. C. Sneed, Ky.

On the Microscope R. C. Stiles, Vt.

On Gangrene of the Lungs C. L. Allen, Vt.

On the Relation which Electricity sustains to the Courses of Disease
Isaac Cas>elbury, Ind.

On the Morbid and Therapeutic Effect of Verbal and Moral Influences
Alfred Hitchcock. Mass.

On the Causes of the Extinction of Aboriginal Races, more especially
of the Red Men of America Geo. Sucklcy, N. Y.

To report on the practical workings of the U. States law relating to
the Inspection of Drugs and Medicines E. R. Squibb, N. Y.

On the Causes and Treatment of Ununited Fractures E. K.
Sanbone.

On Diptheria Alonzo Clark, New York.

On the Effect of Stimulants in the Treatment of Fractures John W!
Russell, Ohio.

On Dislocation of the Hip and Shoulder Joints Moses Gunn, Mich.

To investigate the conditions demanded for a Diploma of Doctor o f
Medicine in the various Medical Schools and Universities of Europe J.
Baxter Uphain, Mass.

In regard to the Committee on the Memorial to John Hunter, the
following resolutions were adopted :

Resolved, That it be recommended to the different States to collect
subscriptions, of not more than one dollar each, from every regularly
educated physician. All money so collected to be forwarded by the
Chairman of the Committee hereby appointed, to the Treasurer of the
Hunter Medical Fund in London.

Resolved, That Drs. Henry J. Bowditch, Mass.; Charles Hooker,
Conn.; Henry D. Bulkley, New York ; Wm. Elmer, N. J ; John L.
Atlce, Penn.; C. C. Cox, Md.; J. B. McCaw, Virginia ; Cornelius
Boyle, D. C; James H. Dickson, N. C; H. K. Frost, S. C; J. C.
Nott, Ala ; R.J. Breckcnridge, Ky., and others, be a committee to col-
lect subscriptions.

A resolution was adopted to send a copy of the resolutions passed to
each Medical School in the country.

The order of the day was suspended by consent, and the following
resolution was offered by Dr. McCaw, and made a part of the Report of
the Conference Committee :

Resolved, That this Association shall prepare a conspicuous scarf to
be appended to the diplomas of every Medical College which shall com-
ply with all the requirements of the foregoing resolutions this seal to
be withdrawn whenever there should be any failure on the part of such
institution to carry out its provisions.

[to be continted.]

SOUTHERN

MEDICAL AND SURGICAL JOURNAL

(NEW series.)

Vol. m AUGUSTA, GEORGIA, SEPTEMBER, 1SG0. Ml. !l

ORIGINAL AND ECLECTIC.

ARTICLE XXI.

The Humoral and Vital Pathology. By D. M. Clay, M. P.,
of Irwinton, Ga.

The effects of remedial and morbific agents on the
vital constitution of man, have doubtless given rise to as
much or more scientific investigation than any other sub-
ject belonging to the domain of theoretical medicine. The
ranks of the pathological, as well as the physiological,
school of medicine, have been divided on this momentous
subject ; one school advocating the merits of the humoral,
the other the vital theory,

Out of the discussion of these two theories, sprang
another, intermediate in importance and consideration, viz :
" The Chemico-Yital," which is probably more favorably
received by the mass of the profession than either of the
former, owing likely to a mixed character of which it par-
takes, and ready adaptation.

Each of these theories has been urged with due claims
upon the profession, and each alike has passed the un-
friendly ordeal of professional criticism, (as usual) without
receiving much injury. The humoral theory of medicine
is much more familiar to the ordinary practitioner than the
vital, hence its almost universal adaptation. To add more

currency to the apparent orthodoxv of this theory, it is only
41

i'A'2 Clay. The Humoral and [September,

accessary to state, that age lias the precedence, combined
with the natural antipathy of modern authors and instruc-
tors to discard anything relating to antiquity, more espe-
cially when it has received the sanction of some of the
ablest men belonging to the profession. It is a well known
fact that Dupuytren, enlarging on the doctrines taught by
Duhamel, Galen and Camper, was erroneous. His theory
referring to the manner in which union in fractures is
accomplished, was received without suspicion, as a fixed
principle, up until quite a recent day, when Mr. Paget
called the principle into question, and proved its fallacy.
.Many other instances might be brought forward to show
the inconsistency of medical maxims.

Notwithstanding the familiarity and commonness of this
humoral or "blood theory" of medicine, the medical mind
gradually and imperceptibly grasped the vital action of
remedial and morbfiic agents. Xot until the profession
had progressed rapidly and far into this theory, did the
illustrious Auorat's mind conceive an idea of change,
fraught with the highest detriment to professional equa-
nimity. At this period, vitalism had gained shch a strong-
hold upon the talent of the medical world, that it was with
the greatest difficulty he could substantiate his revived,
but once exploded theory, upon a basis sufficiently sure to
attract the attention of the fraternity.

When the two theories were arraved against each other
in point of merit, and the discussion begun, facts were
elicited, conclusive, I think, in favor of vitalism. As I
have before stated, the humoral theory is much more
familiar to the ordinary practioner than the vital, hence it
also becomes a matter of convenience, it serves as a ready
method to account for all the phenomena, either simple or
complicated, connected with health or diseased action.
This theory (humoral) certainly protects the professional
man from the shrewd attacks of the non-professional, espe-
cially when the cause of disease is sought after, from the fact,
that the received opinion is that all diseases spring from
humors in the blood, ft is not uncommon for us to have

I860.] Vital Pathology. 64S

old women and men Bpeaking of bad blood being the cause
of all their diseased troubles ; tins, unfortunately, is not con-
fined only to the "old knowing ones," bul professional
characters love to ease themselves off on this panacea of
etiology. I cannot allow this opportunity to pass without
quoting from that truly and justly celebrated surgeon, John
Hunter, on this subject; he writes: " Among physical peo-
ple we find such expressions in common use, as the humors
are effected in the blood, sharp humors in the blood, the
whole humors being in a bad state, the whole blood must
be altered or corrected, and a variety of such expressions,
without meaning. They even go so far as to have us the
parent of our own humors, saying that we breed bad
humors. Humors are even supposed to gravitate to the
legs slowly, and, in short, the whole theory of disease is
built upon the supposition of .humors in the blood, or the
blood itself being altered. I cannot conceive what is
meant, unless it be that a strong susceptibility to a specific
disease exists, as small-pox may bring on scrofula, or a strain
the gout."

It is true, the vascular system plays an important part in
the human organism, we are ready and willing to admit;
the machinery ofiife ceases to go on when the circulating
fluid is arrested the solids languish and die when the rich
and nutritive elements are insufficient to meet the demands
of their requirements ; consequently, we perceive the de-
pendency. But to look for the cause of this change in tin-
blood, and all its peculiarities, it is the object of this paper
to refer the reader to its proper source ; to produce evidence
to show, that it is the effect of a cause operating on tic
nervous system. This theory, at a glance, may not only
appear strange, but preposterous, to those who are thorough-
ly wedded to humoralism, or to the entire exclusion of all
other doctrines; yet it may become rational, philosophic,
and in accordance with the views of a reflecting practi-
tioner. I am sure this would be the ease, if the subject
were discussed in our journals by abler men than myself:
particularly with the rising generation of surgeons and

(>44 Clay. The Humoral and [September,

physicians. But it is a source of regret for us to know, at
the present day, that the young men who attend medical
lectures at our colleges, allow themselves to become the
dupes of exploded theories, without ever venturing one
thought.

As to knowing or thinking of the precise modus operandi
of remedial or morbific agents on the vital constitution of
man, I would venture to say, that many care not one
cent for the principles, so they get the practice, conse-
quently the science is left to the mercy of a few.

It is asserted by the humoralist, that substances delete-
rious to life, may be and are taken up into the system by the
lacteals, carried the rounds of circulation, affecting the
constitution at large.

Upon sound pathological principles, deduced from actual
experiment, this doctrine of humoralism can be refuted,
beyond a doubt.

The lacteals, according to very high authority, absolutely
refuse to absorb or take up anything foreign to nutritive
chyle : it seems that other agents do not possess that
peculiar stimulus requisite to overcome the exquisite irrita-
bility, to which this great endowment of elective power is
owing. I can think of instances where they may become
diseased or morbidly irritated, by sympathy, until they will
emit certain substances deleterious to life in the main cir-
culation ; but, then, this will not prove that the circulation
will be the primary recipient of the effects. It may be, and
is, doubtless, that the deleterious substance produced such
a powerful impression upon the organic properties of
the stomach with which it conies directly in contact,
that the substance was permitted to pass through the
pylorus (the valve having lost its irritability and sensi-
bility) to the lacteals, from thence, unchecked, into the
circulation.

Admitting that substances deleterious to life, enter the
circulation, has it not been proven that the kidneys and
the various eliminating organs of the system, are sufficiently
adequate to remove them in a time that would preclude the

I860.] Vital Pathology. 645

possibility of their affecting the system? li Is probable
thai poisonous substances ad as a stimulus, for awhile, al

least, to the various eliminating organs of the human sys-
tem, and thereby establishing a more active function.
Again, it may be argued in favor of the vital theory, thai
which may, by chance, enter the circulation, will be so much
diluted by the fluid as to render it totally inert. The pecu-
liar irritability of the system at large, and the powerful de-
termination of nervous power, acts intuitively in arousing
all the organs to action, while nature is engaged in throw-
ing oft' some morbific agent. To show the utter fallacy of
this theory still further, it is only necessary to state that the
blood is undergoing constant changes; in fact, twenty mil-
lions of corpuscles die at each pulsation. It is reasonable
and conclusive to my mind, that all agents, no matter whal
their nature may be, would be rendered totally inert by the
constant modification in the circulation of the blood. Ad-
mitting, again, that all agents pass into the circulation to
produce their final effect, docs it not seem that nature has
acted very unwisely in placing her susceptible parts so
remotely from the main channel of all kinds of sympathy ':
The tunics of the blood-vessels must be very sparsely sup-
plied with nerves, as they have, to this day, defied any
definite arrangement by the best anatomists ; taking this,
and the rapid flow of the blood into consideration, it would
seem unreasonable, that remedial and morbific agents
should affect the system in this way.

The application of morbific agents to man comes daily
under our supervision, in some form or other, sufficiently
appreciable for us to arrive at correct conclusions, as to
what system is acted on, and when the effects arc displayed.
"We will take a disease winch is not so common as many
others, to illustrate our point still further or more fully, viz :
Hydrophobia: We see many days, sometimes months, and
years, intervening between the infliction of the wound and
the development of the alarming symptoms still the virus,
the materies morbi, has been absorbed, (as the humoralist
have it) carried the rounds of the circulation time and

646 t Clay. Tfo Humoral and [September,

again, without producing any effect Again, is it possible
for any substance, I care not of what nature it may be, so
it be foreign from the natural elements of the blood, to
remain in thai fluid days, months and years, without losing
its virulence, or becoming eliminated? Certainly not.

If the latent causes of disease are not to be found in the
blood, where is the mind directed to search ? As a matter
of course, in the nervous system. To illustrate this point
farther yet, it is only necessary to refer the reader to a
class of diseases marked by regular incubative stages, where
the materi.es morbi, the very essence of cause, lias been
operating for several days. After lie has investigated
thoroughly, and reflected seriously, on the occult cause of
this peculiar class of diseases, ask himself where were the
primary influences exerted, and where latent*.'' In this class
of diseases, (contagious,) upon purely vital principles may
that peculiar phenomenon, the liability of non-recurrence, be
accounted for. The impressions are so permanently made
upon the organic properties of life, that susceptibility is
totally destroyed. Of hereditary diseases and their trans-
mission from parent to child, much might be said or
written, but a published paper at the present day is some-
times estimated by its length; consecpiently, it becomes one
to be brief.

There are many diseases classed under the general term,
cachexia, and all of them partaking of a more or less heredi-
tary disposition. When an individual, who is the victim of
a hereditary taint, and is in robust health, chemical analysis
has failed to detect any unusual deviation from the healthy
standard of the composition of the blood. From this it
would seem that the material was sound from which the
secretion was secreted, and ought to impart a healthy action
to the ovum, but we find the reverse of this to be the case.
1 think the correct theory o^ this abstruse principle of
nature to be inherent in the vital habits or constitution of
the parent. The spermatozoon of the male, and the germ of
the female, partaking of the qualities to a more or less
extent of either or both, is a physiological fact, embracing

I860.] Vital Pathology. 647

the entire animal kingdom, for the parent to impart charac-
teristics of themselves to their offspring. It then seeing
that the healthy or unhealthy condition of the ovum depends

entirely upon the peculiar state of the vivifying properties
of the spermatozoon of the male, or the inherent qualities of
the germ.

From evidence produced, all remedial and morhitie agents
must act upon purely vital principles the virus vitea. or
the organic properties of an organ to which they are
directly applied. "In their highest development, sa\>
Prof. Martyn Paine, the properties of the vital principle
are six, viz : Irritability, mobility, vital affinity, vivification,
sensibility and the nervous power. A glance at these great
attributes of a common principle, one may conceive how
the admirable laws of sympathy are originated and kept in
action. Upon these attributes, remedial and morbific
agents make their impression, and are reflected to the senso-
rium commune, there registered by the great registering
ganglia of the brain, at which point the system becomes
cognizant of the effects. The impressions made by agents
upon the sentient extremities of nerves, are variable, owing
probably to the peculiar susceptibility of the constitution, or
the power of the drug. It usually requires from five to
thirty minutes for narcotics to effect the system ; this may
be argued in favor of the humoral theory, on the grounds
that it requires a more or less time for the absorption ; yet,
after due reflection, the fallacy may be seen. It follows, as
a matter of course, that it will require more or less time for
an agent to bring a nerve, or a system of nerves, under it^
influence; consequently, the effect may be produced instan-
taneously, but scarcely appreciable at first.

In passing on to the termination of my paper, I will notice
but a few more points characteristic of the vital principle.
In the Xovember and December numbers of that valuable
periodical, the London Lancet, I sec two letters addressed
to the editor, by a couple of English physicians, in reference
to the venous circulation. The one writing in the Xovem-
ber number, seems to think the main cause in propelling

G48 Clay. The Humoral and [September,

the venous blood along the course of the veins, is due to
the lateral pressure of the arteries ; the other, writing in
the December number, to heat.

Now, as far as the lateral pressure of the arteries are con-
cerned, in materially aiding the venous circulation, the gen-
t Ionian, I think, has justly and correctly refuted his own
doctrine. His main argument seems to have consisted in
the position of the arteries, especially the deep-seated ones,
and those of the brain. Superficial veins and capilaries
have no accompanying arteries still the circulation and
temperature is well sustained. During the obstruction of
large arteries by aneurisms, ligature, calcification, &c,
which has an accompanying vein, the circulation is not at
all disturbed, or at least for any length of time. Lastly, the
arterial circulation would seem to have a tendency to retard
the venous, on account of the current going in contrary
directions.

The other gentleman, advocating the theory of "heat,"
seems so positive in his assertions, and so thoroughly con-
vinced of the correctness of his views, until it almost pre-
cludes the possibility of investigation. He may be in some
degree correct, as there is a vast deal of heat evolved during
the reparation and destruction of the tissues. He has com-
pared the venous circulation to boiling water, conveyed in
tubes to different apartments of a house for the purpose of
warming it. Heating a fluid to the point of ebulition cer-
tainly establishes a current, but if venous blood were heated
to such a degree of temperature, it would more than likely
prove incompatible with life. The lungs being the great
furnace of the system, would, from the above theory, repel
rather than attract blood to that organ.

As far as the vis a tergo, atmospheric pressure, propelling
action of the blood-vessels, suction of the heart, &c, are
concerned, I have no desire to call them into question, but
regard them as dependent auxiliaries of a common princi-
ple. Taking the six attributes of this principle (vital) into
consideration, the true physiologist can at once perceive
the vast influence exercised by them on the circulation,

I860.] Vital Pathology. 649

especially vital affinity, vivification and nervous power.

Vital contractility, bo beautifully displayed In the heart
ami blood-vessels, acts an importanl pari in aiding the
circulation of the blood. During the simple act of blushing,
we need no better evidence of the circulation being under
the control of the nervous power. Numerous other in-
stances mighl be brought forward in proof of the correctness
of this theory, if space and time would permit, but enough
has been written for my purpose.

T have written this paper, not in the spirit of dictation to
the medical profession, hut merely to direct their minds to
an important branch of the theory of medicine, here of late
fallen into disrepute to some extent. I do not lay claim to
originality entirely not by any means; the theory I have
attempted to advocate in this communication, is as old as
the hills ; it was familiar and peculiar to the illustrious
Bichat, Mattucci, Hunter and others ; and at the present
time ably defended and vindicated by the learned and ven-
erable Paine, Professor in the University Medical College,
city of Xew York, both in his lectures and writings.

I misfit mention numerous other names adorning this
scientific galaxy, but those already mentioned are sufficiently
renowned to satisfy the scrupulous. In this communication
it will be seen that I have scarcely made a beginning in the
investigation of this subject, but hope what has been writ-
ten may serve as an incentive to others, who are at ease
with all the true and vague theories of the day.

Much, I think, yet remains to be elucidated clearly and
satisfactorily on the vital constitution and the modus
operandi of remedial and morbific agents. The suscepti-
bility of the various races of man, especially that of the
Caucassian and African, may form a basis of physiology
and therapeutics, that may be of vast benefit to the world.

fi.r)0 Pitts. Union of Strands of Hair [Sept.,

ARTICLE XXII.

Union of Strands of Hair across the Incision in Wound* of
the Scalp. By P. M. Pitts, M. D., of Waco, McLennan

To., Texas.

May lOtli, 1860. At an early hour this morning we were
called to see Mr. G. of "Waco, who hi a fit of delirium tre-
mens, had attempted to commit suicide, by striking his head
forcibly against the sharp edge of the heavy square post of
liis "bedstead. The whole weight of his body was projected
violently against the post, and ot course produced a very
serious scalp wound.

He was found reclining upon a couch, with Lis head sup-
ported over the edge by an assistant, and was having cold
water poured freely over the wound. This was continued
for twenty or thirty minutes, with the effect of arresting the
hemorrhage almost entirely, and so far removing the coas:-
ulated blood as to enable us to examine the wound.

The scalp was cut entirely through, in a line extending
diagonally across the top of his head, and about five inches
in length. It was also torn from the periosteum, to a dis-
tance except near the extremities of the wound of nearly
two inches, towards the right ear.

It was at once determined, by my colleague, Dr. J. II.
Sears, and myself, to adopt the plan of dressing suggested
by Dr. H. F. Campbell, in the March number of the South-
ern Medical (f Surgical Journal for 1860.

Owing to the peculiarities presented in this case, we
thought it best to shave the scalp, to some distance from
the wound, on either side, to facilitate the application of
the cold water dressing, and thereby prevent, if possible,
any erysipelatous or inflammatory action in the wound.

In shaving the scalp, small tufts of hair were left on either
side of the wound, at points exactly opposite, and corres-
ponding with the places of entrance and exit of sutures, if
they had been used.

The wound was now carefully sponged, and the operation
of fastening commenced.

The perforated shot, which we have used very frequently

I860.] Across Incisions ojL Scalp- Woimils. ',;>i

in performing the modern operations for vesieo-vagina] fis-
tula, had given so much satisfaction, thai we determined to
ust' them on the hair. A sufficient number of ordinary duck

shot were perforated and the united ends of each pair of
tufts passed through a shot. The shot was then grasped by
a strong pair iA' forceps, and passed down sufficiently t<>
unite the edges o\' the wound, when it was mashed firmly,
and the most complete and satisfactory fastening that I
have seen lor wounds of the scalp, was finished. The hair
above the shot was removed, and a cold compress applied,
and kept in place by a light handkerchief bandage. The
delirium subsided in about thirty-six hours.

The wound was carefully watched and the compress fre-
quently renewed. Tnion by the first intention was secured
throughout the entire wound. May 21. To-day the 11th
since the accident the shot were removed and the edges
found nicely united and remarkably free from tenderness.

This hasty report is forwarded with the belief that it will
not he wholly uninteresting to Prof. Campbell, and to ex-
tend our testimony to a method of dressing scalp-wounds
which both our judgment and our experience highly com-
mend.

[Since the publication of our remarks in the March num-
ber of this Journal, we have repeatedly applied the method
of treatment above described, and are glad to be able to
report our entire satisfaction with the result in every in-
stance. One of our recent cases, in which the spit-shot
were applied, was after the removal of sebaceous tumors
from the scalp; the flaps were brought together and the
wound healed well in a few days, the patient having been
saved the inconvenience of the loss of a single hair. AVe are
much gratified to find the value of a treatment we ourselves
like so much, so fully confirmed by the experience of oth-
ers.II. F. C]

652 Coleman. Deaf Mutes, [September,

ARTICLE XXIII.

Treatment of Deaf Mutes, Translated from the Gazette des

Jlopiiaux, for the Southern Medical $ Surgical Journal. By
John 8. Coleman, M. I)., of Augusta, G-a.

The Profession, and public generally, of Paris, have been
a good deal interested recently, in the discovery of a
reputed cure for deaf mutes.

About the month of August, 1855, Miss Cleret, a private
instructress of Paris, demanded assistance from the Minister
of public instruction, founding her claim, among other mo-
tives, on the discovery of a remedy capable of curing deaf
mutes. This remedy, which she had discovered accident-
ally, and which she had used with a certain number of her
students afflicted with deafness, after having proven its
efficacy upon herself, consisted in the employment of sul-
phuric ether dropped into the ear, and meatus, in the
dose of from 4 to 8 drops a day. After continuing for 15
or 20 days, suspend the use of the remedy, in order that its
efficacy may not be diminished. In this way it can be con-
tinued indefinitely, at any rate for a very long time.

A committee was appointed by the minister, the medical
portion consisting of Drs. Lelut, Berard and Behier, to
investigate the state of the children submitted to their
examination by Miss Cleret.

The committee were pursuing this study with the greatest
attention, when suddenly Miss C. was attacked by a terri-
ble malady. After waiting, without much hope, for an
amelioration in the mental state of Miss Cleret, the com-
mittee reported the result of their investigation, though
they had not come to any definite conclusion.

Twenty-nine children had been treated by this instruc-
tress, all of whom were benefitted. Two of them, who had
been treated by her before the organization of the commit-
tee, were examined, and found to be perfectly cured.
Seven children were examined before commencing treat-
ment, and the affection satisfactorily proven. In all, and
especially in four, after eight or nine months treatment, a

1800.] Theory of TerUary Syphilis. 658

manifest change was noticed. Any noise, i. e., the sound
of the voice, was perceived with the greatest facility. The
committee staled that they had taken the most minute pre-
cautions to avoid all error, and to screen themselves from
any illusion which might resull from perceptions obtained
by the aid of other senses.

- This is not all. The committee wishing to increase the
opportunities of studying the means employed by Miss
Cleret desirous, above all, to examine other children than
those confided exclusively to the care of this lad}', requested
one of its members to take charge of a number of cases
himself.

About twenty persons were given him, children, most of
them deaf mutes, and a few7 old persons whose hearing on
one side was injured or lost.

In all of these patients there was a marked improvement.

The committee had also seen the same means promptly
cure deafness resulting from typhoid fever.

In conclusion, with the exception of two or three child-
dren, in whom the affection had been attested by authentic
certificates, and who now hear well, the committee could
only report the results of incomplete experiments, com-
menced, but not terminated, of marked improvements, but
nothing definite.

The Theory of Tertian/ Syphilis According to Gam-
bcrini, is a prodigious humbug, having the effect of con-
fusing and confounding that which otherwise would be
easily understood. The regular succession of symptoms in
the onward progress of syphilis, as described by Ricord,
may and may not occur. The so called secondary and
tertiary syphilis are but different local manifestations of the
same general disease. The secondary and tertiary forms of
syphilis may alternate or co-exist, thus demonstrating their
identitv.

664 L iwres on Rickets. [September,

A Series of three Lectures on Rickets, delivered at the Hos-
pital for Sick Children, in December, 1859, and January.
I860. By Wm. Jenner, M. I).. Physician to University
College Hospital, and to the Hospital for Sick Children.

LECTURE III.

Summary : Anatomical Characters of Albuminoid Infiltration of Spleen. Lym-
phatic Glands, Liver. Kidney. Thymus and Brain State of the Voluntary Mus-
cles Symptoms Age. Constitutional Symptoms which precede the" Bone
Disease Derangement of Digestion Perspiration of Head Desire to lie cool
at Night General tenderness Commencement Abrupt or Gradual Softening
of the Bones most marked when the Constitutional Disturbance is Severe and
the child very Young Symptoms Consequent on the Softening of the Bones
Loss of Muscular Power Large Abdomen of the Rickety Child and its
Causes Intellect deficient in Power and Capacity Teeth Skin Fontanelle
General Aspect the chief Causes of Death in Rickets Influence of Soften-
ing of the Ribs on the Fatal Termination of Bronchitis Symptoms of Albu-
minoid Infiltration of Lymphatic Glands, Spleen, etc. Laryngismus Stridulus
Pathology of Rickets Not mere want of Lime in the Bones Causes
Special influence of Mother Hygienic Conditions Treatment.

Gentlemen. At the conclusion of my last Lecture I
described the appearances presented by the spleen and
lymphatic glands, when the seat of that disease from which
rickety children so often suffer viz : infiltration with a
homogenous, firm, tough, transparent, glue-like substance.
And I told you that the disease was rarely, perhaps never,
limited to those organs. In both the children to whose
cases I referred when last addressing you. the liver and kid-
neys were infiltrated with the same substance as the spleen
and lymphatic glands. The liver when the seat of the
albuminoid infiltration, as I have observed it in rickety
subjects, is larger than natural, heavy in proportion to it-
size, very tough, its cut surface smooth, its substance semi-
transparent; sometimes the exudation infiltrates the portal
canals and the interlobular spaces, in others it invades the
circumference of the lobules. [ have never seen the whole
of the structures of the liver infiltrated.

In the boy F.. the cut surface of the liver had the appear-
ance of stiff not very well-clarified size, tinted red and
thickly studded with small opaque yellowish spots. These
latter were lobules, the cells of which were in a state of
fatty degeneration. In some cases the infiltration of the
organ is concealed by its congestion, but a brief soaking in
water removes the blood and makes the lesion of structure
visible. The kidney of the rickety child when the seat of
this same disease is somewhat enlarged, heavy for its size,
tough, more transparent than natural, and. as a rule, very

I860.] /. tores on Kidfcete. 656"

pale. When the disease attain- a high degree, all appear-
ance of structure is losl to the naked eye. Fatty degenera-
tion of the cells may accompany it.
The thymus in ricketty children is often larger than

natural; its increase in size being dm', in some cases al
least, to its infiltration with the same substance as thai
found in the spleen, etc. The so-called hypertrophy of the
white matter of the brain seems really to be albuminoid
infiltration of that structure. The transparent substance
which T have described as infiltrating the organs of certain
ricketty children, presents neither blue, violet, nor crimson
reaction with iodine and Bulphuric acid, such as are said by
Virchow to he characteristic of lardaceous infiltration. I
am therefore inclined to believe that it differs in nature
from what that pathologist considers to he lardaceous, hut
for which, prohably, the name he has himself proposed, viz.
amyloid, is preferable.

The voluntary muscles that have lost their power in
rickety children, are small, very pale, flabby and soft.
Examined with the microscope, their h'bres are found to be
singularly colorless, transparent and soft, the transverse
str'ue very delicate, sometimes scarcely to be made out. I
have never been able to detect in these iibres a particle of
olein. The disease from which they suiter seems to be the
very opposite of tatty degeneration.

Symptoms I have never seen congenital rickets. I have
often heard the mother say that the ricketty deformities of
her child had existed from its birth ; but no value can be
attached to such assertions if unsupported by strong con-
firmatory evidence. The general cachexia very rarely
manifests itself before the fourth month; usually between
the fourth and twelfth months.

I have now a boy under my care in whom the symptoms
of the constitutional disease did not manifest themselves till
he was a little more than three years old, and I saw, some
years since, a girl, aged nine years, who was then only be-
ginning to suffer. It is rare, however, for the general
cachexia to first manifest itself after the child has passed
its second year. At the outset of the disease, there is no
deformity of the bones, no enlargement of the wrists, of the
ends of the ribs, etc.; no thickening of the flat bones, no
bending of the long bones. The child is dull and languid :
its skin is hot; it is drowsy, or sleeps little ; its appetite is
lost; it is thirsty ; if it has begun to walk, it is "taken ott'
its legs." It lies about, is unwilling to play or to be

656 Lectures on Biekets. [September,

amused. The bowels are irregular confined, or more
commonly relaxed the stools being usually of a dirty
brown or leaden color, and most offensive. The offensive
odor is peculiar, resembling that of rotten, half decayed
meat. In all these symptoms there is nothing diagnostic.
They might arise from deranged digestion, from improper
food, or from tuberculosis. By many they are referred to
that over-ridden hobby, the irritation of teething; or to that
cloak for ignorance infantile remittent fever.

When conjoined with that infiltration of the spleen and
lymphatic glands which I previously described, as it was in
the boy II., whose spleen, etc., were on the table at my last
lecture, it is extremely difficult to distinguish from tubercu-
lization ; and in some cases it is only from the state of the
lymphatic glands, or after the anatomical changes proper to
rickets occur, that the diagnosis is possible.

Commonly, however, there are certain symptoms present
which at once mark the nature of the disease, render the
diagnosis easy, and enable us to predicate that the bone
affection will show itself.

One of the most remarkable of these symptoms is profuse
perspiration of the head, or of the head, neck and upper
part of the chest. Xot uncommonly, it is because this
symptom has arrested the mother's attention, that she seeks
medical aid. She uses the strongest terms to express the
amount of the perspiration : " It. stands in large drops on
his forehead" "it runs in streams down his face" "his
head is all of a reck" "the pillow is soaked." It is espe-
cially when the child sleeps that these copious perspirations
of the head occur, but they are not infrequent at other
times, as when the child is at the breast, or even resting its
head on the mother's arm. A little increased exertion, a
little increased temperature, may induce them at any time.
When these profuse head-perspirations occur, the superfi-
cial veins of the scalp are generally large and full, and
sometimes the carotid arteries may be felt strongly pulsa-
ting. At the same time that the head, face and neck are
bathed in perspiration, the abdomen and inferior extremi-
ties are usually dry and hot.

The second symptom which especially indicates that the
general derangement of which I spoke is the precursor of
the rickety deformity of the bones, is the desire of the child
to be cool particularly at night. As a consequence of this
desire, the child kicks the bedclothes off, or throws its
naked legs on to the counterpane.

I860.] Lectures tm 8 657

"He is always catching cold, because he will lie without

any clothes at night," 18 what One 18 repeatedly told by the
mother in these cases. I have frequently gone into our
wards, after the children have been sonic time asleep, and
seen the rickety children lying exposed, and have been
assured by the nurses that they had put the bedclothes Over,

them again and again, but to little purpose, and this, even in

cold weather, when the other children were well covered. A
third highly characteristic symptom is general tenderness.
The child cannot he moved without its uttering- a cry:
pressure on any part is followed hy like evidence of suffer-
ing, "He is tender all over," says the mother, or, "I can't
think what has come to the child, if I do hut touch him he
cries."

A child in health delights in movements of every kind.
It joys to exercise every muscle. Strip a child, of a few
months old, and see how it'throws its limbs in every direc-
tion ; it will raise its head from the place on which it lies,
coil itself round, and grasping* a foot with both hands,
thrust it into its mouth as far as possible, as though the
great object of its existence at that moment was to turn
itself inside (Kit. The child suffering severely from the
general cachexia which precedes and accompanies the pro-
gressive stages of the bone disease, ceases its gambols: it
lies with outstretched limbs as quietly as possible, for vol-
untary movements produce pain. Its unwillingness to be
moved is so great, that, as Stiebel has observed, it will cry
at the approach of those who have been accustomed to
dance it of those at the sight of whom it previously mani-
fested extreme pleasure (a). As the disease progresses, the
child gets a peculiar staid and steady appearance ; its natu-
ral lively expression is replaced by a pensive, aged, languid
aspect : its face grows broad and square, and when placed
upright on its mother's arms, it sits, as she says, "all of a
heap." Its spine bends, and its muscles are too weak to
keep it erect. Its head seems to-sink between its shoulders,
its tace is turned a little upwards (b). The general

(a) See Stiebel's admirable article on Rickets, in Virchow's l*Path. and
Therap.-" Band 1.

(b) I subjoin a case illustrating some of the points mentioned in the Lecture,
and I do so because I am confident that the symptoms present in these cases are
very rarely correctly interpreted. A. V., aged 3k, male. His present ailment
commenced about four months since, shortly after " a severe cold on the chest."
with the following symptoms : Heat of skin, especially at night; thirst: loss of
appetite; profuse sweating about the head; extreme tenderness of the whole
bodv, so that he could not be touehed without crving from the pain it caused

42

C)'jS Lectures on Rickets. [September,

cachexia is sometimes very severe, at others extremely
trifling. And one or other of the more characteristic symp-
toms may be scarcely observable or wanting, while one or
other may be so strongly marked, as to give a general fea-
ture to the case. Instead ot' commencing more or less
abruptly, the disease may begin and progress most insidu-
ously, so that the mother cannot say when the child began
to suffer: Often the changes in the shape of the hones are
the first abnormities she notices.

Ere the general disease, if that be severe enough to at-
tract attention, has lasted long, the bone deformities com-
mence. If the attack be attended with severe general
symptoms, the softening of the bones usually precedes, and
is out of proportion, for some time, at least, to the enlarge-
ment of the ends of the bones. The younger the child
also, the softer are usually the bones.

And now the consequences ofthe bone disease are super-
added to the general derangement. It is strange to see a
little child sitting placidly on the bed without moving for
hours together its legs placed so as to escape pressure, its
spine bowed, its head thrown backwards, the chief weight
of its body cast on to its anus ; and to know, that notwith-
standing the apparent calm, the tiny thing is indeed fight-
ing the battle of life ; for it is striving, with all the energy
it has, to keep in constant action every one of its mus-
cles of inspiration, endeavoring so to supply the mechanical
defects of its respiratory apparatus due to the softening of
the ribs. It wants no toys. It is the best of children if you
only leave it alone ; move it, and you inflict pain on it?
tender frame ; show it the horse or doll that was once its

him ; relaxed bowels, the stools being, to use the mother's own words, "stinking."
a "rotteny smell''; desire to lay exposed ;it night ; again, to use the mother's
w ords, " even in that bitter cold weather he would never lay covered over." k- in
the previous winter he liked to lay warm." Although he had long run alone he
-ion " taken ofl" his legs."
Present state Rather thin ; muscles very flabby \ evident tenderness of head.
i nmk and extremities. The muscles seem to partake of the tenderness; and
the abdominal muscles are as tender as those ofthe thighs. Sits in his chair
unwilling to move, from morning to night. Cries if his brothers or sisters ap-
proach him. Feverish at night ; throws the clothes off; sweats over the head
profusely; the perspiration is limited to the head ; appetite very small: bowels
act once a day. but stools very offensive. Intellect decidedly less acute than that
ot his brothers and sisters was at the same age. Head large, square. He cut
nil his teeth long before his illness commenced. Spine curved backwards from
about the first dorsal vertebra to the sacrum, and forward from first to last
cervical vertebra*. Ribs very soft, so that there is great recession of each rib
where it joins the coTtal cartilage at each inspiration. Physical signs of trifling
catarrh. Very little enlargement ofthe ends of the long* bones. No enlarge-
ment ol glands, liver OT spleen.

186p.] L teres on Rickets. 669

delight, and it turns away its head or stares vacantly; to
notice would divert its attention too much from the per-
formance of those respiratory movements which arc essen-
tial to its existence.

At this time the appetite is often good, but the bowels
arc deranged; the stools being either fetid or white, or the
food is passed as it is eaten. As the disease progresses the
muscles lose power and waste ; but the Loss of power is* in-
finitely greater than can he accounted for by their dimin-
ished size.

A girl, aged six years, was some time since brought to
the Hospital, in whom the loss of muscular power was so
extreme that she was not only unable to stand, but even to
support herself in the least possible degree. She lay across
the arms of the person who carried her, like a large half-
stuffed rag doll. When placed in bed, she was incapable
of changing her position without assistance ; nay she could
not raise her arm an inch from the bed. Long after, when
greatly improved, she could not teed herself, and had to be
tied in a chair and her head placed on a pillow at its back.
If her head fell forward, the nurse had to raise it, for, un-
aided, she could not lift her chin from her breast, (c). And
yet 1 have often seen tubercular children, of the same age.
with muscles much more atrophied, walking about, and
performing for themselves all necessary acts, as cutting their
food and dressing.

Although it is rare to see the loss of power in the muscles
^o complete as in the case referred to, it is very common to
see children of two, three, or even four years of age, who
are quite unable to support themselves in an erect position ;
and if a child has commenced to walk before it becomes the
subject of extreme rickets it loses the power.

The abdomen of all young children is large in proportion
to the size of the chest : hence the Physician often has a
child brought to him because its mother fancies its abdomen
is larger than it should be, when, in fact, it is only of
normal size.

The causes that conspire to produce the large abdomen
proper to the child, are :

1st. The flatness of the diaphragm.

2ndly. The size of the liver.

Srdly. The shallowness and small size of the pelvis.

(c) This child recovered so much as to walk about without assistance. AfU
upr return home, she fell down stairs, and was killed bv the fall.

660 Lectures on Rickets. [September,

Ithly. And especially the weakness of the muscles of the
abdominal and intestinal parietes, which afford facilities for
the accumulation of flatus.

The abdomen of the highly rickety child is larger than
natural, and usually very much larger, for all the causes
which make a large abdomen proper to a young child are
greatly more potent in the rickety.

1st. The chest is smaller and the diaphragm more de-
pressed than in health.

2ndly. The liver and spleen are often larger than natural.

>rdly. The capacity of the pelvis is diminished.

4thly. The muscles of the abdomen and intestines are
less powerful even than they are in their normal condition:
and, moreover, derangement of the digestion is always
present to favor the excessive formation of flatus.

It is curious to note the frequency with which writers
state that the intellect of the rickety child is precocious, nor
is it difficult to account for the origin of the error for error
it unquestionably is. In regard to the intellect of a child,
speaking generally, the mother's opinion must be weighed
before it is received as correct. If a child be not suffering
from chorea, and the mother states that it is mentally defi-
cient, her statement is, I believe, invariably correct: but
the mother constantly tells us that her child is very clever,
quite a prodigy, when it is only a few degrees removed from
an idiot.

The little rickety child separated, in consequence of its
physical defects, from other children, and thrown necessa-
rily much into the society of adults, catches their tricks of
expression, their phrases, and even some, perhaps, of their
ideas, and hence is thought, by the mother especially, to
have a larger intellect than other children.

Children, the subjects of extreme rickets, are almost
always deficient in intellectual capacity and power. Ihey
are not idiots, they offer no signs of idiocy, they resemble
rather children of low intellectual capacity and power much
younger than themselves. Their mental, like their muscu-
lar power, is not merely lowly developed, but it retrogrades
;i- the rickety diathesis progresses. When the disease
ceases, the mind, like the body, regains all its powers.
The muscles of those who were once rickety, in after life
are often marvellously powerful, their bones singularly
strong, and their intellect certainly not below the average.

The teeth are always retarded in their development in
ricketv children. T dwelt on this fact in rav first lecture.

I860. | Lectures on Hid 86]

Not only, liowever, are the teeth cut Late, bu1 they fall from
their sockets very early ; thus 1 have Been the incisor fall
from the jaws before the second molars of the first sot had
made their way through the gums. Occasionally, instead
of falling from their sockets, the tooth decay quickly.

The Back, anus and sides of the face are very often
covered with downy hair. The anterior fontanelle is fre-
quently open till the child is three or more years of age.

On the deformaties of the rickety child I dwelt so long
when speaking of the morbid anatomy of the disease, thai
1 must now pass them by.

The genera] aspect of the rickety child is so peculiar thai

when the < rooked limbs, the large joints, and the deformed

thorax are concealed, you may even deteet its ailment at a
glance. Its square face, its prominent forehead, its want of
color, its large, staring, and yet mild oyQ^, its placid expres-
sion, and its want of power to support itself, like other
children of its age, on its mother's arm, all conspire to form
a picture which lias no like in the gallery of sick children.
J told you in my first Lecture how often rickets termi-
nates in death that it is a most fatal disease. The greal
causes of death in rickets are :

1. Intensity of the general cachexia.

2. Catarrh and bronchitis.

3. Albuminoid infiltration of organs, especially of the
lymphatic glands and spleen.

4. Laryngismus stridulus.
">. Chronic hydrocephalus.

6. Convulsions.

7. Diarrhoea.

It is in rare cases only that the cachexia of rickets proves
directly fatal. Death is commonly the immediate effect oi'
some one of the other diseases which I have just enumera-
ted. In this particular it agrees with those other general
cachexia of children tuberculosis, scrofulosis and syphilis.

Catarrh and bronchitis are unquestionably the most com-
mon cause of death in rickets. The softening of the ribs
rendering the mechanical power by which inspiration i-
performed so defective, that, the impediment offered to the
entrance of the air by the mucus in the bronchial tubes
cannot be overcome, and collapse of large portions of the
lungs follows. Of this cause of death, and of the state of
the lungs in such cases, I spoke at length in my last Lec-
ture. From what I then said, you will have seen that the
danger of catarrh and bronchitis in rickets is in proportion,

662 Lectures on Iticketa. [September,

not only to the intensity of the inflammation of the air-
tubes, but also to the degree of softening of the ribs; so
that, in estimating the danger of bronchitis in the rickety
child, it is by no means sufficient to listen to the chest, or
to note the lividity of the lips, or the action of the nares. or
the frequency or severity of the cough, or the heat of skin
and other evidences of febrile disturbance ; but you must
strip the child, and note to what degree the ribs are soften-
ed, how much they recede during inspiration, and to what
extent they are forced outwards during expiration.

Albuminoid infiltration of the lymphatic glands, spleen
and other organs, is by no means an uncommon cause of
death in rickets. The two great features, during life, of
albuminoid infiltration of these organs in a young child arc
emaciation and pallor. The anaemia is often most remark-
able ; and if, as is sometimes the case, there is a little
serosity effused into the cellular tissue, the child has that
peculiar transparent, waxy, greenish yellow tint, which is
sometimes seen in the anaemia of young women. Xow and
then there is decided anasarca ; the face as well as the ex-
tremities, the hands as well as the i'e^t, being (edematous.
The emaciation may be very great. 1 showed you a child
suffering from this complication of rickets at my first Lec-
ture, who was very thin, and in the boy Howie, then in the
ward, emaciation was carried to its utmost limit. The
rickety' deformities, in such cases, maybe moderate or ex-
treme ; t liey may precede or they may follow the infiltration
of the organs. The glands thus diseased, are never very
large. Usually they vary in size from a large pin-head to
: sweet pea. We feel them in the groins, the axilla and
the neck : they are not tender, and rarely, if ever, inflame :
they roll under the finger, proving their freedom from
undue adhesion to each other, to the cellular tissue in
which they lie, and to tin' skin. When the child is very
thin they are visible to the eye. They are hard to the
touch, and rounded in form. The spleen is usually, at the
same time with the glands, the seat of extensive albumi-
noid infiltration. It is strange how often enlargement of
the spleen is overlooked in the child, seeing the ease with
which it may be detected by touch. In every obscure dis-
ease of earl}' childhood the absence of enlargement of the
spleen should be established. If we place the lingers of the
right hand directly under the left twelfth rib, just outside
the mass of the lumbar muscles, and the lingers of the left
hand a little to the left of the middle line, in front and half

I860.] /. tures on Rk ...:

way between the umbilicus and the ensiform cartilage, and
then press the parts forward with the right hand, and back-
wards, and to the left with the left hand, the enlarged
Bpleen may always be readily felt in the left hypochondriac
region. We know the hard mass we feel to be spleen, by
the sharpness of its anterior margin, by the anterior mar
gin passing from under the cartilage of the 8th, 9th or 10th
ribs obliquely downwards and inwards, towards the median
line. The obliquity of this line is such that usually it' con
tinned downwards ii would cross the median line aboul
half-way between the umbilicus and the symphisis pubis.
The anterior edge is usually nearer the middle line in front,
in the child than it is in the adult, because in the child
there is a fold of peritoneum, not usually, if at all, described
in English hooks on anatomy, extending from the left side
of the arch of the colon to the left 12th rib, and over the
anterior edge of this the spleen must pass before it can ex-
tend low enough to be detected by the hand. This fold <!
peritoneum causes the enlarged spleen to lie more forward
as well as to have a more oblique position in the child than
in the adult.

The enlarged spleen i> distinguished not only by its posi-
tion, ami by the character and the direction of its anterior
margin, but also by its moveability. If the spleen be
greatly enlarged, ami the parietes of the abdomen be thin,
the notch in its interior margin can often be felt. The
liver in the rickety child is comparatively rarely so much
affected with this disease a.*- to be greatly enlarged. Its
edge is usually somewhat lower than natural, allowance
being made for the depression ot' the organ from the flatten-
ing of the diaphragm! Although the liver be not much
enlarged, the edge feels harder and sharper to the touch
than natural. Notwithstanding the enlargement of the
lymphatic glands and spleen, there is no increase in the
number of the white corpuscles in the blood. This fa
have verified by repeated observations, and on many cases.

The connexion between rickets and laryngismus stridulus
is very close. I think it is about four years ago that I was
struck by the connexion between them, ami since that time
I have seen a vast number of cases of laryngismus, and in
every case, saving two, the child was the subject of rickets:
and I believe the reason of laryngismus stridulus being so
constantly referred to the irritation of teething, is that tin
rickety condition retards the development of the teeth, and
the Practitioner refers the laryngismus to that which like

664 Lectures on Rickets. [September,

itself is the consequence of the constitutional disease.
Carpopeedal contractions, and even general convulsions, are
not, as is well known, unfrequent in these cases, and are,
like the laryngismus, to be referred primarily to the irrita-
bility of the nervous system and muscular debility. The
convulsions in such cases may prove fatal, and nothing be
found within the cranium to account for death.

Pathology. En propounding his theory of Inflammation,
Mr. Paget dwells in hie most excellent manner on the fact,
that, concerned in the process of nutrition, are four agents
viz: the. nerves, the cells, the blood, and the blood-ves-
sels an}- one of which "being deranged at a particular spot,
derangement of the others necessarily follows ; and he
points out, that, when inflammatory action is established in
a part, all four are in an abnormal condition that inflam-
mation is a disease of nutrition. In cancer, and in rickets
also, without doubt, all four agents of nutrition are in an
abnormal condition. Cancer and rickets, then, are both
diseases of nutrition. In rickets, moreover, there is neces-
sarily no pathological exudation or new formation; there
is, so far as we know, merely a change in quantity and ar-
rangement of normal structures and secretions. This is
true, not only of the hones and muscles, but of the secre-
tions of the skin and kidney. Rickets, then, is essentially
and purely a disease of nutrition, not of one part only, but
of the whole body. But, if we admit this as proved, we
have advanced a very little way on the road to the discovery
o\' its intimate nature. But little as we have progressed, we
certainly are in advance of those who still regard rickets t<>
be merely a chemical abnormity of the bones, viz., a defi-
ciency in their earthy salts. That this latter view of the
pathology of rickets is altogether erroneous, seems to me
to be proved by the fact, that not only is there an insuffi-
cient disposition of the lime-salts in the growing extremities
of the long bones, but there is an error in position of the
small amount deposited there. The earthy matter is found
in the cartilage-cells instead of the matrix. And yet.
further, not only is there an insufficient quantity of the
lime-salts and error in position of those present, but there
is absorption of those deposited ere the disease began : for
bones, previously hard, soften. The lime is taken up from
the well-constituted shafts of the long bones and from the
flat bones, enters the blood, and is thrown out of the system
in the urine. It lias been said, deprive a hen of lime, and
-he lav- eggs with soft shells ; deprive a child of lime, and

I860. ) LfCctures on Rickets. <'ti-~>

its bones will be soft. Hut there i> no pathological rela-
tionship between the soft shell of the hen deprived of lime
and the softened bones of the rickety child, hi the Former,
die lime has never been deposited; in other respects/the

growth is normal. In rickets, the lime litis been deposited ;

it is re-absorbed, and then excreted in another place from
the blood : and the growth of the bone is abnormal, irre-
spective of the absence of lime. The agents concerned in

the nutrition o\' the hone.- not only do not take the lime
from the blood, hut they take the lime from the bono.

It is not probable that there is any lack of lime in the
blood, seeing that one secretion from the blood, viz., the
urine, was found, in Marchand's experiments, to contain
six times its normal quantity of lime-salts.

E adverted in my first Lecture to that singular change in
the chemical constitution of the bones in rickets pointed out
by Lehman and Marchand, viz., that they no longer yield
gelatine on boiling a fact, it fact it be, which shows some
tar deeper change in the nutrition of the bones than a mere
want of lime. I should have thought it unnecessary to
dwell on so superficial a theory, had I not so often seen it
adopted as a basis of treatment. And even the frequency
of rickets in London has been supposed to depend on adul-
terations of the bread whereby its lime-salts are deprived
of their solubility.

Of Meyer's opinion that rickets is an inflammatory affec-
tion of the periosteum and endosteum, I shall only say that
my many examinations of rickety children after death have
enabled me to lend no support to such a notion; that I
have seen no sign of pre-existing inflammation of the bone
or its covering, although I have looked carefully for such.
It is, therefore, so far as I can judge, not only an hypothesis
without foundation in fact, but an hypothesis to which all
known facts are opposed.

It has been said that there is an excessive formation of
lactic acid in the stomach of the child : that this acid enters
the blood, and that to its presence in the blood all the phe-
nomena which I have described as the symptoms and lesion
of structure of rickets are directly secondary. I can only
say of this theory that I know of no tacts which remove it
from the category of pure hypotheses; while the fact that
lime is deposited in abnormal situations is opposed to it.

Causes. ft is of much greater interest to the patient and
to the practitioner to determine what are the circumstances
which cause a child to "become rickety, than it is to learn

666 Lectures on Rickets. [September,

the nature of rickets. [ know pf no facts to prove that
rickets is hereditary. The health of the mother, however,

has a decided influence on the development of rickets in
the child. Whatever renders her delicate, whatever de-
presses her powers of forming good blood, that tends to
induce rickets in the offspring. Of the influence of the

father, F am very sceptical. Of this much I am sure, that
where the mother is in delicate health, in a state of which
anaemia and genera] want of power form the prominent
features without being the subject of disease usually so
called ; there the children are often, in a very decided
degree, rickety, and that although the father is in robust
health, and the hygienic conditions in which the children
arc placed are most favorable. On the other hand, I know
no case, (though I do not deny that there may be such)
in which the mother being robust, the hygienic conditions
favorable, and the father delicate, the children have proved
rickety.

Phthisical parents are no more likely to have rickety
children than are non-phthisical parents. Nay, the facts
contained in a table made for me by my friend, Dr. Ed-
wards, some years ago resident at this hospital, and hoav
Physician to the Consumption Hospital at the East of Lon-
don, renders it probable that they are even less likely.

It is very common for the first, or the two or three first,
horn children to be free from any signs of rickets, and yet
for every subsequent child to be rickety. Again, if a
woman have one rickety child, in the large majority of
cases all her subsequent offspring will be rickety. The ex-
planation of this fact is that among the poor the parents
are generally worse fed, worse clothed and worse lodged,
the larger the number of their children the man's wages
remain stationary, the calls on his means are increased.
And among the rich and poor, the larger the number of
children the more has the mother's constitutional strength
been taxed, and the more likely is she to have lost in
general power.

Whatever external conditions are favorable to the forma-
tion of hydremic blood in a child seem to be favorable to
the development of rickets. Impure air constantly breath-
ed food insufficient in quantity or defective in quality
taken daily deficient light want of cleanliness.

Whatever ailments interfere with nutrition, and so with
the formation of good blood. Deranged conditions of the
digestive organs diarrhoea attacks of local inflammation,

I860.] /. ''/- i Rickets. 667

especially if neglected, or if treated by excess in blood-
letting, mercury or antimony. Active treatment is some-
times necessary to save a child's life; but be careful, I pray
you, how you employ active depleting remedies in children
you may cure the disease for which you administer your
agents, but you may at the same time kill the child by the
injuries inflicted on its general powers. And with refer-
ence to mercury, 1 would advise yon to have your grey-
powder bottles marked: Dangerous, especially in alterathu
doses. I do not mean that such arc never given with
advantage ; but I do mean that where they are once riven
wisely, they are many times given to the injury of the child's
health.

The frequency of rickets among the poor is no douht
partly the result of the improper food with which the
children are so often dosed even from their birth. This is
the common modi- of rearing the children of the poor in
London.

For the first two or three days after birth, their tender
stomachs are deranged by brown sugar and butter, castor-
oil and dill-water, gruel and starch-water; as soon as the
mother's milk flows, they are. when awake, kept constantly
at the breast. And well for them if they are nor again and
again castor-oiled and dill-watered, and treated with a few
doses of mercurials for the poor have learned the omnipo-
tent virtues of grey-powder.

After the first month, bread and water, sweetened with
brown sugar, is given several times a day, and during the
night the child is. when not too soundly asleep, constantly
at the breast. As soon as the little ill-used creature can sit
erect on its mother's arm, it has at the parents' meal times.
"a little of what we have " meat, potatoes, red herring,
fried liver, bacon, pork, and even cheese ami beer daily,
and cakes, raw fruits, and Trash of the most unwholesome
quality, as special treats, or as provocatives to eat when its
stomach rejects the ordinary diet. Then instead of being
weaned when from ten t<> twelve months old, the child is
kept at the breast when the milk is worse than useless, to
the injury of the mother's health, and to the damage of its
after brothers and sisters, in the hope that it may retard the
next pregnancy. The children are sacrificed that the pas-
sions of the parents may not be restrained. Can we wonder
that rickets is prevalent among the poor of London '.' ('an
we fail n> wonder thai geography, history ami crotchet-
work form so large boms in the instruction imparted at our

668 Lectures on Rickets. [September,

national schools, and the doctrines of life so small. Let
the girls there educated be taught that Constantinople is
the capital of Turkey, it' it be any advantage for them to
know it, but let them also learn how to dress, nurse, feed
and lodge an infant, so that it may run a fair chance of not
swelling the amount of that truly awful column in the
Ueu'isti'ar-licneral's returns "Deaths tinder one year.'"

I have told you that rickets causes, primarily or seconda-
rily, more deaths than any other disease of childhood ;
from what I have said of its causes, you will also have
learned that it stands very high on the list of preventable
diseases.

Dr. Merei collected some, not all very trustworthy, iacts
bearing on the comparative prevalence of rickets in different
parts of England, Scotland and Wales. The subject is one
of very great practical interest. If you, who hereafter will
practice in many parts of the country, would each pay at-
tention to the prevalence of this disease in your own sphere
of observation, and the causes that induce it, much valuable
information would seem to be collected, and practical con-
clusions readily deduced.

Treatment. There is no specific for the cure of rickets.
Whatever agents are calculated to improve the general
health, are the most efficient for curing the rachitic diathesis,
and where that is not possible for preventing its worst
effects. In the diet, the ventilation of the rooms in which
the child lives, and the state of the digestive organs, are the
points which ought chiefly to engage the Physician's atten-
tion. If, as is usually the case, the child be under eight
months old, and brought up by hand wholly or in part, milk
diluted with, about a fourth part of lime-water, and with a
teaspoonful or two of cream added to the half-pint, will
generally be found the best food. It is better not to add
sugar to the milk if sugar is used, it is said by some thai
sugar of milk is preferable to cane sugar, and I have fancied
that it is. If farinaceous food is required, a little gruel or
plain buscuit, as Robb's, or baked flour, may be added to
the milk. The children of the poor, especially, should be
W'(\ with a spoon rather than a bottle, as the cleanliness of
the feeding apparatus, so essential for preventing acid fer-
mentation of the food, is rarely secured, A little beef-tea
and bread, eggs aitd farinaceous pudding, may be added,
when the child is older. Should the child be still at the
breast, it will be necessary, if the mother's milk is deficient
in quantity or defective in quality, to partially or completely

lsiJO.] Lectures on Ttkkcts. 609

wean it. or t<> obtain another nurse. There is no objection
to giving the child two or three meals of milk and lime-
water in addition to the breast-milk. Be careful to see
that the child is not always at the breast, but gets its meals

at stated intervals. It should be well washed all over al
leasl once in the twenty-tour hours, with warm water and
soap. Daily tepid or cold sponging, according t<> the
weather and strength of the child, is useful. The room in
which it sleeps should he well ventilated. It should lie
alone. It is well to place a good-sized lamp in the chimney
forthe purpose of aiding ventilation. In the day-nursery,
light is as essential lor health as fresh air.

As to medicines, it is well if the stools are very offensive,
even though the bowels are rather relaxed, to jnve a sinele
dose of aperient, such as ateaspoonful of castor-oil, or grey-
powder and jalap, and then about once a week a dose of
rhubarb and soda. These and a little prepared chalk and
soda once or twice a day, to correct acidity, will generally
be all that is required at this stage of the disease. When
the febrile disturbance has subsided, the child must be fre-
quently taken out of door. In fact, it should as far as may
he. live in the open air. care being taken that it is warmly
clad ami not exposed to cold and damp winds. If practica-
ble, it should be removed into the country. Dry, bracing
sea air is the best. The east coast, as Scarborough and
Lowestoft, in the hot months; Brighton, when London is
enveloped in fogs. Tonbridge Wells, though inland, has a
special advantage ; for not only is the air of the place good
for such eases, but as iron is an invaluable medicine in
rickets, the water from its springs is a powerful curative
agent ; and many young children will drink the waters
readily. Steel wine, though it contains very little iron, is
extremely useful. I think it one of the very best forms for
administering iron to rickety children. A teaspoonful or
two of steel wine, with half a grain of quinine, and a drop
or two of dilute sulphuric acid,- constitutes a capital mixture
for such cases. It should be taken just before meals.

Cod-liver oil is considered by some French writers of
repute a specific in rickets. One advises us to be careful
how we administer it to children much deformed, or in the
course of a week or ten days we may consolidate the hones.
and then reeovery from the deformity beeomes hopeless.
But although my experience of cod-liver oil does not eon-
firm the statements of Bouehut, it enables me to say that
it is a very valuable remedy. It is best to ffive it immedi-

670 I '.'"/< 8 on Rki [September,

atelv after meals. Orange-juice and orange-wine are the
vehicles for its administration most agreeable to children.

The condition of the intestinal dischargee requires, at this
stage of the disease, also to be attended to. Occasional
aperients, castor-oil, or rhubarb and soda, or a little essence
of senna or magnesia, arc usually all that are required.
When any of the food is passed from the bowel as it is
taken by the mouth, it will generally be found that it is
improper in quality or imperfectly masticated.

The teeth of rickety children are so often absent or
defective, that great attention must he paid to this point.
It is right to pound their meat in a mortar it is not enough
to cut it small. Potatoes should he carefully mashed ; and
you cannot too strongly impress on the mother the impor-
tance of seeing that no little lumps escape, for such little
lumps will assuredly he swallowed whole; and if you
examine a dish of mashed potatoes, you willl frequently n'nd
that the majority of the pieces that have escaped crushing
are either half cooked only, or diseased.

Rickety children of twenty months or two years of age
require a small quantity of meat every day, in addition to
good beef-tea. Milk should form, for them, as well as for
older children, the night and morning meals.

If the stools are reported at any time to be white, they
should be examined, as it may he that the white color is
due to the quantity of undigested curd contained in them.
Under such circumstances, it is no use to stimulate the liver
or to give alteratives ; antacids and a little lime-water with
the milk, or the substitution of beef-tea for part of the milk,
is indicated.

With reference to the hone deformities and their conse-
quences, you will find, when the ribs arc much softened, a
well-adjusted bandage round the abdomen useful, by retard-
ing the rapid descent of the diaphragm during inspiration.
It is in exceptional cases only, that benefit is derived from
mechanical supports to the spine and extremities.

I agree with Dr. Merci, whose work on infantile develop-
ment and rickets contains very much that is most excellent.
when he says. "Both the morbid conditions of the bono.
and the constitutional state of rachitic children, do not
admit of any notable degree of mechanical compression or
embarrassment of movement by steel apparatus, of which
frequent instances are observed to the detriment oi' the
patient."

I have sometimes directed splints to be applied in such a

I siin. ] Diseases of tfn I. 67 1

way as to pro j eel below tho feet, for the purpose i pre-
venting walking1.

Time does not permit me to dwell en the treatment of
the complications which so often cause death in rickets, I
shall therefore conclude by two or three general remarks,
having reference to certain points respecting their treatment.

Active depletion in any form, especially blood-letting,
whether by a single leech or otherwise, is not to be employ-
ed in any of the inflammatory complications of rickets.

Large doses of antimony, so useful in the pneumonia of
children of healthy constitution, and even in the subjects of
tuberculosis or scrofulosis, are t<> be held as poison to the
subjects of progressive rickets.

Mercury, unless as an aperient in conjunction with some
other drug, is equally objectionable.

Ammonia, with or without ipecacuanha and citrate of
potash, is the great remedy for the inflammatory, bronchial
and lung affections of progressive rickets.

Iron, cod-liver oil, good diet and fresh air, are the greal
agents for the cure ^Y laryngismus stridulus and general
convulsions.

Iodine, iron, and cod-liver oil for the hydrocephalus.

Clinical Lectures on Diseases <>r the Eye. By Dr. Jacob. (Re-
ported by A. II. Jacob, A. B., L. \i. C. 8. I.)

(J RANI' LA R C0NJ I'XCTI VA.

I have this morning to give you more of a general than a
clinical lecture, having reference to a form of disease which
we have had daily before us during the session, and which
you must have before you all your lives in your dispensary
or military practice: it is one of the most refractory and
troublesome of eye affections, and will test your powers of
perseverance more than any other. Being a morbid change
of structure in a portion of the conjunctiva, I must explain
to you what the conjunctiva is; it is the skin of the eve.
in more dignified language a modification of tegumentarv
membrane, and evidently a mucous one, for you have only
to put the tip of the finger into the inner canthus and look
at it to prove that true mucous is there. Now, you know,
I hold that there i> no mucous without mucous glands.
that no mere memhiane makes mucous, and so we must
find mucous glands here, as Ave do, for surely the con-
junctiva lining the lids is profusely furnished with minute
ones, and these glands become the granulations of which I

672 Diseases of the JEye. [September,

have now to speak. On the outside of the eyelids there is
true skin, with dry cuticle or epidermis, but on the inside
all is soil and wet but modified according to the place it
occupies; the palpebral portion glandular, the reflection or
fold from the palpebral cartilages to the eyeball soft pulpy
membrane, the layer over the sclerotic transparent and
flexible, and that on the cornea peculiar and delicate.
Some will have it thai the conjunctiva over the cornea is
epithelium ; but as that is often but a name for something
between moonshine and matter, I must adhere to the old
notion that it is real tegumentary membrane with a fine
pellicle of epithelium over it. Be this as it may, take my
advice, and believe, right or wrong, that the Lnsides of the
eyelids are studded with mucous glands, and that the cornea
is covered by skin; it will save you a world of trouble, and
prove a safe foundation for practice. This being premised,
let us see what these granulations look like, which we can
whenever we meet a sore eye of three or four months
standing. Catching a light hold of the evelashes of the
upper lid, draw it firmly toward you, bolding on for a
moment until you fatigue the orbicularis palpebrarum,
and then, by a sudden elevation and depression, turn the
part inside out : it is easily done, when you learn the
knack of it, but surgeons often use a probe to help them,
laying it on the skin above the margin of the cartilage.
and in private practice this may be preferable, as people
like instrumental interference. The lid thus everted, if
fully granulated, and never touched with caustic or blue-
stone, shows a bright scarlet surface, studded with little
bodies closely resembling warts, about the size of heads o{
large pins or small shot, having deep fissures between them.
At an earlier stage, the granulations are smaller, fewer in
number, and more irregular in their distribution; while at
the commencement there is merely an extreme roughness o\'
the surface, from distinct pointed elevations. Alter the
free use of astringent or escharotic applications, the granu-
lations are found less numerous and less prominent, the
spaces between them larger, and the whole surface smoother,
in fact, a partial cure has been effected, and you have only
to finish it. All this is accompanied by increased and
chronic vascularity of the conjunctiva over the sclerotic, and
generally by opacities, red vessels, or small ulcers of the
conjunctival layer of the cornea. Let us now see what you
are to do with the first case to which I have alluded, where
the granulations are large, prominent and distinct, growing
like vascular warts from the surface, unchecked bv escha-

I860.] Diseases of the Eye. 678

rotics or astringents. Here is the case, and the only one,

in which you can resort to the knife with advantage, hut
to do so requires a keen blade and delicate hand ; no lancets
or scalpels will do; you must he provided with this little
scimitar with convex edge and probe point, yon see it

is about an inch and a quarter long, slightly curved, and

should be sharper than a razor; something of the kind is
to be iound in eases of eye instruments, for enlarging the
.section of the cornea in extraction. Having everted the lid
perfectly, and dried it with a clean soft bit of old linen, wait
a little until all spasmodic squeezing of the orbicularis palpe-
brarum ceases, the learned call it blepharospamus, and then
lay the flat of the blade to the edge of the crop of granula-
tions, as you would a scythe to the grass, and mow away ;
sliding the blade hack and forward until you shave off a
good slice, and replacing the lid and leaving it to cease to
hleed while vou attend to something else. After some
time evert the lid again, remove the clot of Mood, and
take off another slice if you can, and then adjourn the
treatment for a week, advising light water dressing when
the parts become inflamed and painful, and interdicting
exclusion of light or confinement to the house. But all
this will not cure your patient, it is little more than a pre-
paratory process, although Sir William Adams some fifty
pears ago thought otherwise, and as the story went in those
days, hacked by our versatile Prime Minister, who, you
know, is at everything in the ring. After a week or ten days
you must follow up this preliminary proceeding with the
escharotics, the two most popular being nitrate of silver or
sulphate of copper, "the caustic or blue-stone*' of dis-
charged soldiers, touching each remaining patch of granu-
lation delicately with a fine point, and not scrubbing the
entire surface as if you were scouring a flag; and so pro-
ceed at intervals of forty-eight hours until you level the
surface. But you will often find that in all this you have
heen more or less anticipated, and that you have nothing to
do but to finish some other man's work, in which case, or
in a case where the granulations are not prominent enough
for the knife, you have to handle the escharotics more
freely ; this, in fact, will he your business in a great major-
ity of cases. What escharotic, then, are you to choose,
and how are you to use it? The two most popular, as I
have said, are the "blue-stone and caustic," and either
answers the purpose, as our dispensary proves, for every
day we see cured or half-cured cases treated with these
a

<)74 Diseases of the Eye. [September,

remedies, and especially by the former. Where the granu-
lations are visible, tangible, and distinct, I prefer the nitrate
of silver, although requiring more care in its application,
it is more decisive in its operation, more easily controlled
in its effects, and more within reach of counteraction if
spreading in the application. To apply it neatly and effect-
ually, you should be provided with small and large points
of it, according to the state of the surface ; small, to touch
separate granulations here and there ; large, for complete
dressing of the whole face of the lid. As I have directed,
having everted the lid, dried it, and steadied it, take your
pencil of caustic, and rub away freely with it, for rub as
you may it does not sink deeply into the structures beneath
like alkaline caustics, it forms a tough layer, which pro-
tects the parts below: but for fear of accident, have some
solution of iodide of potassium at hand to decompose any
of the salt which may remain on the surface, and wash
freely with a large camel-hair pencil and plenty of water,
for woe to the patient if you turn a causticed eyelid in on
his cornea. After this let the parts rest for three or four
days to allow sloughs to clear off and surfaces to heal; and
then, if necessary, repeat the application. The sulphate of
copper may be used more freely, for if a true escharotic at
all it never leaves marks of destruction behind it, or sinks
into the subjacent structures; you may, in fact, rub away
freely with it as surgeons in general do, but wash it off with
having a little soda or potash in it to decompose the excess
of salt. Do not, however, be too sure of pleasant results,
especially in private practice, for sometimes severe inflam-
mation follows, and great abuse of the doctor ; and recol-
lect, that if you would cure these cases, you must stick-
to them until you polish them off, for if you leave any
granulations behind they will keep up the old irritation.
Kecollect, too, that after the surface is made as smooth as
glass, the cure is not yet complete, and your patient must
wait a long time, for the long-established vascularity and
irritability of the entire conjunctiva continues for months,
and nothing but time effects a perfect cure. What else
have we to expect, seeing that our cure is but a mutilation,
leaving the surface without its source of mucous, and a
cicatrix instead of a perfect patch of glands. You hear
me tell discharged soldiers to return to their native places
and to undertake any labor they can accomplish in the
open air, regardless of occasional temporary returns of
inflammation: this T call sending: them to grass: :lt nil

I860.] MdrPraci 675

events, tell them to shun hospitals and poorhouses as they
would the place which is paved with good intentions, li
is the hospital which brings the soldier to all this, and if
ever you come to have influence as army Burgeons recoiled

what I say, and endeavor to contrive sonic plan which will
keep a man with a sore eye out of it. Keep him even out
of guard-rooms and barrack-rooms, hut let him attend
parades and other out-door light duty, put him in a clean
fVcsh hut or under canvas-, and the less doctoring the
better. I have not said half what I have to say about this
granular conjunctiva and its causes and consequences ; it
is the great Irish difficulty in our line, and must he en-
countered by every man who has to do with dispensaries
or workhouses, so do not he thinking that you can escape
from the consequences of ignorance when the time arrives
for action.

Mai-Practice. By J. \Y\ Davis, of the- St. Joseph Bar.

It is important, in every profession and business, that those
who constitute it should be perfectly competent to discharge
allot' their respective duties; but in none is its importance
greater than in medicine, as the life of the patient is placed in
the hands of his physician.

For suffering humanity, we wish that it could be said that
every physician was a complete master of his profession. But
this cannot be, because all men are not endowed by nature
with the same capacity. The proficiency and extraordinary
skill posses-ed by one physician, nine-tenths of his brother
practitioners have not, and can never hope to acquire. The
question is asked, are physicians of ordinary and extraordi-
nary skill all held to the same accountability in law \ By no
means.

The law only requires the physician to exercise the skill he
professes to possess. Hence it is very easy to infer that the
duty required by law of the practicing physician is simply to
confine his pretensions to his natural ability and acquirements,
and to use ordinary care and diligence in their exercise.

This rule for the government of the physician is a simple
one, and its justice must be evident to every mind. In unset-
tled and out of the way places, the very best medical services
cannot be obtained, and if a bone is broken, no surgeon- can
be had to set it ; then, let the physician that such a commu-
nity may maintain perform the operation ; never assuring the
patient that he will be as well treated as if he were in the
hands of a Gross, or a Pancoast, or that his arm will never be

67 6 Mal-Praclice. [September,

stiff. But rather let him remember that lie possesses but little
skill and experience, and let his acts and words be governed
by this recollection, and he will leave little foundation for a
suit for malpractice, even if his treatment does fall below the
standard of ordinary skill.

In sparsely settled communities, where there are no sur-
geons, the physician can with impunity hang out his sign let-
tered " physician and surgeon." For though he never set a
bone, or dressed a wound in his life, some one may be shot or
crippled to-morrow, and if he don't attend him, who will i
Xecessity, then, allows such an assumption, and if such a
physician, in such a locality, is besought by the sufferer, as a
" dernier resort," to perform a difficult operation, and he per-
forms it with less than ordinary skill, the law would deal with
him leniently. If a city physician should perform such an
operation with less than ordinary skill, the law would hold
him to a strict accountability. For a skillful surgeon had an
office next door, and there was no necessity for the physician
performing the operation common honesty required him to
send the patient to the surgeon. Every one is the best judge
of his own capacity ; and, if honest, he will measure it cor-
rectly, anil hold himself out to the world accordingly, and his
works will never get him into trouble. That his works should
correspond to his pretensions, is all that the law requires of
the physician. It will not permit him to excuse himself be-
cause he was ignorant, or because he exercised all the skill he
possessed,, but hold him rcsj^onsible at the high-water mark of
his pretensions.

As intimated before, the law does not demand of the phy-
sician extraordinary skill, such as is possessed by men of rare
endowments and attainments, but only such ordinary skill as
characterizes the profession. This skill, however, must be
exercised according to the best and latest authorities. The
law will not tolerate crotchety notions, nor permit a physician
to say that he followed the old practice ; every physician must
keep up with the times must follow the latest and best treat-
ment.

What lias been said, however, must be understood with
some qualifications. In all implied contracts, the work done
is only to be in proportion to the money paid, or to be paid,
for it. So, to some extent, the fee paid may serve as a rule
to measure the amount of skill to be employed. If a man is
so parsimonious as to pass by the office of a physician he knows
to be skillful, in order to get the services of a cheap doctor,
if he thinks so little of his life and limbs, as to hazard them
in order to save a few dollars, he could not expect the law to
place a very high estimate upon them.

18(10.] MaUPracUce. 677

Also, the question will be submitted to a jury as to whether
the patient sought the physician, or the physician the patient
i. e. it' a man goes to a physician and asks for his medical
services, then the physician is looked upon with favor; but
where a physician hunts up a patient for instance, a man
with a still" joint, tells him that he can, by operating, takeout
the stillness, that it is necessary that the operation should be
performed, and thus induces the operation then, the physi-
cian is strictly answerable, (and, J. apprehend, without the
sympathy of his fellow practitioners,) if he is guilty of mal-
practice. For it may be considered in medicine, what main-
tenance is in law, and also because it is meddling with good
enough ; the stiff joint, though an inconvenience, could not,
probably, in any way be fatal to its possessor.

It is with pleasure that we reflect that the standard of ordi-
nary skill is higher than it used to be that in our day an
impostor, like St. John Long," cannot deal out suffering and
death, in allopathic doses, and in every case have a verdict of
"not guilty:'' that no judge will now dare declare from the
bench, as Lord Ellenborough once did, that a physician might
mistake the uterus for the placenta, tear it out by reason of
this mistake, kill the woman, and yet not be guilty of gross
negligence. At the present day, no excuse is to be found for
an error of this kind.

This change in Medical Jurisprudence is highly beneticial
in compensating those who may be_ victimized by quacks, and
in checking, if not suppressing, empiricism itself.

While such a change has taken place, it is gratifying to
know that our courts now, as ever, regard suits for mal-prac-
tice without favor, and show no disposition to encourage this
class of litigation ; and in this the courts are supported by a
large majority of the members of the bar.

Members of the bar can prevent many malicious and un-
founded suits ; this they can accomplish, in a great measure,
by informing themselves thoroughly upon all the facts in a
case, outside of the mere statement of their client, and be sat-
isfied in their own mind, by evidence that cannot be doubted,
that there has been a case of mal-practice, and then, and not
till then, consent to prosecute the case. If every attorney
would take this precaution, many suits for mal-practice would
never be instituted; and we are pleased to sa}r that the mem-
bers of the bar, generally, adopt this precaution, and that suits
tor mal-practice are now of rare occurrence. AVe arc con-
vinced that it is but just that they should do so, when we re-

* Vide Rex vs. John St. John Long. C, & P. 423 . 6 Bingham , -I -J u.

678 Mal-Practicc. [September,

fleet that the investigation and management of animal life" is
peculiarly the province of medicine, which it is impossible
to fully understand. Sir Gilbert Baine says:* "animal life
is not only the most complicated department of nature, but
the most vague, for besides being more or less subject to me-
chanical agencies, it possesses such a number of attributes,
peculiar to itself, and those of such a varied and fluctuating
nature as to put their influence and combination beyond the
reach of all calculation, and so as to present the most formi-
dable and discouraging obstacles to those who may propose,
apriori, to predict or control its operation, whether in health
or disease." In inanimate nature, we can establish with cer-
tainty rules for its government. The intellect of man has
brought all things to a degree of certainty; but this certainty
holds less strictly in the living human body than in any other
subject in nature which the intellect of man has contemplated
and studied. With all of man's learning, lie cannot give }Tou
a certain opinion, nor treat with certainty, any object, -unless
he can either obtain complete control of it, or unless it is gov-
erned by fixed and immutable laws. It was truly asserted,
by a learned man, that there is nothing certain outside of pure
mathematics. The chemist, by reason of obtaining control of
the mineral and vegetable products of the earth, can, by his
learning, tell you the result of exercising that control. The
astronomer, without having the control of the planets, and
being distant thousands of miles, will tell you what they will
do for ages to come, simply because the planetary system is
governed by unchanging laws. But the human body is ani-
mated by the flat of the Almighty, and He alone has absolute
control of it and there are no certain and immutable laws
for its government there are just as many constitutions and
temperaments as there are human bodies. Such being the
ease, the great difficulty and uncertainty attending the prac-
tice of medicine and surgery at once address themselves to
every intelligent mind, and should enable the lawyer to fully
comprehend all the embarrassments and impossibilities attend-
ing the practice of a noble sister profession.

Mr. Ehvell, in his treatise, justly observes: "If a lawyer
is clearly satisfied of these difficulties, as he certainly will be
by looking into their causes, very much vexatious and ruin-
ous litigation would be prevented, and worthy and intelligent
men be left unmolested to pursue their important professional
duties." But it may be said that if a physician is innocent of

* Ehvell, 38. Elmt. Med. Knowledge, London. 1825.

L860.] Mol-.hu,;. 67U

mal-practice, he will be acquitted, and he jured there-

by. Not so. [f the fonl breath of Blander touches the ro
of chastity, the purest innbcency, thrice proved, will not erad-
icate the stain: so, if a professional man is impleaded,

matters not it' the jury do acclaim him innocent, without ri
from the box; the fact that lie was once on trial for mal prac-
tice will live as long as he lives, will follow him wherever he
goes, and he will always afterwards be regarded with a degree
of suspicion and distrust he is no longer known among the

people as Dr. , (especially if he is so unfortunate a

have a name that is difficult to remember,) bur is known as
the Doctor they had up 'fore Court for killing Squire J<<
son: and the longer the physician lives, the worse does it mil-
itate against him ; for at iirst there were those who remem-
bered all about the trial, but in course of time they grow I
and in nine cases out often, any one inquiring about the trial
would receive the reply : u I've heard them say, that a long
time ago, he was up before Court, and that's all I know
about it."

Wo do not wish to be understood as desiring, under any
circumstances, to screen the physician ; on the contrary, we
are willing and anxious always to visit upon him the penalties
of the law, if he is guilty. We would gladly second a propo-
sition to transport the whole tribe of empirics and quacks that
infest, the medical profession from earth, if it were possible,
and there was any place in the whole universe, above or below,
where they could obtain admittance. But, as we have before-
said, the physician is injured by going through atrial, and out
of justice to the profession they should not be impleaded unless
it is certain they are guilty.

The premises considered, how important is it, then, that the
physician should be sufficiently well acquainted with the law,
to "thoroughly understand his responsibility ; and that the law-
yer should understand sufficiently of medicine to know and
appreciate when, and under what circumstances, he should
consent to prosecute a suit for mal-practice.

We have before us an excellent medico-legal treatise on
mal-practice and medical evidence, comprising the elements
of medical jurisprudence, by J. J. Elwell, M. ii., of the Cleve-
land Bar, to which we have made reference in this cursory
article. We have not examined the wTork thoroughly, but we
can state that the subject is well treated, and contains quite a
number of leading cases, both English and American, and we
do not hesitate to say that it is a work that should have a
place in every legal and medical library. St. Joseph (J/<>. \
Journal of Medicine c& Surgery.

680 Effects on Children of Mercurial [September,

The Effects on Children of Mercurial Treatment of Syphilis in
their parents. By Dr. F. C. Faye.

At a time when the opinions of medical men as to the util-
ity of a mercurial treatment in constitutional syphilis appear
to be very contradictory, as lias moreover been the case seve-
ral times during the course of the last few centuries, it appears
to me that it ought to be of great importance to obtain the
well established result of numerous medical observations of
the state of health of children born of syphilitic parents who
were treated by mercury.

We know very well that a great number of these children
have been impregnated with the dyscrasia ; and we also know
that new modes of treatment, from which mercury is excluded
have failed to produce the wished for results in children ; and
especially, that the treatment by inoculation with chancrous
pus, (otherwise called syphilization,) and the simple derivative
method, have disappointed our expectations in this respect. It
is clear that the absolute condemnation of mercurial treatment
of late years pronounced by some physicians, ought to be
based on something else than superficial appearances ; and
that in order to be final, the comparison between the two
methods ought to be carried out with precision and accuracy.

The surest and most simple proof of the cure of syphilis the
I rue tonchtone showing that the disease is destro}Ted, or at
least so neutralised in the system that the function of the ova-
ries and testicles remain intact, should undoubtedly be sought
for in the circumstance, that the children of parents who have
been born healthy, and do not subsequently become affected
in any way evidently attributable to the syphilitic dyscrasia.

The time has not yet arrived for deciding to what degree
this test, important as it is both in a humane and therapeutic
point of view, shall afford a satisfactory result with respect to
several new non-commercial modes of treatment; but on the
other hand, we have the experience of centuries to show, in
contradiction to the repeated condemnation pronounced by
the anti-mercurialists, that many children produced by syph-
ilitic parents, who have been suitably treated either by mer-
cury alone, or with mercury, assisted by other remedies, have
been born without any trace of the dyscrasia, and have con-
tinued healthy a favorable result, which is obtained more
frequently when the father alone has been affected. On this
point we must ever remember, that the father may, although
imperfectly cured, sometimes procreate a healthy child with
a woman who is perfectly sound.

To enable us to judge with certainty, and to base our opin-
ion upon an extensive induction, it is necessary, I think, to

186(X] lYeatment of Syphilis in Parents. 681

draw not only upon hospital, but alBO upon private practice, to
ascertain the effect <>t* mercurial treatment upon children. I,
therefore take the liberty of requesting each practitioner who

is interested in these questions, and who is in possession of
well established tacts bearing on them, t<> he good enough to
communicate the results of their experience in Borne mode,
and to give me the references necessary to enable me to find
them, it' they are already published. I would also request
the several medical societies, and editors of journals, kindly to
assist in the publication of the wished-for researches. What
I should desire to be briefly informed of is as follows : How
many children born of syphilitic parents who have been treated
with mercury, have come into the world healthy and have
continued so, and how many have succumbed to the dyscrasia
or have been successfully treated (

Also, how far the observation, long since made, has been
found correct, as to the favorable effect on the health of the
children of mercurial treatment undergone by the mothers
during their pregnancy, when these mothers have previously
produced syphilitic children? However, we must here bear
in mind the remarkable tact, that women may purify them-
selves by repeated accouchements, and may finally give birth
to healthy children after having had several diseased ones.

In order to attain the above object more completely., it is
very desirable that the report should state whether the father
or the mother, or both have been affected. In this mode we
may more fully test the accuracy of the generally received
opinion, that fathers who have undergone treatment produce
healthy children more frequently than mothers, even appa-
rently cured. To obtain conclusive information, it will not
suffice to observe the children of the lower classes of the pop-
ulation who have been treated in hospital, because the mem-
bers of these classes often^lead an irregular life, and are ex-
posed to relapses. Persons in easy circumstances, on the con-
trary, who have been treated at home, and subsequently had
several children born in wedlock, are more under the control
of the physician, and we may have more confidence that the
results of observation will, in such instances, possess a real
value in enabling us to judge of the influence of anti-syphil-
itic treatment upon children.

It is, therefore, to my brethren in all countries, and partic"
ularly to those engaged in private practice, that I have the
honor of addressing my request, to collect their observations,
which I should wish to arrange, as soon as I shall be informed
of their publication, or shall have them specially sent to me

882 Ireatonent of Abscess. [September

bo as to render them subservient to a comparison of the model
of treatment in different countries. Dublin Quarterly Jour-
nal.

Treatment of Mammary Abscess,

A discussion upon this subject arose at the Boston Society
for Medical Improvement. Dr. Cabot observed that this ab-
scess was due to a peculiar cause, which made it differ from
common abscess, and rendered it less amenable to treatment.;
The anatomy of the breast, with its milk tube- radiating from
a central depot has been compared to the fingers of a glovd
radiating from the palm. The inflammation caused by the
plugging of one of these tubes, backs up until it reache-
depot and then runs down the other tubes. He thought that!
bandaging the breast, so as to insure complete support, w.
great benefit. Dr. Stevens had never seen mammary abs
cured by external applications. Dr. Clarke spoke very highly
of the application of leeches during the time between the
chill and the existence of the pain, or when pain is only felt
<>n pressure. By such application the abscess may often he
abated. Dr. Buckingham thought that nineteen out of twenty
of these abscesses are the result of meddlesome interference.
He strongly objected to rubbing the breast, or applying the
breast pump as soon as any pain is felt. It should be let en-
tirely alone, the child only being applied to the well side, and
its nursing will cause milk enough to flow from the affected
side to relieve it. If both breasts are affected, the child should
not be applied to either. They will swell and grow painful
for twenty-four or thirty-six hours, when a tlow of milk will
relieve them. Even after the formation of pus the let alone
treatment is the best, the application of leeches only increas-
ing the pain. He thought the same method should be follow-
ed with sore nipples. The child should be nursed from the
well side, and the milk allowed to flow from the affected side.
If there is much pain, extr. belladon. of a cream like consist-
ency, applied to the areola with the linger, gives some relief.
Woman with dark nipples rarely have them sore, while those
with pink ones are very liable. He regarded the various
tringent washes used as preventatives as injurious, by remo-
ving the oil which is secreted for the protection of the nipple.
The application of oil prior to labor, is of more service than
anything, possibly because it prevented the patient using mis-
chievous washes. Dr. Putnam thought that it was good

18ti0.] Treatment of Abscess. 683

to leech, and to keep the breast moist and warm after a chill.
After the woman stops nursing he often applies a bland, soft
ointment, in order to cause the nurse and others to let the
breast alone. Re observed that the apparent uncertainty of
treatment arose from not considering the exact condition of
the breast. In some cases the milk tubes were obstructed,
while in others the inflammation was in the cellular tissue. In
either case, it' seen early, free leeching was of great advantage
and next to this he had derived most benefit from cold appli-
cations, acetate of lead, lotion-, etc When small knots were
formed, gentle friction was of use, and it was good practice to
open the milk ducts when they were manifestly distended :
one objection to the let alone treatment was, that by keeping
the child away too long the secretion might fail altogether.
He thought that blistering was only the let-alone treatment
by compulsion ; for the patient would be very careful how
she touched the blistered surface, whatever the amount of
distension. Dr. K. II. Clarke spoke in approbation of the
let-alone treatment, which he had followed for three or four
years, lie, used leeches occasionally after the chill. Dr.
Reynolds stated that he had had several opportunities of treat-
ing threatened inflammation of the breasts according to Dr.
Buckingham's plan, and had been satisfied with the results. In
only two out of fifteen or sixteen eases had suppuration oc-
curred. Patients did not usually object to the method on
account of the pain it gave rise to. being willing to submit to
anything which promised an escape from suppuration. Dr.
Reynolds questioned, however, whether in cases in which great
traction of the nipple existed, the old plan of drawing this
out. and rubbing the breast with oil, was not the best. Dr.
Parks had followed the let-alone plan with very satisfactory
results. He applied it only to those cases in which there ap-
peared to le distension of the breast from over-secretion, ami
using the common method in obstruction of the ducts or com-
mon inflammation. Dr. Coale thought that it would bo a
difficult matter to get patients to wait thirty-six or forty-eight
hours. The pain was usually . and the whole system

in an irritated, excited state, which made the Buffering more
intolerable, lie had been very well satisfied with the results
from gentle friction with camphorated oil, very sensitive
lumps being dispersed by these in a few hours. The friction
should be gentle, and prolonged for fifteen or twenty minutes
at a time. He could call to mind cases in which the breasts,
painful and distended breasts in the morning, became relieved
by the evening or next, morning. In more advanced ca
blistering tissue was applied closely over the breast, and fire-

684 Holopathy. [September

quently gave great relief by the amount of fluid discharged.
A part of the harm done by breast-pumps was due to their
faulty shape, and they ought not to be used at all as now
made. The sharp edge of the cup presses upon the tubes as
they enter the nipple, and obstructing the flow of milk, de-
feats the very object for which the pump is employed. Dr.
Bowditch considered that the wash of the acetate of .lead was
of use in diminishing or arresting the secretion ; and in some
cases this effect had been produced sooner, and more com-
pletely than was intended. Dr. Sargent had not understood
Dr. Buckingham to say that suppuration would be avoided
in all cases by letting the breast relieve itself, but that a dis-
crimination must be made between those cases in which in-
flammatory exudation had, and those in which it had not,
taken place. In the latter, suppuration might always be
avoided, and in the former it was, to say the least, not mure
likely to ensue if the breast were let alone. Dr. Minot
thought that the formation of abscess was sometimes pre-
vented by strapping. It was his habit, after the chill, to
compress the breast in this way, and to give a cathartic in
order to induce watery stools. This course had seemed id
some cases to have prevented threatened suppuration. Dr.
Clarke, on the other hand, had tried strapping without avail,
and thought that in a few instances the early use of leeches
prevents suppuration, although this usually will occur. Dr.
Parks, referring to Dr. Clarke's opinion that a really inilamed
breast was rarely, if ever, prevented from suppurating, ob-
served, that although this was true as a general rule, cases
did occur in which there were chills, with pain, redness, and
swelling, but not resulting in the formation of pus. He had
lately treated several cases of acute engorgement with quar-
ter-grain doses of antimony, producing nausea and vomiting,
with relief to the symptoms, which had been very severe.
Boston Medical de Surgical Journal^ vol. lxi. pp. 102 105.

Holopathy. The Lancet says that a distinguished physi-
cian of Paris, M. Marshall de Calvi, is now lecturing on a
new medical doctrine, to which be has given the name of
holopathy.

He considers that diseases are only phases or episodes of
a general affection of the organism, which affection or
diathesis produces the episodes when circumstances favor
their appearance. The lectures, it is said, arc creating
some sensation in the French capital.

i860.] Hypophosphites in Disease, 685

Hypophosphites in sorm Conditions of Diseasi in Ymng Chil-
dren. By 0. 0. Gibbs, M.D., Frewsburg, X. 5f.
November 15th, 1859, we were railed to see a female child,
aged 11 months. The child was of a decidedly scrofulous
habit, had from the first few weeks of life been troubled
with scrofulous sores and cutaneous eruptions: bu1 at pres-
ent it was suffering from an attack of pneumonia. The
general and physical symptoms were all well marked. We
ordered syrup of ipecacuanha, spirits of nitre, and paregoric
in appropriate docs for internal remedies, and applied
mustard to the chest. The patient was closely watched, vet
the symptoms gradually increased in severity. On the third
day, syrups ipecac, and liquorice were given in combination,
ami powders composed of Dover's powder, quinine, and
small doses of the chalk and the mercury mixture were
added to the treatment. The symptoms still increased in
severity; though the skin was moist, the cough was trouble-
some, the pulse very frequent, from 130 to 140, and unplea-
sant head symptoms began to manifest themselves. The
ipecacuanha was abandoned, and the iodide of potassium
was substituted, and wine or brandy was soon superadded
to the treatment. In spite of treatment, great prostration
came on, the pulse was very feeble, and so frequent as to be
with difficulty counted. The patient was seemingly un-
conscious of all surrounding objects, a constant moaning
was kept up, the arms were constantly sawing the air.
muscular spasms were occasionally observed, and the eyes
were either strongly drawn to one side, or strabismus was
added to the list of ominous symptoms. The eyes were
generally open, yet at times there was no evidence of seeing.
The pupils were sometimes greatly dilated, and at others as
preternaturally contracted. The pectoral symptoms were
upon the decline, the cough was less, and the physical signs
gave evidence of an abatement of the original disease ; yet
all hopes of a favorable issue grew less day by clay. A
blister was applied over the cervical region of the spine, and
croton oil applied over such places as had been the more
jonimon sites of the former cutaneous disease, with the
liope of establishing an eruption not unlike that which for
[jtwo or three weeks had passed away. Iodide of potassium,
[uinine, small and frequently repeated doses of opium for
its stimulating effect were continued, and milk punch and
beef tea were administered liberally.

On the evening of the 23d, the eighth day of treatment,
we left our little patient, informing the mother that death

686 /7///" 7'/ ospkites in jD&a [Septembei

would probably end the child's sufferings before morning:
It was with much sorrow and regret that we gave this un-
favorable prognosis. The parents were our intimate friends,
and the patient was an only child. To please a friend of
the parents, we had been asked to consult with a physician
of limited study, and still more Limited experience, and who]
previously, in his intercourse with us, had so shamefully
disregarded all principles of professional honor, that we
were compelled, on this occasion, to decline the solicited
consultation. Death, under such circumstances, would givfj
unfriendly influence an opportunity to incite complaining!
and regrets. If other influences were wanting to nerve us
to the fullest extent of our energies, it might be found in
the fact that, though in quite active business, for more than
two years, we had not lost a patient under sixty-live years
of age, and we were desirous <>f protracting that, interval to
the utmost.

On <tur way home, wc mentally reviewed the symptoms
and the treatment from the beginning. That the pneumonia
was gradually subsiding there could be no doubt. It was
quite probable that there was no inflamation about the cere-
bral meninges, and that there was no effusion upon, or
within the brain. It was probable that the symptoms arose
from ancerma, and that death was about to take place because
the nerve centres did not receive the requisite stimulus.
Yet wdiat treatment better than that in use could be brought
in requisition, unless we practiced transfusion ? This last
we had never practiced, and were unwilling to commence
in so young a patient. A more decided nerve stimulant
and tonic was wanted. Was it to be found in our list of
remedies '.' Strychnia was thought of; but could so power-
ful a remedy be safely administered, in a child so young,
with hopes of beneficial results sufficiently speedy for our
purpose ? Reflecting thus, a conviction came over us, with
the assurance almost of prescience, that the syrup of the
hypophosphites of lime and soda was the best remedy in the
Materia Medica, to meet the indication presented in this
case under consideration. The brain and spinal marrow
contains phosphorus largely, and it is quite probable that a
remedy that will supply it in an immediately available form,
will supply the stimulous desired. So plausible was this
reasoning to our mind, at the time that we returned imme-
diately back, and in the darkness of a stormy night sought
our little patient again. In addition to the treatment for-
merly advised, we ordered five drops of the syrup of the

I860.] Dimfecka

hypophosphites of lime ami soda, to be repeated every two
hours. \Vc urged a persevering use of remedies, however
discouraging the circumstances, until death or improvement
should take place.

i > 1 1 the following morning we found our patient apparent-
ly somewhat improved. The moaning was less, the Btrabis-
mus and spasmodic drawing of the eyes to one Bide had
passed away, and the sawing of the air with the hands was
pouch diminished. Though the prostration was great, and
the symptoms still very alarming, yrt thegeneral expression
was one that gave us reasou to hope still for a favorable
sue.

The treatment was continued, and the patient made a
rather slow but perfect recovery.

We are aware that any conclusions drawn \h>\u one case
would he as likely to be false as true, and our readers are
left to draw their own conclusions from the ease. The
reasonableness of the treatment of hydrocephaloid Risease.
with the hypophosphites, connected with the prompt and
satisfactory result in the above case, have induced us to
report it. Subsequent experience only can determine the
value of the remedy.

1\ chnical Chemistry. Disinfectants.

The use of a mixture of coal-tar and plaster-of-Paris for
purposes of disinfection and for dressing wounds, as pro-
)Osed by Corne and Demeaux (Comptes JRendus, xlix, 1*27 ;
see this Journal, xxviii, 425), has been recently reported
upon in the French Academy by a committee Chevreul,
J. Cloquet, and Velpcau (rapporteur) to which the subject
was referred in July, 185(J.

The great interest, which this method, so favorably com-
mented upon by the distinguished sura-eon Vclpeau soon
liter its publication, excited among the medical men of
France gave rise to the publication of numerous other sys-
tems of disinfection, which being submitted to the Academy
or its approval were also referred to the committee, in
niestion. The labors of its members have thus been imp-
erially increased, and their report swelled to the dimensions
>f a general treatise upon disinfectants especially those
applicable to wound-.

In numerous experiments made at the Hospital dt la
Zharifr the mixed coal-tar and plaster of Corne Was exploy-

.

688 Disinfectants, , [September,

ed, both in the state of powder and as a poultice made by
mixing it with oil. When applied as a thick layer, three or
four times a day, upon putrid, gangrenous and sanious
wounds, the powder destroyed their odor without giving rise
to any special pain. CJpon indolent sores, however, or upon
recent burns the contact of the powder produced consider-
able smarting upon some patients, though well borne br-
others. AVounds of the first class were often found to be
cleaned as well as disinfected ; Avhile those of the second
class generally acquired a dirty, pale, gray tint, their cicca-
trization being hindered.

The poultices were found to be more advantageous than
the powder in the treatment of cavernous wounds, purulent
or fetid, and sinuous fociopen suppurating abscesses, anthra-
coidal suppurations, etc.

Applied directly to the sore, the poultices destroyed the
putrid odors, allayed the inflammation without augmenting
the pain, leaving beneath them a healthier pus, and the
surfaces in better condition. In a word, the mixed coal-tar
and plaster, when properly applied, disinfects wounds and
putrid suppurations. As for the absorbent and detergent
qualities which its inventors also claim for it, these are less
clearly evident.

The powder absorbs better than the poultices, the latter,
it is true, take up a portion of the morbid exudations, but
unless the dressing is carefully renewed, five or six times a
day, pus will nevertheless collect beneath it. From this it
follows that after having been somewhat cleansed the wound
ceases, at the end of a few days, to clean itself, or to heal
more rapidly than it would with the usual topical applica-
tions.

Upon ulcerated cancers, the mixture, either as powder or
poultice, disinfects them partially, but neither dries up the
suppuration nor alleviates the pain.

It is in the dissecting-room, upon organic matter in a state
of putrefaction, that the mixed coal-tar and plaster is all
powerful. The most infectious masses, when imbued with
the powder, or simply rolled about in it, lose at once their
disagreeable odor. According to Yelpeau, his autopsy room
was as approachable towards the close of last summer as it
had formerly been repulsive. It was freed from flies and
other insects, as well as from putrid odors.

Although it would have been out of the province of the
committee to experiment upon the application of this mix-
ture in disinfecting filth upon the great scale, they have

I860.] Disinfectants.

Nevertheless proved thai it can be advantageously used in
hospitals for deodorizing urine or fecal matters.

The following inconveniences, to which the use of the
mixture in surgery would give rise, are enumerated:

It not only soils the clothes of the patient, but hardens
them and causes them to weigh more heavily upon orabout
the wound ; it imparts to the bandages, with which the
poultices are covered, a very tenacious rusty or yellow color;
it must he frequently renewed, and although it destroys
putrid smells, it retains a bituminous odor by no means
Agreeable to many persons.

These inconveniences are of comparatively slight impor-
tance, it is true, and may possibly admit of being remedied.

Of the other disinfectants submitted to the committee,
several were only modifications of that of Come and De-
meaux: Vegetable tar, as shown by Renault, may be sub-
stituted for coal-tar. A mixture composed of hydraulic lime
and tar did not disinfect wounds to which it was applied,
nor could it be supported by the patients. With regard to
the assertions of some practitioners, that common earth,
talc, flour, or other vegetable and mineral powders even
poudrette when mixed with coal-tar furnish a more con-
venient and less costly disinfectant than that prepared with
plaster, the experiments of the committee have proved that
while coal-tar, mixed with common earth, well dried, or
with sand, is equally, or perhaps much more, efficacious for
disinfecting fecal matter as when mixed with plaster: that
while comparative experiments made from the point of view
'upon sulphate of lime, clay, charcoal, linseed meal, and
earth have resulted in favor of the latter, the same is by no
means true in surgery. When applied to wounds or infec-
tions suppurations these different mixtures were only par-
tially successful, having proved to be less efficacious than
the mixed plaster and coal-tar. In like manner the pro-
posal to use an emulsion of coal-tar and tincture of saponine
has not been found advantageous in practice; most patients
eomplained of it, their wounds exhibited scarcely anything
satisfactory, while the disinfection was very imperfect. The

Knixture of plaster and coal-tar was substituted for it, upon,
he same wounds, with decided advantage.

Although the modifications of Corne and Demeaux' pro-
cess have not been particularly felicitous thus far, they have
evertheless served to confirm the fact that in reality it is

44

690 Disinfectants. [Septembefrj

the coal-tar which acts the principal part as disinfectant in
these various mixtures.*

Among- the numerous other substances proposed as dis-
infectants, or for dressing wounds, the following have not
afforded satisfactory results:

( liloratc of 'potash, mixed with clay or kaolin (for
ample, 10 parts of chlorate to 90 parts of white clay or fine
sand) which was proposed as an absolute disinfectant,
neither disinfected nor absorbed the pus of fetid wounds.
The mixture would be in any case much more costly than
coal-tar and plaster and certainly less efficacious.

Whites <>f eggs, mixed with chalk and applied to wounds;
previously oiled, succeeded no better than simple-cerate.

Powdered sugar. When employed in layers upon ulcers
forms crusts, beneath which the suppurations accumulate
and hinder the process of healing.

Cherry-laurel water, glycerine and cellulose. According to
Antier, glycerine mixed with equal parts of cherry-laurel
water forms a valuable absorbent or disinfectant to be ap-
plied as a lotion or injection. This mixture converted into
pomade by mixing it with powdered almonds was also pro-
posed as a topical application for all kinds of wounds. But
in the hands of the committee neither the licpior nor the
pomade by themselves or mixed with kaolin produced any

* The inefficiency of sulphate of lime as a general disinfecting agent when
used by itself may be readily demonstrated by the following experiment which is
of interest in view of the fact that a belief in the utility of gypsum as a deodo-
rizer appears to be widely spread among recent writers. For that matter we are
i old by Paulet [Comptes Rendus, xlix. 190] that during the last 25 years more
than fifty authors of processes of disinfection have announced, each as he be-
lieved for the first time, the use of plaster as a means of disinfection.

If a mixture of about equal volumes of powdered gypsum and fresh urine be
introduced into a small phial, the mixture placed in a warm room and thorough-
ly shaken several times a day until the urine has become putrid, it will be ob-
served that an exceedingly disagreeable odor will be developed, differing from
that of ordinary stale urine inasmuch as it is unalloyed with the odor of am-
monia. For the complete success of this experiment it is important that a large
excess of sulphate of lime should be present and that the mixture should be fre-
quently agitated, else the whole of the carbonate of ammonia will not be decom-
posed and will tend to mitigate the fetor of the special odor of the putrid urine.
So far from disinfecting in this case the sulphate of lime really destroys a deo-
dorizing, or at least a masking agent, ammonia : leaving free, purified as it
were, aud unadulterated, an odor, the peculiar ofiensiveness of which is re-
markable. Sulphate of iron being substituted for gypsum in this experiment
afforded a somewhat similar result, although the odor obtained was a trifle less
insufferable than that of the experimentr with sulphate of lime. It should be here
mentioned that the odors in question were in no instance contaminated with
sulphuretted hydrogen, a< was ascertained by careful trial-.

F. II. Storkr.

1800.]

Disinfectants. 691

effect more marked than that of lead-cerate and other anti-
putrid or detergent solutions already in use.

The members of another group of disinfectants are worthy,
in various degrees of consideration.

Among these charcoal appears in the front rank. Sur-
ls have long regarded it as one of the best antiseptics
known. Confined between pieces of linen according to the
process of Malapert and Pichot it is more readily applied
than when used as powder directly upon wounds; but the
mixture of coal-tar and plaster, which disinfects still, better
and is more cleanly, is susceptible of a simpler and a more
general application.

Coke of Boghead coal, in powder as proposed by Moride*

* In view of the claim of Moride (Comptes Rendus, xlix, 242) as well as from
its general interest the following extract from a report made to the British Secre-
tary of War by Lewis Thompson (London Journal of Gas Lighting, Water
Supply and Sanitary Improvement, 1S56, v. 11) may here be cited-

Mr/Thompson states that he has instituted a set of experiments having a
purely money basis as their exponent. The articles enumerated were each em-
ployed until they practically deodorized one uniform quantity of the same mass
of putrid sewage and the money value of the proportions thus used was deduced
either from a broker's price-list or. where this failed to give the requisite infor-
mation, by special inquiry from a wholesale dealer. The amount of sewage
operated upon in each experiment was half a gallon taken from a single tank
which had been recently filled out of a large and very offensive ditch or open
sewer. Two indications of the progress of the disinfection were had recourse to
in these experiments; one with paper dipped in sugar of lead which gradually
ceased to become brown as the deodorizing agent was added in successive por-
tions ; the other had reference to the discontinuance of any offensive smell ; and
the attainment of this last condition was regarded as the termination of each
experiment.

By this means he was enabled to draw up the subjoined table which shows at

^ glance the comparative cost of executing the same amount of deodorizing work

with each agent on the supposition that Boghead charcoal can be had at the

iirate of 3.00 |=12*.l per ton.

Tabic showing the cost of Purifying one uniform Quality of Feculent Sewage by the

several Articles mentioned-

I Boghead charcoal (coke. 53.00

N'itric acid, - 8.50

i Black oxyd of manganese. 9.25

I Chlorid of lime. - 10.7'>

i Peat charcoal, 11.00

: Subchlorid of iron (imperfect), 11.25

1 Animal charcoal. ....... 16.75

I Ohlorid of manganese (imperfect) , - - . - - 17 50

I Bichlorid of mercury, - - - - - - - IS. 00

t fmpure chlorid of zinc in damp powder, 26.00

\ Chlorid of zinc in solution as patented by Sir Win. Burnett, - - 37.00

i Sulphate of copper, - - - - - - 39.00

The sulphates of zinc, iron, and alumina; common gypsum; sulphuric, sulphur-
i jus, and muriatic acids ; peroxyd of iron, highly dried clay, litharge, and wwr-
' lust were found imperfect even when very large quantities were employed.
! Arsenious acid and creosote on the contrary, were very active: but the dnuger
jf a subsequent evolution of arseniuretted hydrogen in the first case, and the
t difficulty of diffusing an oily fiuid like creosote in the second, seemed to interdic
:he use of these substances. i H s

D [Sej

likecarboD when employed comparatively with coal-tar and
plaster, alternately upon the same patients, proved to bl
efficacious, less convenient and more disagreeable than
the latter.

M ndcharcoal, proposed by HerpinofM

irritates the wounds, disinfects badly, and soils everything
it touches.

I arboni . -proposed by the same author, appears to,
the committee to he too difficult of application in pra< I
though theoretically founded upon important analog

Bituminous WaJU 'of Visos pr by Manne, and the

mud of rivers used as a poultice by Desmartis, do not ap-
peartob f being substituted for the mixl

of Oorne and Demeaux.

The following substances have Lone ago acquired a pL
each in its own way. in the class infectants.

Tinctur ne has been employed as an antiseptic by

ital Burgeons since 1820. By modifying the surf;
to which it is applied, it usually improves the appearand
the pus, lessens its acridity, and is, to a certain extent, anta-
gonistic to putrid infections. It disinfects, however, i
incompletely, causes severe pain when applied

inds, and would be expensive it' used on a larg -
anally, the odor of iodine is neither agi*eeable nor unattend-
ed by inconvenient

ron has been used for some twelve years in
an antiseptic and as a means <J modifying cer-
tain wounds, and putrid or sanguineous foci. Without
diffusing the disagreeable odor of tincture of iodine, it
like the latter, tin- fault of disinfecting badly, of cau.;
much pain, and of acting violently upon the diseased tiss
des injuring the cloths which are soaked in it even n
than is tho case with the coal-tar and plaster.

Both iodine and the salt of iron just mentioned, are in
agents of another order; they have rendered, and <\o
still lender important - They are certainly well

worth preserving, but should not be compared with
mixture of coal-tar and plaster.

O nd other sui - which In

hern proposed at one time or another, have not realized the
expectations of their inventors: their price has been

omewhat expensive ''disinfecting fluid'- (Ledo;-
whicfa t\ led in this country -

I860.] Disinfectants.

great, their employment required too much care, or their
action has not boon sufficiently certain that they could be
t advantageously used in practice. There ig, nevertheless,
one of these which deserves special mention, viz., chli
Ever since Gfciyton Morveau demonstrated the true action
of muriatic acid upon putrifying animal matters, the efficacy
of chlorine has been rested in almost- innumerable ways.
Solutions of chlorine, of "chlorid of soda," and of "chloric!
of lime," have rendered signal services to medicine and in
the cause of public health, especially since Labarraque, some
thirty years since, indicated an improved method 01 employ-
ing them. But the odor of clorine, disagreeable, in itself, is
neither easily borne nor devoid of inconveniences. Wounds,
moreover, hardly accommodate themselves to it any better
than the sense of smell, whenever somewhat large doses ^i'
it are required.

( 'hlorinated Spongt . The idea of applying sponges saturat-
ed with chloinated solutions, directly upon purulent or gan-
grenous wounds, as suggested by Hervieux, appears to be
excellent for certain cases. Such sponges, renewed several
times per day, absorb the pus gradually as it forms better
than anything else, and disinfect the wound very well. Un-
fortunately, chlorine rapidly alters or destroys the spoi
and soon causes undue irritation. While this method,
therefore, is an excellent one for cleaning certain gangren-
ous and sinuous wounds, it is, nevertheless, inferior in mosl
instances to the mixture of coal-tar and plaster.

Sub-Nitrate Bismuth suggested by Fremy as an absorben
and disinfectant, was applied to a large number of wounds
Upon large cavernous cancers it disinfected somewhat bettei
than Peruvian bark, charcoal, or chlorate of potash, but less
than the coal-tar and plaster. By its use, however, several
bad looking wounds were cleansed quite rapidly. Since it
causes no pain or irritation, and since it neither soils
skin nor the clothes, the subnitrate of bismuth is preferable
to a multitude of other antiseptic powders: but it is useful
rather as a solidifier (mcarnatif), or dryer, than as an absor-
bent or disinfectant.

In their resume the committee affirm:

1. That coal-tar mixed with plaster, according to the for-
mula of Come, (see this Journal, xxviii, 420), can disinfect
putrefying organic matters. Mixed with alvine deject':
this powder destroys their odor, and leads one to hope that
by its aid profound reforms in the present system of main-
taining and clearing out cess-pools, &c, may some day be

694 Disinfectants. [September;

brought about. For this purpose, ordinary earth, coal-

ashes, or sand may be substituted for the plaster, as Cabanes
prefers, being at least equally efficacious.
II. In therapeutics the coal-tar and plaster lias fulfilled

only a part of its promises. As a disinfectaur^n the di-
ting-room, upon the folds of bandages, everywhere where
there is infections matter, it qualities are incontestable.
This is also true as regards putrid or gangrenous foci, fetid
suppurations, sanious wounds, ichorous putrilagenous cavi-
ties, hospital gangrene, fee.; but upon acute and exj
wounds, or upon ordinary wounds or ulcers, other topical
applications are preferable to it.

TIL Dsed with lint upon cloths, with pomades or cerate.
it has afforded no useful result, and nothing has occurred
to prove that when administered internally it has produced
the least benefit.

IV. As an absorbent it leaves much to be desired, although
it is not entirely devoid of action. When applied as a poul-
tice, in particular, it absorbs very incompletely. For that
matter the mixtures of coal-tar with earth or with other
powders, absorb still less than the mixture of Corne and
Demeaux, and are scarcely at all applicable in therapeutics.
In this connection it must not be forgotton that the morbid
liquids, and particularly pus, are very different from water.
A substance like plaster, for example, which absorbs water
strongly, might be incapable of absorbing pus. It is never-
theless true, that as an absorbent, the mixture of coal-tar
and plaster, either as powder or as poultice, is of some
upon fetid and putrid wounds or suppurations.

V. Cellulose, glycerine and cherry-laurel water: chlorate
of potash mixed with talc, clay, marl or kaolin, are neither
sufficiently efficacious, nor in application are they
venient enough to be retained in practice.

VT. The mixture of saponine and coal-tar does not appear
to be preferable for dressing wounds to many other liquids
already known, tincture of aloes for example. The same
may be said of the mixed coal-tar and charcoal of Ilerpin;
nor does it seem as if carbonic acid should be used, in
some improved method of applying it can be devised.

VII. The Boghead residue would be useful only in lack
of coal-tar and plaster. While charcoal in porous enveL
does not mould itself to cavernous and sinuous wounds with
sufficient readiness to come into general practi<

VIII. From its low price, and by its action, at once mild.
rbent, and disinfectant. a< well as by its drying proper-

860.] Disinfectants. (5SU

ties, the subnitrate of bismuth will render important ser-
vices in default of the mixture of coal-tar and plaster. It is
even preferable to this when the wounds are accompanied
or surrounded with heat or irritation.

IX. Tincture of iodine and perchlorid o( iron act rather
by modifying the surfaces of wounds and of purulent foci,
than as absorbents or disinfectants. They have their special
applications in surgery, but agents of this sort are not com-
parable with the mixed coal-tar and plaster.

X. Sponge soaked in chlorinated water can also render
good service upon pale, burrowing sores and upon gangre-
nous foci.

"We have occupied ourselves, say the committee, only with
the practical or experimental side of the question. A dis-
cussion of its theoretical or chemical bearings would have
carried us too far. Moreover, since the authors of the differ-
ent communications which have been submitted to us have
themselves neglected this for the most part, it has seemed
to us useless to treat of it at present; whether it be the
phenic acid or rosolic, or brunolic acid, or the anilin, picolin.
etc., of the coal-tar, which disinfects, is in reality of but
little importance. Science will inform us of this some day
no doubt; for the moment Ave have merely to ascertain
whether or no the various disinfectants which are brought
to us do really disinfect.

After citing the labors of various persons who ha\ e pro-
posed methods of disinfection, the* committee go on to say :
"M. Corne, and the authors indicated above, occupied them-
selves only with the disinfection and the solidification of
animal matter, having in view the preparation of manures.
* * * * It is M. Demeaux who appears first to have
had the thought of applying to fetid wounds, in surgical
practice, the powder invented, or adopted and extolled, by
, his neighbor. In addition, it is evident that here, as is the
case with so many other complex facts with which science
is enriched, there is, so to say, neither invention nor prior-
it}' for any one. The subject has been worked upon for
more than a century a multitude of savans having com-
peted with each other in studying it. Little by little the
evolution of the discovery has been effected. M. Corne dis-
engaged it from its gangue a little better than his prede-
cessors, and Demeaux, knowing, perhaps, that from time
immemorial sailors and the inhabitants of certain southern
countries often dress their wounds with tar; that tar water

696 Disinfectants, [September,

and pomades of tar are frequently employed in medicine,

has extended its applications to therapeutic-.

"Many other efforts are still necessary. In point of fact
flic results thus far obtained are merely rough outlines.
only first trials. So long as the world at large is not in
possession of a simple, easy, and economical method, ac-
cessible to every one, which shall be capable of disinfecting
immediately, and without inconvenience on the large or
small scale, dejections and tilth of all kinds, in dwellings as
well as in privies or slaughter-houses ; in dissecting-rooms
and the like, as in the sick room, upon wounds, improve-
ments will still be wanted; there will yet be room for new
attempts. While recording those of to-day and those of
yesterday upon the road already traversed, let us be careful
not to diminish the ardor of the laborers in the future, who
will finally endow civilization with a complete and general
disinfection."

Finally, certain indispensable precautions must be follow-
ed, in order to obtain from the process of Come and De-
meaux its proper effect. It is evident, from having neglected
some of these precautions, that different experimenters have
been led to believe that the method is useless. Fine mould-
ing plaster, and not the common article, should be employ-
ed. The coal-tar, which is mixed with it in the proportion
of 2 to 4 parts to a hundred, by triturating or grinding,
ought to impart to it a gray tint, without destroying its dry.
pulverulent condition. Objects to be disinfected should be
rolled in this powder until each point upon their surfaces
has been brought in contact with it. Gangrenous or putrid
sores should be covered with thick layers of it, by handfuls,
several times per day. If one is treating pus, blood, dejec-
tions, or the like, enough of the powder should be added to
form a paste of the mass, taking care to replace the first
layer of powder by another as soon as it no longer absorbs
any more. Mixed with oil to the consistence of a thick pap,
it forms poultices of convenient application, if they are made
thick and broad.

Within the limits which have been indicated the mixture
of coal-tar and plaster is a good disinfectant, and may be
recommended for use in domestic economy as well as in
hospitals. "What we have ourselves seen leaves no uncer-
tainty of the reality of this property, nor of the possibility
of its application.*' * ;:: ;: i: It remains only to draw

from it reasonable, practical consequences, either takingthe
fact as it is, or by modifying and perfecting it. Con-
Rendus, 1, 219.

I860.] Morphia m. Convulsions. 607

[For corroborating testimony, received by the committee
from various sources, the reader is referred to their report
in question. Numerous other articles upon the subject, by
different authors, may also be found in vol, xiix of the
Comptcs Bendus. p. h. s.]

Subcutaneous Injection of Morphia in a Cast of Pucrjwral Con-
vitisions. By Professor Scanzoni.

Professor Scanzoni observes that, following in the steps of
Wood, C. Hunter, and Behier, lie could record additional
cases of the success of the practice of subcutaneous injection

in neuralgias, hyperesthesias, etc., but he prefers drawing
attention to a ease ot puerperal convulsions which supports
the positions laid down by 0. Hunter, inasmuch as it proves
that we possess in the subcutaneous application of narcotic

agents a means of acting more rapidly and more certainly
on abnormal irritation of the brain than by administering

the same agents by the mouth. It will be readily allowed
that opium and its various preparations deserve the first
place in the treatment of puerperal convulsions. At all
events, the observation of a large number of cases has led
Professor Scanzoni to the conclusion that a species of in-
toxication produced by opium leads more certainly to a
favorable termination of the disease than any other mode
of treatment. Unfortunately, it is not always possible to
administer to the patient a sufficient quantity of opium or
morphia, whether this may arise from the deep coma in
which he is plunged, from the rapid succession of the
paroxysms preventing administration by the mouth, or from
the immediate rejection of the enemata which contain it.
The subcutaneous method, however, enables us to convey
into the economy a sufficiency of spium to ensure its effi-
cient action. The numerous trials which the author has
made of these injections have convinced him that, although
the effect of this means is not always persistent, e.g. that
the neuralgias are not always entirely cured, phenomena are
rapidly produced frequently in a few minutes which ren-
der the action of the opium on the brain indubitable.

The following is the case of eclampsia in which this prac-
tice upon the foregoing grounds was resorted to:

D., aged 21, a robust primipara, was brought into the
lying-in ward at eight o'clock on June 8, labour having
commenced in the night, and convulsions with loss of con-

698 Opiated Colchkum Wim [September,

Bciousnesa supervening. The entire body, and especially
extremities, were (edematous, while the urine was very
albuminous, and presented to the microscope numerous
fibrinous cylinders. Dilation had commenced, the bag of

waters was in part formed, and the head presented ; shortly
after her admission a violent paroxysm occurred, and this
was repeated five other times by five o'clock ; complete loss
of consciousness, with stertorous breathing also coming on.
At ten o'clock venesection to eight ounces, an enema with
twenty-five drops of laudanum, and a bath, together with
cold irrigations to the head, were prescribed. As opium
could not be given internally, a solution of meconate of
morphia was subcutaneously injected three times. Labour
advanced very slowly ; but by three in the morning the mein-
brances had burst, and the os was dilated to the extent of
half-a-erown. By seven o'clock the dilation had increased
to double this size, the os being very dilatable. The head
remained very high and immoveable, and the coma was
profound. In spite of this high position of the head, the
forceps were applied, though with difficulty. This done the
delivery was accomplished easily, no paroxysm occurring
the while, and the placenta soon following. Some wine,
together with ten drops of tincture of amber and musk
were given every hour, rallying the patient somewhat, but
not restoring her consciousness. At eleven o'clock in the
evening the seventh attack came on, but it was short and
slight. By nine o'clock in the morning she could reply to
questions loudly put, and during the day seemed like one
drunk, her pulse being 128. During the night there were
several slight paroxysms of maniacal excitement, but she
became calm by the morning. We need not follow the
author in the details of the case farther, it sufficing to say
that she left the Hospital on June 21, all albuminuria and
oedema having disappeared. There were but two paroxysms
in the course of nine hours after the injections had been
made, while before then there had been three fits within
one hour and three-quarters. As a general rule puerperal
convulsions not only become more violent, but also more
frequent with the progress of labour. Bulletin de Therap*
March, i>. 193.

On Opiated Colchician-Wine in Rheumatism. By Dr. Eisex-

MAXX.

Dr. Eisenmann, of Wurzburg, first states the wide appli-
ation which he gives to the word "Rheumatism," denoting

860. In Rheumatism. 699

by it every affection which may arise in the healthy system.
independently of ant specific cause, from exposure to cold.
" By exposure to cold I do not understand merely the effect
produced by the contact of cold water or cold and humid

air with the external integument, but also that which takes
place when cold and damp air penetrates into the lungs, or
when cold water is taken into the stomach, the temperature
of the body having been raised by exercise.*" This view is
justified by the facts 1, That cold gives rise to the most
various affections of the nervous and vascular systems: 2,
That these various affections may become, by metastasis,
transformed into each other; 3, That t\\vy communicate to
the economy a marked predisposition to affections of the
same nature, such predisposition being increased with each
reproduction ; 4, and that they yield to the same treatment,
whether they show themselves under the form of neuroses
or of vascular affections. Under the title of rheumatic
inflamation, therefore, the author ranges all infiammatorv
affections of the heart, lungs, pleura, peritoneum, kidneys,
serous membrane of the liver, etc., when these are not due
to any specific cause, and treats them in the same manner
as acute articular rheumatism.

The means which beyond all others he has found of effi-
cacy in the treatment of rheumatism is a mixture of colchi-
cum and opium, the colchicum acting far more efficaciously
when so combined, and then not giving rise to the half-
poisonous effects which often attend its use when given
alone.. Neither the one or the other substances will pro-
duce alone the advantageous effects which result from their
union. Dr. Eisenmann speaks not only from his own large
experience, but from that of many of his Medical friends,
among whom "Eisenmann's Drops" have acquired a great
reputation. These consist of 12 parts of colchicum-wine,
and 2 of tincture of opium, 20 drops being taken three
times a-day. Instead of preparing the colchicum-wine with
sherry as he formerly did, he now makes it according to the
formula of the Prussian pharmacopoeia, which directs 150
parts of colchicum seeds to be macerated in 770 of alcohol;
this preparation being always uniform in strength, and more
active than the ordinary colchicum-wine. Although the
above drops suceed so well in acute rheumatic affections,
they are of little or no use in old and chronic cases. This
induced the author to try the effect of adding minute doses
of corrosive sublimate ; and although his trials of this modi-
fication have been as yet too fewT to admit of an opinion

7<>(| Colehieum Winein Rheumatism. [September,

being pronounced in respect to chronic cases, he has found
the addition of great advantage in many cases of the acute
form. Although in the various forms of rheumatism in
which lie has employed this treatment he has not had to
have recourse to preliminary bleeding, he by no means
denies that this may not be occasionally desirable in the
robust.

In treating acute articular rheumatism in this way its course
has usually been cut short in from the third to the fifth day,
convalescence rapidly following, and no trace of heart affec-
tion persisting. When the pains have been very sev
tepid applications of a very weak solution of corrosive sub-
limate have been made to the joints, with the most satis-
factory results. Sometimes after a rapid amelioration by
means of the colehieum. when the pulse still continues
irritable, and the tongue remains loaded, an emetic or pur-
gative expedites convalescence. Among the rheumatic
affections of the mucous membranes, which may be rapidly
and durably cured by means of the opiated colehieum,
without the sublimate, maybe specified angina, pulmonary
catarrh, and influenza, gastric fever, catarrhal diarrhoea, and
catarrho-rheumatic conjunctivitis. In the case of catarrhal
ophthalmia, even of a severe character, its remarkable effi-
cacy may be watched step by step. Among affections of
the serous membranes, pleurisy and perihepatitis stand pro-
minently forward, as amenable to this treatment. Of
parenchymatous inflammations, pneumonia has been the only
one in which the medicine lias been tried, and that only in
two slight cases, which recovered with rapidity. Inmuscidar
rheumatism of the head, loins, etc.. from two to four doses
have always sufficed. It is also of great efficacy in cases of
rheumatic neuralgia, especially in facial or intercostal, in
sciatica and odontalgia. But the case must be recent, or it
will be of no avail. In odontalgia the results are truly re-
markable, a single dose rapidly dissipating the pain. The
distinction between the rheumatic form of odontalagia, and
that which arises from carious teeth is exhibited by the
different effects of the colehieum. For the relief of odontal-
gia arising from carious teeth, the author, after having
cleaned out the cavityofthe tooth, introduces into it a mor-
sel of nitrate of silver as large us a pin's head. In about a
minute the moisture of the mouth dissolves this, and the
mouth is then to be gargled with cold water, and the pain
disappears. He has employed this plan of relieving the pain
of carious teeth for the last twenty years, and lie lias seldom

1860. | ' htaract. i "1

known it fail, oven niter the ineffectual trial of various othei
measures. It causes no pain, and it retards the progressed
the caries. Bultetinde Therap, tome Ivi. pp. T~>. l_>r>.

Synthesis of Cataract. At the meeting of the Medical
Society of London, on Monday, Dr; Richardson made a
second communication on the synthesis of cataract. On
the last occasion, he had brought forward forty-six experi-
ments, Bhowing that a peculiar kind of cataract was pro-
ducihle, as Mr. Mitchell, of Philadelphia, had first pointed
out, by the introduction of sugar into the bodies of animals.
since that time, lie had made experiments with other sub-
stances, which experiments he now proceeded to describe:
Glycerine. Two experiments were performed with gly-
cerine. In the first, one drachm of glycerine being inject-
ed into the dorsal sac of a frog, there was produced, in three
hours, posterior opacity of the lens. In a second experiment,
a drachm and a-half was injected, which caused death in six
hours, without cataract. Alcohol. A drachm of absolute
alcohol, injected into the dorsal sac of a frog, caused deatli
in two hours, with extraordinary shrinking of the body, and
distinct double cataract posteriorly. Ilalf-a-drachm of
absolute alcohol, injected into the dorsal Bac of another frog,
caused death in six hours, with distinct, hut, singularly
enough, on one side only. The cataractous condition pro-
duced by glycerine and alcohol resembled that produced
by sugars. Ghoride of Sodium. By introducing into the
dorsal sac of a frog from two to three drachms of a solution
of chloride of sodium, of specific gravity 1150, the animal
was rendered tetanic; and, in twenty minutes, the limbs
were drawn immovcahly towards the body, but jactitation
of the muscles continued for an hour, when the animal died.
Distinct cataract was produced in. both lenses hefore death.
Ln another experiment, a drachm and a-half of the solution
was used; the same symptoms followed, but more slowly.
Distinct cataract resulted. In a third case, one drachm of
the same solution was injected; death occurred in two
hours, marked cataract having previously appeared. In a
fourth case, half-a-drachm was used: death occurred during
the third hour, with the same signs of cataract. In a fifth
case one drachm of solution of chloride of sodium, of
specific gravity 1050 was thrown in. In three hours there
was distinct double cataract; the animal was immensely
shrunken, and the skin was dry, almost like parchment.
Placed in water, theaninud recovered; and, the water being

702 Synt/iesisof Cataract. [September

frequently changed, the cataract entirely disappeared in
fifty-three hours. Cataract was reproduced in this animal,
again removed, and again reproduced. Dr. .Richardson
presented the animal, with cataract a third time produced.
The character of the cataract produced by chloride of
sodium seems to differ materially from that produced by
sugar. The lens is much firmer, and the opacity extends
through the whole structure. The lens resembles one that
lias been boiled. Iodide of Potassium. From the chemical
analogy between chloride of sodium and iodide of potassium,
Dr. Richardson had been led to use the latter salt in the
same way; the general symptoms produced were very
similar, but the cataractous condition did not result. Acid
Urate of Soda. From the fact of the insolubility of the
urate, Dr. Richardson said he did not expect that a cataract
could be produced by the introduction of this substance into
the blood. He did not conceive, that is to say, that any
osmosis could, be established, by the salt; but an accidental
experiment had led him to try what could be done in this
direction. On March 2, of the present year, he had com-
menced to administer to a well fattened and healthy bitch,
the acid urate of soda, in doses of two to three drachms daily,
with her food. His object was to ascertain whether any
affection of the joints would be produced. At this time,
she had taken nearly a pound of the urate, with no effect
whatever on the joints ; but, within the last three weeks,
with distinct and rapidly-increasing indications of double
cataract. The animal was exhibited to the Society. Acting
on this suggestion, the author had tried to produce the same
effect on frogs, by charging them with the urate of soda, but
without any similar result. The occurrence of cataract in
the larger animal might therefore be a coincidence ; but Dr.
Richardson was inclined to think that it was an indirect
effect of the urate ; that is to say, he believed that the urate
was decomposed in the digestive process, and changed into
a soluble salt of soda; which, being conveyed into the bood,
produced the cataractous condition. In proof of this, he
showed that a solution of lactate of soda, of specific gravity
1060, produced cataract in frogs when injected. Dr.
Richardson drew the following conclusions from the experi-
ments: 1. In addition to the sugar-cataract, there is pro-
ducible what may be called a saline cataract; 2. The
appearances of the cataracts as produced by different solu-
tions vary; thus the cataract produced by chloride of sodium
differs from that produced by grape-sugar; 8. The same

I860.] DeUrium 7

cataractous appearances ran be produced in a clear lens,
after removal from the body, by immersion in solutions of
sugar, salines, etc.; 4. As the cataractous appearance is
modified b) the density of the producing body, and is re-
movable by reversing the renditions which have \a\ to it,
and as it is producible in a clear Ions removed from a body,
it is a demonstration that the cataract induced in the dif-
ferent animals is a purely physical that is to say, osmotic
chancre.

.1 Clinical Lecture, at the Royal Frei Hospital, London, on
Delirium Tremens* By Dr. Brinton.

The patient, a cabman, aged about 33, long addicted to
hard drinking, and now in the fourth or fifth day of his third
attack of delirium tremens, affords a good illustration of some
practical points in the cure of this dangerous malady. Ili>
face is wild, flushed and perspiring, and his noisy, struggling
delirium, which has been incessant during the twenty hours
now past since his admission, evidently, from his language,
swarms with the delusions incident to this state. Amongst
these may perhaps be included that of expecting us to know
all his symptom-, without any observation or inquiry, every
approach to which he treats as an insult.

However, we want little oral information. His . pulse.
though very quick, (120,) is wiry rather than feeble. His
epigastrium is tender. His tongue, dry and furred, with red
edges, is very tremulous. These tacts, taken with those just
stated, and the circumstance that his present attack winds up
a tolerably continuous debauch of some ten days' duration,
afford a clue to what will probably be a successful plan of
treatment.

Opium and the " habitual stimulus " are usually regarded
as the specifics for this malady. Confessing their frequent
value, I would warn you against any but their casual and
deliberate use. In other words, apart from some special risks
occasionally contra-indicating them in even moderate doses,
in this as well as some allied states in which they would other-
wise be demanded, there seem to me great perils from their
copious administration as a matter of routine.

Let us try t< reason out the therapeutics of the malady.
How do people die of uncomplicated delirium tremens '
Generally, I make bold to say, of exhaustion. And what
exhausts them I The perpetual delusions, ravings, shouting-.
movements, of this state. It i^ a urnst invidious analogy to

704 Detiriitm Tremens. [September,

otter; but I venture to say that any one who lias ever spoken
in public for one hour together, would, if he multiplied that
hour by the factor requisite to bring it up to the many days
sometimes passed in vociferous delirum by a patient, quite
understand the perilous degree of exhaustion necessarily pre-
sent. Besides, the morbid impressions are scarcely less injuri-
ous and fatiguing than the actions of the delirious state. Sen-
sation, if varied and intense enough, is very hard work for the
nervous system.

Every one who has ever foolishly attempted to "do" a
gallery of pictures, must allow that it is easy to tire out the
brain through the eyes in a very short time.

The first indication of treatment, then, is to prevent exhaus-
tion ; and in fulfilment of this, there is much to do and to
avoid. A comfortable room, perfectly well lit as well as
aired ; a good nurse, with quiet, decisive, fearless, manners ;
an absence of all that is likely to excite and irritate if
possible, that is, a separate ward. Above all, no mechanical
restraint.

This prohibition cannot be too stringently enforced. X o
matter to what degree reason may be degraded or dethroned,
the delirious patient always seems sensible of the debasement
and brutality implied by straps and bands. If one nurse
could not restrain a patient, I should call in two, or ask for the
further assistance (always generously given) of any or every
convalescent in the hospital. But I should never strap or tie
down a patient, however delirious. I suppose, in the last
seventeen years, I have seen and treated a fair proportion of
such cases. But though I have once or twice walked up to a
raging patient whom nobody had for hours dared to approach,
to loosen his bonds, I never had occasion to regret it. Indeed.
I have always found that the more limited, temporary and
casual that graduated restraint of the patient which the hands
of others afford, the better. Watching and persuasion gene-
rally suffice.

The same indication, again, dictates the drugs to be admin-
istered. That there arc instances in which a delirious patient,
exhausted by long habits of tippling, or prostrate under some
independent disease or injury, is best treated by the stimulus
he has latterly been deprived of, I do not deny. The subject
of our observations, however, not only illustrates the golden
rule of practical physic to treat the case rather than the
malady, and to avoid giving such and such drugs merely
because the disease is diagnosed to be so and so -but repre-
sents, I think, that common and important variety of deliriuin
tremens in which this routine treatment, is specially to be

18l)<>. ] Delirium Tremens. 705

avoided. In plain English, when a patient comes t< me with
delirium tremens as the climax of a fong debauch, I generally
find that this state is modified by two other circumstances.
He is more or less drunk, on the one hand; he has more or
loss gastritis, on the other. Jlis Purred tongue, his tender
epigastrium, the nausea (or even vomiting) occasionally
noticed, are, doubtless, associated with a condition which 1
have verified, after death, in the gastric mucous membrane
a firm, white condensation of the cell-growth, and a deep con-
gestion of the subjacent vessels, such, as for want of a better
term, we may roughly call u inflammation."

Both of these circumstances prohibit the administration of
alcohol and opium in their ordinary forms and doses. To
what purpose, when a man is already raving drunk, should
we give additional quantities of the poison which has made,
and is keeping him so \ What, again, will opium often do,
save increase this drunkenness? Combined with alcohol,
opium is, for most races and idiosyncrasies, a stimulant rather
than a sedative. Indeed, even when taken alone, opium often
acts as a stimulant upon the Malay, the Turk, the Hindoo
aye, and on many an Englishman quite unaccustomed to its
use. And I am sure that, given in any but the mosl over-
powering or dangerous doses, it oftener increases thau lessens
the ravings of the delirious patient ; while it certainly so far
obscures the symptoms, that after its sufficient (i. e., copious)
administration, you must often remain in doubt whether the
patient dozes because he is half poisoned or because he is half
cured. Furthermore, as respects the gastric lesion, what, in
the name of common sense, are large doses of alcohol to do?
To increase inflammation ; to add fuel to the lire ; to consti-
tute an additional source of the pain, fever, delirium, slee] -
lessness, which gastric irritation alone amply suffices t<>
provoke i Thus much at any rate might be alleged, that their
supposed benefits could hardly be deduced or explained by
Rational Medicine, unless it were presumed that, in this
instance, the general effects of alcohol counterpoised that ag-
gravation of the local injuries which its introduction into the
stomach would necessarily provoke. But to this generally
beneficial effect we have already demurred ; so that we need
hardly point out that, granting it useful in this way, there
could scarcely be a more clumsy, ineffectual and dangerous
mode of administering it, than by pouring it in large quanti-
ties and a concentrated form, into an intianicd organ itself
essential to life.

Much might, I think, be said for emetics and cold affusion
in well-chosen cases of this kind. But in this instance neither

45

706 Ammonia in the Treatment [September

of these two measures seems necessary. Two Bpeoial attend-
ants; a separate ward; a full dose (fifteen minims) of ipeca-
euan wine, with a little (seven minims) laudanum, and (ten
minims) chloric ether, well diluted, every three or four hours;
some three or four ounces of brandy, largely diluted, in the
twenty-four hours ; and mustard poultices to the epigastrium.
arc all that we need now order. A mutton chop, to he taken
as soon as he wakes from his first sleep, completes the pre-
scription. The action of ipecacuan, thus guarded and com-
bined, I will not now dwell upon, further than to say that it
seems to effect a two-fold benefit; to allay cerebral congestion
and excitement on the one hand, and to provoke gastric and
intestinal secretion on the other. ["The patient became gradu-
ally calmer, and in twelve hours fell asleep. The next day lie
was quiet and rational. Under full diet and stout, with bark,
he recovered so rapidly as to leave the hospital, cured, in five
days. | Laiicet.

Therapeutic Effects of Ammonia as a Dermic Agent in tht
Treatment of Disease. By John Grantham, V.'\i. C. S.

The importance of the skin in the function of assimilation
in nutrition is powerfully shown tyy Erasmus Wilson, who

says ; 1 counted the perspiratory pores on the palm of the
hand, and found 3528 in a square inch; now each of these
pores being the aperture of a little tube of about a quarter
of an inch long, it follows that in a square inch of skin on
the palm of the band, there exists a length of tube equal to
882 inches, or 73 feet!"' Surely, such an amount of
drainage as seventy-three feet in every square inch of skin,
assuming this to be the average for the whole body, is
something wonderful ; and the thought naturally intrudes
itself What if this drainage were obstructed ? The num-
ber of square inches of surface in a man of ordinary height
and. bulk is about 2500 ; the number of pores, therefore, is
8,820,000 : and the number of inches of perspiratory tube is
2,205,000 ; that is, IH^ToO feet, or 61,250 yards ; or nearly
thirty-four miles ! Of the fact of absorption by the skin, it
has, by many physiologists, been fully proved, that after
bathing in infusions of madder, rhubarb and turmeric, the
urine lias been found tinged by these substances; it is also
proved, that imbibition takes place in the skin according to
the physical laws, in conformity with which they pass most
readily into the vessels which present the thinnest walls
and the largest surface. Excepting the notice taken of

I860.] Of i> T"7

ammonia, being the principal agent in the Buxton wat
by Dr. Bradley, 1 am of opinion thai no writer has given il
the iniportairi position it merits, when combined with hoi
water as ;i dermic agent in the treatment of eong< tive
diseases.

A.s far back as the year L828, I remember a neigh hori
Practitioner, Mr. Hurst, of Dartford, sponging the skin in
in some cases of scarlet fever, with tepid water containing
r few drachms of the spt. timmonise aromaticus; since
which time 1 have frequently \\^(\ the ammonia in a much
more potent form, viz : liquor ammonire fortior, one ounce
and a half to two quarts of hot water, at L20 of heat, as a
Bponging bath ; and as a general bath, the same quantity
of ammonia in water, at 100 of heat. To render this st;
ment more intelligible, I will relate some examples. Firstly,
an extreme ease of severe purpura hemorrhagica. At the
onset of the ease, the patient was suffering from continuou
bleeding from a decayed tooth, which tooth was immedi-
ately removed ; still the bleeding continued from another
decayed, tooth; that, and a third, were taken out; it ;
became evident that the bleeding oozed from the whole
surface of the mouth, resisting th,o application of the nitrate
of silver, matico, zinc, alum, etc., then a further loss of
blood from the kidneys and intestines occurred, with an
eruption of maculae on the skin, of a dark purple color;
these effects continued to an alarming extent, until [adopted
the sponging of the skin with two ounces of strong am-
monia, in two quarts of hot water, over the chest, body and
extremities: after this ammonia fomentation, the skin was
dried, and then rubbed over with hot lard, and the chest and
abdomen were covered with wool; from that time the ner-
vous system became tranquil, and the exudation (^.' blood
gradually ceased; and with the internal administration of
quinine, opium, milk and beef-tea, etc., the patienl in time
became convalescent. This narrative being only written
from memory, precludes my entering into particulars ;
nevertheless, it serves to prove the power of ammonia when
so applied, as a compensatory measure. 1 am also of
opinion that the inhalation of ammonia gives a stimulus to
the change of the blood as it passes over the air-cells of the
lungs, and may assist the vital law of generating animal
heat. Secondly, in a case of scarlet fever, when the patient
was delirious, the skin of a. dark red color, and the- \>oAv
slightly tympanitic, the ammonia bath when so applied, at
120 of heat, bore unmistakeahle evidence of its salutan

708 Venereal Diseases. [September,

effects in quieting the nervous system, procuring sleep and

abating nausea. Thirdly, a case of stridulous breathing in
a child three years old, yielded to the effects of the ammonia
bath, at 100 to the chest, and the after application of hot
lard and wool to protect the animal heat and keep up the
action of the sudoriperous function. Lastly, the ammonia
bath at 00 as a sponging bath in the morning, I have
known to be very beneficial to the anaemic patient.

1 trust that by this statement I am not advocating a par-
ticular for a universal ; hut simply proposing a means of
Treatment which may be advantageously adopted in the
management of fever, particularly in the congestive or
comatose forms.

Treatment of Gonorr hcea.

Lectures on venereal diseases, by F.J. Bumstead, M. D.,
Surgeon to St. Luke's Hospital, arc being published in the
Xew York Journal of Medicine. The first two lectures
were published before our Summary was commenced, and,
consequently, did not fall under our observation. AVe shall
endeavor to give our readers the more important practical
observations of these very interesting and comprehensive
lectures.

Jn reference to the abortive treatment of gonorrhoea, in the
male adult, he gives his preference to the weak, rather than
the strong, solution of nitrate of silver. "The formula for
the strong injection should not contain less than 10 grains
of the nitrate of silver to the ounce of distilled water, and
more than fifteen grains are objectionable." Of this, "only
one injection will he required." The weak solution, winch
he prefers, should contain from one to one and a half grains
io six ounces of water, and this should be repeated at short
intervals, and continued until the discharges "become thin
and watery," and slightly tinged with blood. Of this abor-
tive treatment, Dr. Bumstead says: "I recommend it only
in the first stage of the disease, and not after acute inflam-
matory symptoms have set in, or the patient suffers from
scalding in passing water."

Where the abortive treatment is not appropriate, he com-
mences treatment with a brisk cathartic, and, if the penis is
much swollen, ov there is mach scalding in passing water,
the following is advised :

I860.] Ven

]{-. "Potassas bicarbonatis, - - 3ij.

Tincturae hyoscyami, - .Yi.

Mucilaginia acaciae, - 5v.

\ table-spoonful everythree hours.*'

[fa Byringe can be inserted without much pain to the
patient, the following injection is advised :

K. "Extracti opii, )".

Glycerine, - - - - - .Vi-
Aquae puree, - Siij.

M. Injection to be used after every passage of urine.

[f the ease is subacute, from hall' to one grain of sulphate
of zinc to the ounce of the mixture may be added. A a
local means, for the relief of uneasiness, local pain, scalding
in micturition, Dr. Bumstead fully endorses Dr. Milton's
statements in regard to hot water. " Water, as hot as i an
be borne, is the most grateful local application that can be
used."

In the third stage of gonorrhoea, Dr. Bumstead speaks
very highly of injections. He says: "In spite of all that
has been written and said against them, I do not hesitate to
ay, that the surgeon who voluntarily renounces injections

Hi

deprives himself of his best weapon in contending with
gonorrhoea, and is comparatively impotent in his attempts
to conquer it."

Of the kind of injections, he says: "If no other- ingre-
dients for injections, except sulphate of zinc and nitrate (^
silver, were known, I believe that the therapeutics of
gonorrhoea would he the gainer rather than the loser."
"My own preferences for an astringent as the active princi-
ple of injections in the third stage of gonorrhoea, arc very
strongly in favor of the sulphate of zinc." * * "In

most cases, we need not, at any period, exceed the propor-
tion of the sulphate in the following formula :

IJ-. Zinci sulphatis, - - - % gr. xij.

Aquae pura?, - 5v. M."

In connection with the use of the above-mentioned injec-
tions. Dr. Bumstead advises the administration of copaiba
and cubebs, separately or combined. For the administra-
tion of copaiba, the following formula is recommended:
ft. "Capaibae,

Spiriti setheris nitrici, - - - aa.. rjj.
Liquoris potassae, - oi.j.

Spiriti lavanduhe comp. - - r>ij.

Syrupi acacia?, - vj. M.

From a tea-spoonful to a table-spoonful after each meal.''

710 / [September,

Cubebs may be administered alone or combined with
iron or qninine, if the case demands a tonic. It may be
combined witb copaiba, and administered in pill. "The
following prescription is particularly adapted to delicate

!?. Copaiba?, - - - r>ij.

Magnesia?, - . - - - - oi-
( rlei mentha? piperita?, - gtt. xx.

Pulveris cubeba?,

Bismuthi snbnitratis, - - - aa Sij. M.
To be divided into pills of five grains each, and coated
with sugar."

From 4 to <s are to be administered three times a day.
; ill'' relief of the chordee, lupulin may be adminis-
cl in L5-grain doses, or camphor-tincture in full doses, or
if preferred, two of the following pills at bed-time:
W. 1 iacl iicarii,

Pulveris camphi - aa .>)]].

M. It. pil., No. xx."

Aim rk in Medi hly.

nt of Gh 1 1.

In the continuation of the lectures of Dr. Bumstead on
venereal diseases, the subject of gleet is treated of in the
of the Sew York Journal of Medicine.
In the treatment, "the bowels should be kept open daily,*'
and "one of the following pills, taken at bedtime, will
usually insure a free stool in the morning:

\{. Strychnia?, - grj ss.

Pil. colocynth, comp., - - 3ss. M.

1 divide into thirty pills."

A< a. tonic and astringent, the muriated tincture of iron

aally indicated. The proper dose is usually from live

wenty drpps, three times a day. Tincture cantharidea

is also indicated, and may he combined with the iron as in

the following formula :

!<. "Tinctura? cantharadis, - - - .")ij.

Tinctuwe ferri chlorodi, - - - oyi. M.
Ten drops, in water, three times a day."
Wh< re the constitutional impairment is considerable,
quinine may he added to the treatment, as in the following:
R-. "Tinctura? cantharidis, - - - ."">;.
Quinia? sulphatis, - - - 5ss.

Tinctura? ferri chlorodi, - - 5i,i-

A.cidi Bulphuricidilnti, - - (gtt.) xxx.
Aqua? destillata?, - Sviij. M.

10.1 Venereal Diseast , 1 I

( )ne ouuee three limes a daj ."

In regard to local treatment, Dr. Bumstead speaks highh
of bougies. Except when they are found to aggravate the
symptoms, the passage of the Dougiemaybe repeated even
Beeond or third day al first, and afterwards every day! or in
some instances as often as twice a day." II' desirable, the
bougies may be medicated, and the following ointment will
be found of service :

Iv. Unguenti hydrargyri, - - - .V- .

Extracti belladonnas, - - - 5ss. VI."

Of injections, as in gonorrhoea, he ordinarily prefers the
Bulphate of zinc. "From two to three grains of the snl
phate of zinc to the ounce of water may be taken as the
standard of medium strength, and the solution should be
employed as frequently as the patient is able to [>ass his
water, or every two or three hours." Of blisters, lie does
not think as highly as does Dr. Milton ; in obstinate cas< .
however, he thinks they are worthy of trial. American
Medical Monthly.

Balanitis.

In continuing the subject of venereal, \)\\ Bumsteail
devotes one Lecture to balanitis. In regard to treatment,
'All that is necessary, in most eases, is to free the parts
from any collection of matter by gently washing them with
tepid water, and then to cut apiece of lint or soft linen into
pieces about an inch square, and laying them upon the
glans with their upper margin well up in the corona, to
draw the prepuce over them. In this manner the inflamed
surfaces are isolated from each other, and speedily take on
a more healthy action." If the case should prove obstinate,
the lint may be moistened in the following mixture, and.
changed three or four times in the twenty-four hour-:
\{. "Extracti opii, - - - - j.
Zinci sulphatis, - gr. vj.

Glycerin, 5i

Aquae, - - ' - - - gij. VI.
Or the following may "be introduced between the glans
and prepuce by means of a camel-hair pencil :
]{. Cerati simplicis, vel. mellis,

01 ei olivae, - - - - aa., j.
Hydrargyri chloridi. - - - .1--.
Extracti opii, - - - - - 5j. M."
"The influence of along prepuce in producing relapses
oi' this disease has already been referred to. I have some-

712 Woorarain Tetanus. September,

times succeeded in remedying this by directing the patient
to keep his prepuce constantly retracted by means of a
narrow bandage around the penis, posterior to the glans."
This should be worn for several weeks, and if it prove
unsuccessful, "our only resort is the removal of the super-
fluous integuments by circumcision." American Medical
Monthly.

Woorara in Tetanus.

We have already noticed the fact that M. Vella, of Turin,
had experimented with the above material in cases o\'
tetanus which occurred lately in the military hospital at
Turin. M. Bernard had often shown in his lecture at the
College de France, that this substance, when introduced
into the system, exhibits an action directly opposed to that
of strychnia : it seems to paralyse the action of the motor
nervous system. In animals the poisonous effects of one of
these substances have thus been frequently counteracted by
the properties of the other. It was from tacts of this kind
that M. Yel la took his practice. In two of his cases the
remedy was tried late in the day, but although the patients
died, their symptoms were markedly ameliorated. In the
third case he commenced operations earlier; and before
twenty-four hours had expired, the woorara was applied in
fomentations to the wound 10 to 50 centigrammes of it to
40 grammes of liquid. " In about three-quarters of an hour
after each application, and for half an hour at a time, there
was a marked diminution of the tetanic rigidity, followed In-
such a complete relaxation of the muscles, that the patient
was able to drink, make water, and sit up in bed." "On
the other hand, when the action of the woorara had ceased,
the wounded limb was again first seized with spasms. For
the first three days of this extraordinary treatment, absorp-
tion by the wound was sufficient to produce muscular relaxa-
t ion, and general repose of the body. After this period, the
Surgeon applied a blister to the thigh, and on the eighth
day, repeated it, in order to produce a large absorbing sur-
face. During four days the dressings were renewed every
three hours; and afterwards every five hours. On the
twelfth day, the attacks, which had gradually diminished in
duration and intensity, completely disappeared. Fifteen
days afterwards, the man left the Hospital." This case M.
Bernard considers as a beautiful specimen of the application

I860. | ment of I. 718

iontitio logic to therapeutics; bill M. Volpeau does not
with him, mid think- people often juni]) too rapidly
inclusions. * The author of the communication," >;i\ -
M. Velpeau, "lias stated thai there were numerous cases of
tetanus among the wounded in the Army of [taly. Now, I
have heard from many Surgeons, and from M. Larreyhiin-
Belf, the head o[' them, that, on the contrary, there were
very few cases. Moreover, this rase of tetanus that is
arrested, that begins again, that is again .-lopped, and. as
it were, at the pleasure of the Surgeon, inspires me, 1 must
say, with little confidence! Now here are three cases
spoken o\' : two die after ordinary treatment, and the third
recovers under the use of woorara. Now, 1 lmve had at
La Charite three cases of tetanus in the course of 1857 and
- ; and o[' these two died and the third recovered, just
as happened at Turin. It is these cases of recovery that
have given a temporary reputation to numerous means ol'
cure which have been vaunted as efficacious in tetanus, and
which have, nevertheless, left the disease almost constantly
a fatal malady. A single fact and I only see one here
is worth little in therapeutics." The physiological effects
oi' woorara as an antidote to the symptoms produced by
strychnia, fully warrant us in making further careful
experiments of a similar kind to the one here spoken of.
Such experiments are rational, and founded on the most
legitimate scientific induction. Medical Times <y Gazette.

Treatment of Lupus.

Peter F , aged 17, was admitted into the Royal Free

Hospital in the first instance, on the 14th of May, 1856,
under the care of Mr. Weeden Cooke. His occupation was
that of an oyster-dredger, at Maldon, in Essex ; and he had
Buffered for seven years from lupoid ulcers of the face, nose
and lips. He had been a patient in the Colchester Hospital,
and also in St. George's Hospital: At the time of his ad-
mission, the whole face was covered with either the
rices of old ulcers, or ulcers encrusted and dipping into
the muscles beneath the skin. The columna nasi was
destroyed, and the disea.se was encroaching upon the alae.
Ihe upper lip was thickened and ulcerated. The scaly
ulceration extended upwards to the inner canthus of both
eyes. Added to these miseries, he was extremely deaf, and
altogether presented a most pitiable and unsightly appear-

7 1 ! WhiU Li c<l Paint \ Septen

ancc. Mi*. Cooke ordered an ouuce and a half of leinoa

juice to he taken three times a day, meat and porter, witl
green vegetables; and the following lotion and ointment
bichloride of mercury, 8 grains; hydrochloric acid, 1(
minims; water, 8 ounces ; to be applied three times a da;

a wash, afterwards covering the parts with zinc oint
ment. lie remained in the hospital under this treatment
gradually improving, until August 17th, when he was dis
charged, with all the ulcers entirely healed, tie- deafhest
diminished, and his general health re-established.

in May, 1857, he again came to town and was admitted,
the disease having returned on the cheeks and upper lip.
The same treatment was adopted, and this time he was well
again in a month.

In July, 1859, lie again appeared among Mr. Cooke's
out-patients, the tipper lip and one cheek only being affect-
ed with the scaly "ulcers, lie was enabled to stay with a
sister in town, and was therefore not admitted, hut placed
under the same treatment namely, lemon juice. fresh
green vegetables, bichloride of mercury lotion, and zinc
ointment. The cure was very rapid, the ulcers having well
cicatrized in less than three weeks. His hearing also at
this time was very greatly improved, and his general appeal*
ance so altered, that lie was scarcely recognized as the same
unhappy youth who first came under notice in IS

Mr. Cooke states that there was no sponginess of the
gums, but that the strumous aspect of the lad, and his occu-
pation as an oyster-dredger at the sea, led him to prescribe
lemon-juice as an antiscorbutic remedy, and, as it turned
out, with the happiest results. Still the adjuvant effect of
the local applications must be by no means slighted or
overlooked in the treatment of similar eases. Perhaps,
however, the leaning generally is to depend too much upoii
local, and especially caustic applications. Lancet*

Whitt Lead Paint in Cutaneous Maladies.

Mr. Alfred Freer (Dublin Hospital Gazette) calls atten-
tion to the value of the common pigment, white lead in oil,
in treatment of erysipelas, carbuncle, furuncle, etc. lie
state - :

I first became acquainted with its great efficiency in the
treatment of erysipelas by my late father and my brother.
It is in this disease that the most striking benefit results

. -'

/// ( )i& Mafntfit's. 7 1

from its application. 1 have never yel nicl witli ;
this nature where it has not done immei i. 1 lin<! it

far superior to lead lotions, mucilage, hoi fomentation*,
nitrate of silver o'r collodion. After erysipelas, the paint
proves of itest service, perhaps, in eczema in Its

ral Tonus. In -'ironic cezematous eruption- of the

':. it affords much comfort, and often speedily effects a
k-ww. Of late years 1 have extended its employment to
other complaints of the skin, including herpes in its several
forms. 1 have tried it in some cases of small-pox, with the
view of diminishing the number of vesicles on the face, and
o[' controlling their size; the latter indication it seems likely
to fulfil, but 1 cannot -peak with confidence about the
former, the papules being already numerous at the time of
my visit. 1 have also used it in several cases o\' carbuncle
and furuncle. The first was in an instance of a huge car-
buncle situated on the loin of a man, and rapidly extending,
notwithstanding tree incisions, linseed poultices, and appro-
priate constitutional treatment. I applied a thick, wide
circle of paint round the swelling, and dressed with resin
ointment and cotton wool. There was ne advance of the
disease from that time, the centre- rapidly broke up, and

very took place It is, however, probable that the
Amission of the warm poultice may have contributed to the
improvement, for I" have often observed that warm poultices,
however well made, seem to foster and spread carbuncular,
inflammations.

The paint seems to act in two ways: tirsl and chiefly, as
an efficient excluder of the air that great irritant to the
cutaneous surface when disordered; and secondly, as a
'direct sedative to the sentient nerve filaments, rendering
them less prone to become involved in inflammatory action.
In boils it relieves the painful tension, and favors resolution.

ome forms of painful ulcer- of the leg, of a small size, it
gives relief. In galling of the skin, where anasarca, is pre-
sent, itisalsoof use ; and is the best application that we have
in burns of the first and second degree. But it is in erysipelas
that its triumph is most manifest; the patienl bids

the comfort ofit. The tight, shining skin soon b<
wrinkled and shrunken; indeed, the inflammation very
rarely extends after the second or third painting.

All my friends to whom I have recommended the pig-
mentum album, sneak highly ofit, and one who is a Surgeon
in the Peninsular and Oriental Company's Bervi
used it for the last two vears with great success. The

716 Prolapsus of th Funis. [September

manner of applying it is by means of a feather, painting the
aftected parts and a liitU beyond, and laying on a fresh coat
every two hours or so, until a thick layer is obtained, and
then sufficiently often to maintain a covering. In erysipe-
las it peels off in a week or so, with the shed cuticle,
leaving beneath a smooth, clean, healthy surface. Patients
are struck with the benefits they derive from its employ-
ment.

Treatment of Prolapsus of the Funis. By George Mendeni
hall, M. I)., Professor of Obstetrics in the Med. College
of Ohio.

Gentlemen: In a previous number of your journal, I
made some remarks upon prolapsus of the funis as a com-
plication of labor, accompanied by the details of a case, its
treatment and result. I have within a day or two had
another case of this kind, where two or three inches of the
cord prolapsed, following the evacuation of a large quantity
of liquor amnii. I immediately placed the woman upon her
breast and knees, introduced the hand into the vagina, and
readily replaced the cord. It kept its proper position hv
gravitation until the contractions of the uterus pressed the
head pretty firmly against the os uteri, which prevented its
descent. In a few minutes after it was replaced, the woman .
was placed on her left side, and the finger was kept in con-
tact with the os so as to ascertain whether the prolapsus
the cord returned. This did not take place, and in about
an hour the woman was delivered of a fine living and healthy
male child, much to the gratification of the parents. In
view of the frequent fatality to the child of this complica-
tion, I deem a knowledge of its proper treatment a matter
of great importance. I think with this knowledge that few,
if any, cases ought to result unfavorably to the child, and a
resort to turning the child is seldom, if ever, necessary.

The Value of some New Remedies lately introduced in the
Treatment of Phthisis. Dr. Botini affirms that the hypophos-
phites of Dr. Churchill have not even relieved a single
patient. The phospholeine of M. Baud, extracted from the
spinal marrow of animals, does not seem to possess any
other value than as a nutritive, etc. Milk, iodized by digestive
assimilation, is preferable to the most part of medicaments
containing iodine or iodide of potassa. In view of this fact,
Dr. Carmagnola puts forth some very just considerations,

,

860.] Todohydra it of Ann* 7 1 .

establishing clearly that there is little reason in demanding
from a product of secretion, as from cow's milk, a medicine
whose first action has been to alter the health of the
animals, and even the nature of the milk furnished. Ii
would ho better to use the flesh of the cows, so ;;- to have
iodized soups and beefsteaks. Gaz. Mcdlra Italiana: /.'
Med. d( la Gironde.

dohydrati of Ammonia in Constitutional Syphilis. Pj
Gamberini deduces the following conclusions from fourteen
cases: 1. Iodide of ammonia and the iodohydrate of am-
monia are indicated in the same cases of syphilitic diseases
as the iodide ofpotas; -. The treatment from the employ-
ment of this remedy in increasing doses fromlO to 80 cen-
tigrammes daily, in from 100 to 180 grammes of some
liquid, has lasted from 14 to 35 days, averaging 21 days: -*;.
A sensation of burning or heat in the throat ami stomach
of some patients forced us to suspend temporarily the iodide,
as well as to lessen the dose ; 4. A liniment, composed of
the same remedy, with olive oil, 15 centigrammes of the
former and 30 centigrammes of the hitter, has assisted in
Curing the osteocopic pains; 5. Syphilitic accidents cured
by iodide of ammonia have been case- of arthralgia, rheu-
matic neuralgia, periostosis, ganglionic enlargements of the
groins and neck, and a papulo-vesicular eruption of the
hack.

The process of making this medicine is very simple. It
is that of Ruspini, consisting in precipitating a solution of
the iodide of iron by carbonate of ammonia, filtering the
solution, which is then to be evaporated promptly, until a
pellicle is iormed, and then crystalize. This salt crystalizes
in cubes, and is very soluble in water. Its taste is not vciy
disagreeable, being a little more hitter than iodide ofpotas.
[JBolletino <h H< Scu nza M< dica : IV Union Jkn dicalc >l< l< Gironde.

Phosphornecrosis is becoming so prevalent among those
engaged in making lucifer matches in Paris, that the govern-
ment has consulted the Academy of Medicine as to means
for preventing this terrible malady. Tin1 Academy simply
recommends, that as a preventive, matches should he made
of pureamorphous phosphorous, or without phosphorous at
all, the white phosphorous being altogether prohibited.

Editorial. [September

MTOKLAL AND MISCELLANEOUS.

Medical College of ( Jeorgia. "\Vc call the attention of our readera
to the twenty-ninth annual announcement of this institution, which will
be found enclosed under the i The pro.'

of a large class for the comii are very encouraging, and it will,

he seen by the circular that the most ample arrangements !
made for their accommodation and advantageous instruction.

The building devoted to the Practical Department of Anatomy has been
thoroughly remodelled and enlarged to double its former dimensions.
and more perfect arrangements have been made for the injecting and pre-
paration of anatomical material : and with these improvements, the
amphitheatre of the Medical College of Georgia is, perhaps, one of the
most commodious and pleasant to be found in the United Stal

The present City Hospital, with the rapid increase of the lower and
working classes in Augusta, has been found too restricted in its accoimiKM
dat ions for the number of patients applying, and the municipal authorities
have the plan and arrangements in progress for the erection of a ]
commodious building, well suited to the demands of our rapidly incn
population. The great variety of eases to be found at present, in the
City Hospital, and also the cases of negro disease.-- presented in Jacksonn
street Hospital, will together afford ample means of illustration for a
most valuable and instructive course of ClinicaJ Lectures during the
approaching session.

Students intending to attend Lectures in Augusta this winter,
will observe the arrangements for Preliminary Lectures, which, th
not constituting any part of the regular course, Avill be found hi
interesting and instructive, as the subjects selected by each

Lectures, will be such as will allow him to in
largest amount of medical instruction to the class. Some of these will
bo Clinical Lectures delivered at the hospitals; while others will be
delivered in the lecture I

Tun London Medical Review. We have just received from 3b
Baillierre and Brothers, of New York, the first number of the
ical Journal, just published in London.
The present number i a huge amount of most valuable and

860.] Efltoi Tin

nstructiw medical reading, c< Qtributions of several highly di
jntlemcn of Great Britain. Among the e we find the na i
Samuel Wilks, Mr. Holmes Coote, Mr. J. W. Hulkc, and D
Vote, each furnishing valuable original communications, which, to
villi the Reviews and the Domestio and Porcigu RSlocti D | rtracnts,
ender this number a most interesting issue. The work,
lot, as would appear to be indicated by its title, simply a revi
liar monthly medical journal, conveying excellent medical
lion and interesting medical news ; its readers

Like most of the British journals, both literary and scientific.il
us to guess the name of its editor. We would ] sing it plainly

printed on the cover, that wc might welcome him without danger of
iiistake in o the community of- journalists. Wc cordially commend the
- /' to the attention and favor of our readers, and hope that this
number may prove the beginning of a prosperous and useful career.
American subscriptions should be addressed to s. Baillicrn

Brothers, No. 440 Broadway, New Vork, or directly to ' The editor of
the "London Medical. Review, care of II. Baillierre, -V.) Regent-street,
London W., and should in all instences be accompanied by the name
and address plainly written.'' It affords us much pleasure to add the
name of the above new journal to the list of our forerun exchanges.

Tliirtccnth Annual Meeting of the A i Medical Association.

THIRD DAY. CONTINUED FROM AUGUST NUMBER.

lr was moved, that in order to expedite business without a session
next day. the sections meet at "2.1- P. M., and ar 4 P. M. the Association

convene to close business and receive their reports.

CLOSING SESSION.

The Association was called to order at 4 P. 3VL, by V. 1'. Wilson
Jewell, in the chair.

Various special committees were called upon to report, and failing to
'! so were discharged other reports which had been placed on the
tan's table were, without reading, on motion, referred to the Com-
mittee on Publication, with power to act.

The various sections were called upon for their reports, and the
various papers respectively discussed by them were referred to the Com-
mittee on Publication.

The report of the Committee on Rules of Order, lying on the table,
was then called for and read, and the order of business acted upon, and
the article- severally adopted, and afterwards the whole report was laid
on the table.

A communication was read from the Essex Co. Medical Society, of

720 Miscellaneous.

the State of New Jersey, containing the following preamble and rcsolu-
(ion, for action upon by the Association :

Whereas, the indiscriminate sale of poisonous drugs at retail, is
fraught with danger to the community, be it

Resolved, That in the opinion of this Association, it is the duty of
the public authorities in the different .States of the Union to pass pro-
hibitory laws against the retailing of morphia, strychnine, prussic acid,
etc., except on the written prescription of a regular practitioner of medi-
cine, or on the personal application of a well-known citizen ; and that a
committee be appointed in the different States, to endeavor to carry
into effect the spirit of the resolution.

The paper was received and the resolution adopted.

The report was referred to the Committee on Publication, with power
to act.

On motion of Dr. Davis, of Illinois, it was decided that the committee
called for be appointed at his leisure by the President of the Associa-
tion.

On motion, Dr. Cox, of Maryland, was requested to present at the
next meeting of the Association a paper on Necrology.

Dr. A. N. Dougherty, from the Committee on Tracheotomy, reported
that from the mass of facts they had gathered with regard to the result
of this operation, the proportion of successful operations was 1 in 3 4-10.
The statistics of cases in this country, as far as ascertained, was 17 i
out of 58 cases.

Trousseau before 1844 had 212 cases, of which there were 40 cures
and 132 deaths after 1848, he had in 49 oases 48 deaths. From 1 8 !!'
to 1858, he had at the Children's Hospital, at Paris, 4GG cases which
resulted in 12G cures and 340 deaths. Another operator met with hut
4 cures in 36 cases. Statistics of other operators were presented, and
at the request of Dr. Dougherty, the report was referred back to the
committee, with power to complete the report, and present the same at
the next meeting of the Association.

Dr. Bell, of Brooklyn, offered the following resolution .

AVhcreas, some of the papers submitted to this Association require a
longer period of time for their examination than the annual meetings
will admit of; therefore, be it

Resolved, That the several sections have power to refer such papers
to experts, who shall determine whether they arc worthy of .being refer-
red to the Committee of Publication, for publication in the Transactions.

On motion, this was laid over to the next meeting of the Association.

A motion of Dr. Chapin, that all reapers which had not been disposed
of by the sections, should be referred by the Committee of Publication
to experts, who should report back to them, whether the papers were
worthy of publication in the Transactions, was laid on the table.

Various rules of order and amendments to the Constitution, which had
laid over from previous meetings, were again indefinitely postponed.

TO BE CONTINUED.

SOUTHERN
MEDICAL AND SURGICAL JOURNAL.

(new beriks.)

IWl AUGUSTA, GEOBGIA, OCTOBER, 1X60. Ml. Hi

ORIGINAL AND ECLECTIC.

ARTICLE XXIV.

iRST REPORT TO THE "COTTOX PLANTERS'
CONTENTION" OF GEORGIA:

Vn the Shell- Limestone and Marls of Gerrgia. By Joseph
Jones, M. D., Chemist of the "Cotton Planters ('on voli-
tion of Georgia" and Professor of Medical Chemistry in
the Medical College of Georgia at Augusta.

Summary : Geological position and extent of the Tertiary Lime formation of
Georgia Marls and Shell Limestone of Burke County, Georgia Chemical
Constitution Value as Fertilizers Amounts of Phosphate of Lime, Phos-

, phoric Acid and Carbonate of Lime, which they are capable of yielding for
Agricultural purposes Amount of Lime which they are Capable of Yielding
for Architectural purpose?. Shell Limestone of Washington County, Chemi-
cal Constitution Amounts of Phosphate of Lime Phosphoric Acid, and Car-
bonate of Lime, which it is Capable of yielding for Agricultural Purpose

" Valuable to the State as an inexhaustible source of Lime for building and
Agriculture. Tables Exhibiting the Chemical Constitution of the Marls and
Shell Limestone Comparison of the Shell Limestone and Marls of Georgia.
with the Limestones and Marls of Europe, Massachusetts, Rhode Island, Mary-
land. South Carolina. Alabama, Kentucky and Arkansas The Shell Limes-
tone and Marls of Georgia are equal in Commercial, Agricultural and Archi-
tectural value to any in the World Georgia is independent of the world in
Lime for Architecture, and the Phosphates for Agriculture Comparison of
the Marls and Shell Limestone, with Commercial Fertilizers Superphosphates
Pbosphatic Guanos, and Manipulated Manures The amount of Georgia Marl
and Shell Limestone, which may at a trifling cost be applied to each acre of
land contains more than double the amount of Phosphates contained in the
most expensive and highly prized Commercial Manures Tables Illustrating
the relative value of fertilizers. Relations of the Marls and Shell Limestone of
Georgia to the Soil, Plants and Animals Lime indispensable to the fertility
of Soils Lime indispensable to the healthy Constitution of Plants and Animals
Effects of Calcareous Manures upon soiis and Vegetables Practical experi-
mental results in the use of Marls and Lime Results of Marling in Virginia
Mr. Ruffins Experience Experiments upon Marling in South Carolina, and

46

'i'l'i 2h%liary Lime Formation

other States lii Europe and amongst the ancients Testimony of Pliny to the
value of Calcareous Manures Methods of Applying Marls to the soil. Native
Resources of Georgia for the reclamation of her worn out soils Chemical
Constitution of the various native fertilizers Swamp muck Suspended Mat-
ters in Swamp Water Stable manure Cowpen Manure Black Rush Char-
coal Bones Salt mud Cotton Seed Cotton and Corn stalks and -leaves
General Conclusions The Planters of Georgia have upon their own soil in-
exhaustible stores ot fertility, and it they are true to their present interest, and
to the interest of their children and to the future prosperity and independence
of their native State, they will abandon in a great measure imported Com-
pounds and thus -top a ruinous expenditure of money which flows out of the
State into the pockets of men in most cases, foreign to our soil and thus inau-
gurate that system of agricultural improvement, which will result not only in
the restoration but also in the preservation of the land in its primitive fertility
.loini Clay of Georgia Geological position and extent Proportion of Phos-
phates, which it contains Importance of its relations to Agriculture Value
us an application to sandy land Comparison of the Joint Clay of Georgia,
with various European and American Clays and Soils.

[, G-eotoaical Position and Extent of the Tertiary Lime /' -
mation of Glorgia.

TJie Shell Limestone of Georgia belongs to the Eocene,
the lowest divison of the Tertiary formation.

This formation is culled Eocene, because it is the dawn ol
the existing state of the animated creation, for whilst in the
more recent formations, the Pliocene and Miocene, whicn
in the Southern portions of Virginia, North Carolina, South
Carolina, Georgia, Alabama and other States rest upon the
Eocene, many of the fossil species have been identified wittf
speeies now living in the seas and oceans, in the Eocene
formation on the other hand, but very few of the fossils havo
been identified with, living species.

The fossils characteristic of this formation will be noticed
in the general Report on the soils and geological formations
of Georgia, which I hope to present, to the Cotton Planters
Convention at an early day at present we will merely state
that it is exceedingly rich in fossil shells, corals, bones and
teeth of Sharks and other extinct vertebrate and inverte-
brate animals 300 species of shells have been discovered at
w single locality at Claiborne Alabama, and described hv
Mr. [saac Leu and Mr. Conrad of Philadelphia, and in
Europe more than twelve hundred distinct species of sheila
have been discovered in this formation.

The Cretaceous and Eocene formations underlie the sreat
Atlantic slope ov low region (called the Alluvial Plain by

I860.] Of Georgia.

many writers) extending from Long Island to
Eastern Shore of the Gulf of Mexico. The Eocono
formation crops out, or lias been laid bare, a1 various lo-
calities as Wilmington, North Carolina, ou the Sai
and Cooper Rivers, Stoudenmire Crook at Eutaw and
many other localities in South Carolina, at Shell BlulF,
Stony Bluff, Mill Haven, Jacksonboro, Briar Creel*
mour'sHill, Milieu, on the Ogeechee in Burke Co., Tennille,
Washington i\')., below Columbus Ga., Eufaula and Clai-
borne, Ala., and many other localities. These localities
mentioned in a regular series from North East to South
West. This list which might be greatly enlarged will
our present purpose, in illustrating the wide distribution of
this shell limestone formation. Accompanying the nil!
port to the Cotton Panters Convention we hope to present a
Map showing the distribution and relations of this forma-
tion.

The wide distribution and inexhaustible stores of tin?
Eocene formation in South Carolina, Georgia, Alabama,
Mississippi and other States renders a knowledge of its
chemical constitution oi' the greatest value to the Agricul-
turist.

For the present we have selected Burke and Washington
Counties lor two reasons:

1st. They represent a large planting interest, 2d. They
are intersected by Railroads, which can distribute the Mar!
and Shell-limestone to all parts of the State for agricultural
and building purposes. In succeeding Reports and in I'm-
General Reports to the Convention we hope to bo able to
present the Chemical Constitution and Agricultural value
of the Marls and Shell limestone of every county in Georgia,
which possesses these deposits.
If. Chemical. Examination of the Marls of Burke Q)., (
No. 1 Green Marl

This specimen was obtained upon the plantation of J. V.
rones, Esq., (3 miles East of the 90 mile station, Central
Railroad.

li

724

Tertiary Linn Formation

October

The Mar] is composed of a mixture of Green silicate of
Alumina and Iron, Silicious Sand and Shells.
Section above the bed of Marl.

Sandy Soil 2 feet.

Yellow Clay and sand - - - 3 "
Joint Clay - - 35 "

Bed of Green Marl - - - Undetermined.
The bed of Green Marl is found 40 feet beneath the sur-
face and extends downwards to an unknown depth.

ANALYSIS NO. 1 GREEX MARL.

( larbonate of Lime 48,435 \ Lime

(Carbonic Acid j

Phosphate of Lime ",049 (Lime

(Phosphoric Acid... '

Carbonate of Magnesia !

Sulphate of Line

Sulphuric Acid

Chloridea

Alumina and Silicates of Iron

LllSOluble Silicates

Silicious Sand

Water as M jisture I

I?

So

s

^8

^SI^S

M -

sS

s

24.2*2

19.153
L.972
1.677
0.27

trace.

trace.
0.014
7.196

81.941
8.056
5.714

3ca.otin

39.440
83.640

5.400

1915.
197.

0.230
143.92
0---S.S20
161.10
114.281

1.4
719.
8194.
805.

.-.71

1856
394.

J.

2.8
1439.

i;:!>S
1601.
1142.

7284 9712 12141. 24282.

5745 7661. 9676. L9152

591. 788 986.0 ln72.

608. 670. , 838.5 1677.

81. 1"-. 185. 270.

4.2 6.6 7.0 14.

2158 2876 3598. 719*.

9582 12776 15970. 31941.

2415. 3222. 4027. BOSK

1714. 2286. 2857. 57ll

The Green color of this Marl is due to the presence of
Silicate of Iron.

This Marl will yield 33J pounds of Phosphoric Acid to
the ton of 2000 pounds.

Each ton of this Marl contains 73 pounds of Phosphate
of Lime (Bone Earth) If now we assume that the Phos-
phate of Lime is worth 2 cts. per pound, then this consti-
tuent alone would be wonh 1.40 per ton. The Carbonate
of Lime is also valuable as a fertilizer as are also the Inso-
luble Silicates which contain small quantities of Soda and
Potassa and will during their slow decomposition yield
them to the soil. At a moderate calculation this Marl ifl
worth S2 per ton to the agriculturist. One hundred bushels
oi' the green marl contains four times more phosphoric acid,
and as a necessary consequence, four times more phosphate
of lime, than one hundred pounds of Phosphatic and Peru-
vian guano, (^v of any other commercial fertilizer.

I860.]

Of Georgia,

No. -2 Yellow Marl

From well near the Methodisl Church, 5 miles east of 90
mile station Central Railroad, on the land of J. V. Jones,
fcsq.

This Marl is composed of yellow clay and shells. The
hod lies 30 feet beneath the surface in contacl above with
joint clay and rests below upon hard shell limestone and is
B feet thick.

ANALYSIS 2. YELLOW MARL.

S

y

3.
to
o

o

3

B.

5

o

o
5

go

s

r

n a

o

2.=>
if/*'

-r a

~1

O L.

2.

' B

o

S 2.

* o

o

^rtKteofLime4S.033|S;iicAdd:
No-PbateofLlme "} PhStak'AaK

24.993

3.494
2.971
0.841
0.002

0.001
0.010

W.178
5.620
3.100

249.930
180.300
34.940
29.710

0.020

0.010

0.100

2.650

100.780

56.200

69.880
59.420
16.820
0.040
0.020

112.400

2499.14998

349.4 698.8

297.1 594.2

84. 168.

0.2 0.4
0.11 0.2
l.nl 2.0

4017183;
662. 1124.
3101 62(1,!

7497.
5409

891.3
2Q2
0.6

0.8
3.0

79.
111".-..-;.
1686.

9yj)~

7212

1397.6

1188.4

O.i
0.4
4.0
105.
16071

1240

12496 '24993.
!. 17.0 1 14.

182.

2810.
1550

>

Sulphuric Acid

Chlorides

1.

ID

Oxide of Iron

Silicates Insoluble in Hydrochloric Acid

BUdoua Sand

Water as moisture

265
I017S]

This Marl will yield to the Ton of 2000 pounds.

Carbonate of Lime - - - 860.460 pounds.

Phosphate of Lime - - - 129.300 "

Phosphoric Acid - - - 59.420 "

This Marl will prove a most valuable fertilizer to all soils
and especially to sandy soils, on account of the insoluble
silicates, (clay,) as well as on account of the ingredients men-
tioned above. One hundred bushels of the yellow marl con-
tain eight times more Phosphate of Lime than one hundred
pounds of any known Guano or manufactured manure.

It would be perfectly safe to apply^one hundred pounds of
these marls to any land in Georgia', and if the lands be newly
cleared and rich in organic matters, we might doable and
treble the amount.

The experience of Senator Hammond, of South Carolina.
and others, have rendered it at least probable that the lands
of South Carolina and Georgia will not bear as heavy appli-
cations of marl as the lands of England, Virginia and Mary-
land, and hence I would not, until careful experiments have

r26 Tertiary Tjinu Formation [October?

determined the exact, amount of marl which is sufficient foi
our lands in Georgia, recommend the application of thesd

green and yellow marls, upon sandy and cultivated lands, in
larger quantities than two hundred bushels to the acre.

When 1 have completed the chemical analyses of the soils
of Georgia, and have elaborated and finished my investiga-j
tions upon the climate of Georgia, and its relations to the soil
and ^ egetation, 1 hope to be able to speak with more precision^

It is, nevertheless, evident, that even with this small
amount to each acre, the marls of Georgia will furnish far
more Phosphoric Acid and Phosphate of Lime than a corres-
ponding application of the most expensive commercial fertili-
sers. In making this comparison, we have impartially
compared the yellow and green marls with the very bed
UstWh-cr^ in the market,

No. 3 White Shell Marl or Limestone.

Well at the Methodist Church land of J. V\ Jones, Esq.
This specimen was taken from a bed of conglomerated
fossil shells, lying immediately beneath the Yellow Marl
No. 2.

SECTION.

Sandy Surface Soil - 2 feet,

Yellow Sand and Clay - - - - 3 wt
Joint Clay - - - - - - go "

Bed <>f Yellow Marl No. 2 3 "

White Shell conglomerate - - undetermined.
This bed of fossil shells lies 33 feet beneath the surface of
the soil, Joint Clay and Yellow Marl, and extends down-
wards to an unknown depth, probably for more than I"11

When pulverised itereaemhlcs in appearance slaked lime.

< '

Of Q

1000 bushels

con*

r: o c ?i i - -

tain pound

j,

OQO

- : r

500 bushels

cull-

3 geoeeaSH ~.\ roScc
^S^91 : 7i

tain pounc

Is.

100 bushels
tain poun<

eon*

3.

gg^ c ! =5 - : - '

Sawc - - 2 i cc : i 7 i -
s ,. r i- -7 ~ t ~

zi ,_; ~i ' '

800 bushels

eon*

f> '- y -. -- "-. " y. .7 go-.
;---/:-.- r. S <-.
LZ J2 -O <M tM Cfl i - -? 7i ::
_ _

tain pouni

s.

200 bushels

Cirll-

22 S? 1-1 irf Ut DHWHHCC

tain pound

<.

_[^Oo:i iTJ U5O00IM

H

IOo bushels con-

^^"^'-r- :-,:-."7':

o

rain pounds.

CC Z CM t- C C CC ~ -

r.

OS ODC-t* T-4 7 1 -' -" r-i

H

DOOOOOOOOOC

^

One ton of 1

5000

-fOCl- ~ CC Z\ 7 1 "

X r-4 -- 10 --* O i-j CC CI 7?

j

pds. contains

pds

20 -.7 -' S- :7 71 O id r-i r 1 -71
X I- ~ 77

a

35 i-

s

OOOOOOOOC - -

A

1000 Pounds

con-

NOONOMU: CO 'M'Ml-

s> 1 7 - 711- q q -: 1 7 cq

H

tain pounc

8.

r-i CO ' ~' -+ r- r-i ~" 7 1 > D O r-i

-~ -.:

>**

7 \ r cc 1 - 0 : 7 1 - - ' .- 1 7 1 1 -

1

100 Parts

con-

OiiG DCMNC CO '7 CC

. cq >~ -^ Is-; r-i 71 ~ c *

tain.

35 X -' r 33 CJ ~' 3J> ~ ~

d

rs * *d

7

. 52 . *S . !

--

. < : << : .

J

15

'. - l.S I I

s : :

-~

il :J : :

.c 3 0 7" .

*.S.S : :

<

0 . .

71 ,

CJ 0 *

-ft '^A '

oj .

I CO

77

-'. .

-, , 1

x ~. -y 1

0 '~'

O ~~ *C7

0 .S

S ~ ?o

'p^ ; Z

- a <*

**^ *3 4 "OB

* , -_

=> 0 0 -~

^"3 5*7

0
0 0 -j a

** .2 K3 ^

"S - ^ '^ -j - t k i

5 ^= 2 - ^ S -

p Ph 0 jo *C 3 "S.2 5l

3 Jz 3 -c

^

U Ph U /.

<U^U2

<:'v Tertiary Lime Formation [October,

One ton of this Shell Limestone will yield 1756.840
pounds of Carbonate of Lime and when burned 083.040
pounds of lime. It is therefore valuable for architectural
as well as agricultural purposes.

Xo. 4rSofl White Shell Marl*

From well near negro quarters on the Plantation of J. V.
Jones, Esq., 48 feet beneath the surface of the earth. This
bed of Marl is much softer than those just described and the
lumps .crumble upon the slightest touch when pulverized
it presents a perfectly white appearance and resembles shell
lime.

No. 5. Bluish Black Marlf

This bed of Marl lies in a dense swamp upon the outh
side of Bluck-head Creek, 13 miles from the 90 mile station
Central Railroad and 11 miles from Waynesboro. The
land is owned by Capt. Matthew Meddlers. This speci-
men was taken from beneath the roots of a lars:e water oak
which had been overturned by a storm.

The trees in this swamp are as large and luxurious as any '
I have ever seen in this section of the country. The roots
of immense trees penetrated this marl in every direction
thus showing that it was favorable to vegetable growth.
The hills around were sandy and appeared to be much ex-
hausted by long culture. This Marl or more properly
calcareous earth conisted chiefly of Blue Clay in whicl
small fragments of shells and Carbonate of Lime wei
imbedded, and appeared to have resulted from the wash-
ings of the surrounding hills which are compose*
of sandy soil, joint claV beneath the sandy soil of and she!
limestone beneath the joint clay ; and from sediment (nun
particles of shells, Carbonate of Lime, sand and organic mat
ters) deposited from the waters of Buck-head Creek.

*See Analysis 4 on next page.
fSce Analysis 5 on page 530.

lZ.

I860.]

Of Georgia.

729

500 bushels con-
tain pounds. .

400 bushels con-
tain pounds . .

300 bushels con-
tain pounds. .

200 bushels eon
tain pounds. . .

100 bushels con

tain pounds. . .

1 ton of 2000 pds.
contains pounds

1000 pounds con
tain pounds. .

100 parts contain

X t-h -_r i * I - ^

O _-. : i

5QI HO<NO><NObW

5 i-t co i-i co

cm o

d o

co

oco't

O CO

5 -

30 irf CO
N CO CM

3 T-H

:r

,'- ~ . ':: /. - c'

wCOOr-NHCO>Ci
COSO(M

1/5 T-H

MOOH*tHWo
CO T~l

0 ^, ,-, ... ^ co cc

l i O O

o o o

-coo

*J . ^

kd w -+-'

O CO
X! CD

o o o o o o

-M CO CI O O ^
O O O t-h o CM

mc'c'd^H

CM QO
CO

o o

CM -f

CO CO

o o o
ci

30 UO CO

ci cd tN

O t-H

;^co

noo

30 0 CO
MO (N

dnq

* CO

o o o o o o

CD CO T-H tO GO CM
O CM ^ CD
t-h O* O CM '

t-H CI

o o

CO CI

o ~*

-HH CO

CDOOt t tO CO CM CO CM
OCMOO-H^CDO"^
rH O CM ^ GO

""' ' t-h ci ^"J

'8

11

cs

o

^3

"3

:<!

'. o
cT 2

H^ 2

k c -

a
a

o

CS

o

r-3

m o

O --3

cs .^CO
cS

5 rt73 a o s
o ^ ' "a -^ .o

cs "3 2 ~ f rc3

2 S3

7:'><>

Tertiary Linu Formation

[October,

tain pounds.. .

500 bushels con-
tains pounds

_ _ _ _'

o ~ / 2 o ac

UO X CO a DC

5 I ~ 2 i*- 7

~ 71 '7 71

~ 1 1 ~ i r CJ";

7

Hr-.VI-^

5 ' '" 5 Z- l~ x ~

7^ 7~1 OCOM

ii TJ CO

g S S g

400 bushels eon-
tain pounds. . . s5

|300 bushels j <x

tain pound- . j 2-!

/ x

7i

vr X

200 bushels eon-
tain pounds. . .

lOo bushels con-
tain pounds. . .

Jltonof2000pd&

contain pounds. ..

1000 pounds con-
tain pounds. . .

*t< iO OO OO U7

. i a. -~

r-i 71

oo *f >7 '" oc

d td -* cs

X x - -.

SiiOCC '"

G\ Ol O CO CO \r.

~ y

711 ! ~ 7!

i i

71 -j: cs do

7 X do

71 DO

000

v 5

i- -

53 ' 7 O

i
S~oo~

iC 71
7 X 00

X ,
71 '

CD O

3 r

DO -

a. do

o o

3 O

X

7 1 7-
7i

: =>'

o o

71 -r

ICO <N C

X

DO 71

5 c
oq

l~ DO
' JO

o s

X O

- r.

100 parts contain. 4 ^

DO ~
X DO
7-1 O

6 -

r- 7J
3 - X 77

7i - r

OH

C7 X
l^ 71

1- 71

Shhcohhc

r>Tj*e s ~ ~r ^:ih^

o i- o ST
a ei S o

C 2

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S . H -S , =

O ,_, . a c3 no cl

a

c

pg

,JO

3

^fC

p_l

3 OQ U -1 c DQ dq ^

18(50.] Of Georgia. 731

OnotonofthisMarlor calcareous earth contains 28 pounds
of organic matter, 195 pounds of * Carbonate of Lime, L2
pounds of Phosphate of Lime and 943 pounds of [nsoluble
Silicates (Clay). This Marl will therefore prdve a
valuable fertilizer upon the surrounding sandy lands. It
may be applied in much larger quantities than the shell
limestone El would be safe to apply 1,000 bushels of this
bluish black marl, which occurs on the plantation of Captain
Matthew Meddlers, in Burke county, to each acre of land, for
in this amount wo would haw only 9,739 pounds of carbonate
of lime, intimately mixed with clay.

In this amount we would obtain 610 pounds of Phosphate
of Lime, an amount at least twice a- great as that contained
in a most liberal application of the best guano and commercial
manures.

Hence, with truth and reason we may aitirin that this
bluish black deposit will prove a valuable fertilizing agent to
the surrounding exhausted sandy lands. The day alone will
prove a valuable addition to the sandy lands.

No. G. Black Swamp Deposit rich <n Carbonah of Lime.

Plantation of Capt Matthew McCullers, 300 yards south

of Buck-head creek and 260 yard- south of deposit Xo. 5.

This deposit occurs in a don-.' swamp, and is of recent
origin, being derived from the washing of the surrounding
hills, the vegetable matters of the dense forest, and from
the calcareous matter- dissolved in the waters of the small
stream which issues out of the shell-limestone hills half a
mile distant, and which flows through the swamp near this
deposit. In wot weai her the stream overflows its banks
and covers this deposit This deposit varies from one to
three feet in thickness.

One ton of this dried swamp di ontains 104 pounds

of Organic Matter, 135 pounds of Carbonate of lame, and
16} pounds of Phosphate of Lime. The Large proportion
of Organic Matters also assist in rendering this a valuable
manure. The value of this swamp deposit, as well as the
efficacv of the Shell Marl, is increased bv mixing1 them

732 Tertiary Lime Formation [October,

together, at the time of their application to the fields. It
would he safe to apply one thousand bushels of the black

swamp deposit No. 7, to eacli acre of land. In this amount
we would apply as much Phosphate of Lime, as is contained
in one thousand pounds of the very best Phosphatic Guanos]
and in addition to this we will apply eight thousand two hun-
dred and twenty-one pounds of organic matters and six thou-
sand eight hundred and eight pounds of Carbonate of Lime.

Although these organic matters are not as soluble, or as
valuable sources of ammonia, as the organic matters of Guano,
or of animal manures, still they are valuable, for they consist
of animalcules, stems, roots and leaves of trees in various
stages of decomposition, in addition to various other organic
compounds, as humic and nlmic acids. It is well known to
every chemist that lime promotes the disintegration and pre-
paration for vegetables, of the most stable and insoluble com-
pounds ; hence the deposits of swamps and peat hogs, which]
are comparatively inert, are readily decomposed and prepared
for vegetation by the action of lime. The value of this black
swamp deposit, on this very account, will be increased, by
mixing it intimately with onc-rpiarter of its weight of pounded
lime-stone, or one-twentieth of its weight of lime this would
be easily accomplished on the plantation of Capt. McCnllers,
where this deposit occurs, for the surrounding hills are com-
posed in great measure of shell Limestone. It should he
borne in mind that a less quantity of this mixture should he
added to the land. That portion of this swamp deposit, which
we designate as insoluble silicates and silicious sand, will of
itself alone be a useful addition to the neio-hhorina' sandv
lands, for it is composed chiefly of a clay, rich in lime, and
contains, also, some soda and potassa.

That the deposits from swamps are useful applications to
sandy lands, and greatly increase (when applied in sufficient
quantities) the yield of both cotton and corn, I have had mosi
favorable opportunities of observing in my native county,
Liberty county, Ga.) upon cotton plantations in the immediate
vicinity of the plantations cultivated by my brother and
myself; and in this connection I would simply remark, that

m

I860.]

Of Georgia,

733

I have collected deposits from the salt marshes of I he Atlantic
coast of Georgia, from the brackish swamps, from the deltas
of both salt, brackish and fresh water rivers, and from the
h water swamps which lie above the tertiary formation,
and have been, and am still, engaged in a careful chemical
examination of these deposits. We hope to he able to pre-
sent a report upon these deposits, as well as upon the waters
from which they are derived, at an early day, to the Cotton
Planters' Convention. In this report the agricultural value
of these deposits will be carefully described.

contain
pounds

| O O O O O 1

500 bushels g />:.> 1

contain 89

pounds ~~

t h e 1 e
contain
pounds

cq *; ffi --a oe>

~ -~ tc cr

T-ioO>Q

800 bushels r'-'.-r-ri

contain

i pounds

! : :' <'-!'
1 -I

200 bushels
contain

I pounds

-

it-e CO-**

100 bushels!--"-'. -'.-.'-'
i contain ! ~"~ "
1 pounds

CI 3-. CI *

') d '

1 Ton of 2.000
pounds con-
tain pounds

o o o o o
j_i - 5 x

71

58.240

26.580

568.180

1294.280

1 o o

i 1000 pou n d a '< ~ C. *! =2

contain puds ~ -----

29.1 -JO
13.290
284.090

017.110

100 parts con-|sss21
tuir. Iridddd^

3J < :

'< :-c i
:| :i :

iiiil

* o 1

III]

D

x a "Si

- s "

e I -Si

.-J rt :

:<

l

j

. ,'z

containing Salts of Potassa and Soda

Oxide of iron and Alumina

Insoluble Silicates aud Sand, (chiefly clay)

Water as Moisture

_,

o

::

m

o

Q

04

c

(N

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a

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z

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o

-

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o

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s

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-d

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w

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"en

fcfl

fl

h

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ft

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ce

;?

1 contain

/ :: c

pounds

. -hels

- ~. '. i '
- ; i

contain

pounds

400 bushels

' /. i - _' _-'

s'g's

contain

5?3,",,FH

pounds

U -lie Is

-v_-

t= 00 -3

::M\

S3!

p unds

ushela

tI -." /'.-' a

contain

L-a

pounds

1-1

100 bushels

"T. lT. ~. r. ~.

r"' e

.tain

g*fi

X * |

pounds

Sggj

l Ton of 2,000

i pounds con-

-^ -. X t-_

-;:-

, tain pounds

-1

O O O O O

coo

1000 p'ds con-

' -' --' : :' -'

tain pounds

00

-.: .- -x -

100 parts con-
tain

1

T~-'~yt V,r-7,

"TIO O C f; X'cfo

a

s : : :

* *2 "

^

:-5 :< :

. rt : .

:<j u :

< z :-z

3oJ3S :

and Ulniic
Soda ami 1'

iUclouB San

I u

o" <= 6

o* i Sc

/. :

5 lie

2*i

a aia

-2 S-eo.a3s

a - s = ci - >: --c

^ a* a

c c

:;i

'/; rtiary Ldnu Formation

[October^

No. 7. Reddish Brown Marl.
This deposit Lies on the edge of the dense swanip in
which the previous deposit was found, 340 yards south oi

1000 bushels con- co m *&
tain pound-. . . cooo*"

500 bushels con-
tain pounds, . .

NO c

r.

o c

M CO CS l-H

:i:::i7.
<M <N

i 7i d

ONOC
H CO # c

- ?'

400 bushels eon-

* tain pounds. . .

lid 6^. .

:o oc c r

2 CO CO -r

aa co

300 bushels con-
tain pounds, . .

~i CO BO -"
It o

) - C 1^-00
CO OO -<t

t- o 71

200 bushels con-
tain pounds. . .

.-o'~ .T

- :: :r ~ -
~ I- 71 71 CC

M

co" c
O CO t^CM

-r eo iO cc

100 bushels con-
tain pounds, . .

1 Ton of 2,O0(i |
pounds contain _J1
pounds, L: Lr

id x. .

O r-l O
XHr-i
H

o d
r: co c

CO N N

.'TOO

1MWOH

7 1 71 71 X

CM CM

d o o

r 71 r

co o c
o cd oo oi

1000 pounds con-|igsii

tain pounds. . . gj <g i-i -< *h

Vi

o o c ;

>7 O 71
~ o

71 co
71 77 71 X

71 71

1 OO r-4 OC ON

100 parts ean-|g83g;S
tain jco od o o* o

o

3

-

^lOCO ~ 7 1

a o a z
2 cm oo o> i

71 CO* 7'' X)

"* <M CM

. . . -3 .

'ttT * ' s

:s .< :

:*^ ' o :

\ JO \'Z.

fl i"! :

.2 = a 9, :

r.
s.

:7

7l'

QO
71 -T

o~ c
= too

-^ J

"O 3 (U-,
o

C-i o -3

SS3

o

c

- .S QQ *

,3 O g g ::

"5,2 3.2

3 * ~ 3 tS

U' O gq oq P

18G0.J Of Georgia.

Buck-Head Creek, 290 yards south of Deposit No. 5, and
4<) yards easl of Deposit No. 6.

This Deposit appears to be recent, resulting from the
crashing of the surrounding joint clay and shell lime hills*

This Marl presents o yellow and reddish brown color, and
contains numerous nodules of oxide of [ron, When pul-
rerised, it resembles some varieties of American Guano.

A . S.Bedilish Brown Marl.
- Land of Capt McCullers, near Limestone Spring. This
bed of Marl was found at tin' base of a liill composed of
joint clay and shell Limestone, and extended across the
bed of a stream which issued out of the shell Limestone
formation, one hundred yards beyond. Ii is composed of.a
mixture of yellow mid reddish brown clay and fragments of
fossil shells.

.V . '.. White Shell Limestone.^

Plantation of Capt. Matthew McCullers, near Limestone
Spring. This formation of shell conglomerate is composed
of fossil shells ami star-fish, and appears to form the greater
portion of the surrounding hills. Many of the star-fish are
completely tilled with crystallized Carbonate of Lime.
Many of the shells arc encrusted with beautiful crystals
of Carbonate of Lime. This specimen was selected from
the side of the stream near the Limestone spring.

This stream, like other streams in this limestone region.
issues from the base of a hill, throwing up the small parti-
cles of shell and white sand. The banks of the stream and
the sides <>f the hill are clothed with the magnificent virgin
forest, which tonus a dense and delightful shade. The
water is very cool and as clear as crystal it fails, however,

Ito quench thirst, and is injurious on account of the large pro-
portion of lime which it contains. We shall present, in our re-
port to the -Cotton Planter's Convention." analyses of these
waters, and also poinl out their relation to disease and their
value in agriculture.

For Analyses of this Marl in natural and dried condition, see Anal-
ysis Nos 9 and 10. fFor Analysis see page 738.

36

Tertiary Lime Formation

[October

1000 bushels con-

D 00 00 iH

O O X o

co o o in -

CO CO ~ ' "

tain pound.s . .

OOrtH

oo co

CO O O OC
TICClrH
^H OI

500 bushels con-

oi Tji <=> ^

:o o t o

9 9 6<Nod

CO CO I- O OI

tain pounds, . .

co *+ c: i-

Tf CO - r.

^r co

I ~ I - T 1 O

T 1 1

400 bushels con-

co CO OI -1-

c4 o -t-

"*! rf co oi oi

co i- o ~v

tain pounds, . .

t I- 1- co

CO 1- <X 1-

CO OI

i~ co oo

H

300 bushels con-

a cq ~t w

OS T'^CO

_ co oi i' cd

l: c x o uo

<

tain pounds, . .

lO O O ^f

CNl-OC '*

H
w.

M OI

OI uO CO

h3

200 bushels con-

co' -1 *^ * !

. oi cc 1-5 '

<

tain pounds, . .

CO CO N!N

!- CO OO O t*-

P3

I- CO CO CO

rH O CO ^ CO

H

100 bushels con-

cd * n

^ co -+ O I 3

<

tain pounds,.. .

oooooo

co co co

OO CO T-H

CM CO CM rH

* oo

i i

;1 Ton of 2,000

o o o o

~ CO CO CO

o o o o o

oi -t -t< O OI

>A

pounds contain
; pounds,

CO i-J 1- CM

I- OI 00 rH rH

tf

CO CO CO co"

rH CO* CO O t^

I- CO

OCO^CN

o

i

1000 pounds con-

uO OO X H
CO 00 CO

OOKNOO

x co tH q o

o

tain pounds, . .

CO"o6r^r-i

00 CO

co d co
oi co oi

-t T-i OI

ut X' C r-i

~ - ~CO OI CM lO O

M

100 parts con-
tain,

ooxo o O O X O "f o o
OQC-iH 2 g O CO O O OC

a6dc4coc4rH

Q

w

'T3 * ^3

1

."

a>

:.s . o

.

! p *fi

*

o

-o o

X

Xfx

.~ rt o 5a

t-H

hhO 2 2

OQ

K-"

~*->"l Ph

,

p I

fc

^

h5 ;

<

o 2.s

*-.

rH 2

*

o

O J

N '

o

o 0 c
o o c

o

3

: a 5

2.1

! P ^?

o cu c

" 2 2-g'fl o = -

: Pu ^-^_o "73 ^o g oi

*-. o s.

r; -P e

rHCJC

<

J*

I860.]

Of Georgia,

737

1000 bushels con

i - : d -.'

tain pounds, . .

e '- "m "m

cc "

/

-. 7 1

500 bushels con-

:: _- - ~.
- i- NOT

~ -.-. Z

:r r. /
.:-.i/ : i

tain pounds. . .

o -r i-h

i - Z
71

100 bushels con-

-s ~r-
:: / ~. N

-r -r /-

' .- ?id
71 :t 1 - 71
/_-:

tain pounds, . .

::

; oi

o

300 bushels con-

CO co c4 *2

71 pH I

71 t- ~

o

OT CO CO

SiCQtON

77

CM

tain pounds, . .

90 N

2

<

200 bushels con

71 oo <*.

p -t

"^ 00 CO CO

tain pounds,. .

Til-

01 o. :t '.

-

N^

- ~r

LOO bushels con-

OCi-i^O

1 " oa / cc

Q

tain pounds. . .

O I- ?1 c
HOO 71

H -f fH 71

J

< '

>7 01

1 Tou of* 2000

c ^ 5 f i

TftOOOC

pounds contain

t- 71 X

r X tO "

7i OT rr

pounds,

71 1-
71 r-i

03 M
occ >C

1-H

o
-
pq

o o o o

o o o

LOOO pounds con-

t- 71 C CO
X HO

I- * O O

O 05 X iC

cc

tain pounds,. .

1-71 71

X

r-i d d

-T 7

i I

O 7<l 7

s

IT- <N O O

. .NTj*C0

LOO parts contain

X P O 8) &

o o ca x cc

O tfj jg ,~

ei

x -3 d

-t ~ 71

-

'3 'IS

rH

'3 ' *S

| o . o

fc

CO

of j ! J

E *- -r O.
.5 ea ffl oo

<

* < 'h3 Ph

cf

fc

os <~-

p

*<

oa o

t~ -r r
OS "^ *

> ' O |

>.

cT

0 8

V?

70

0 6 ~

-

-

S . .2 ns

o o c

J-

-5 ,c

J

5 75 ^ s.g

i- w J_

t; -S it

3 - ~7Z "~~

U PhC

X

Ul

UhM

<

47

738

Tertiary Lime Formation

[( >ctober,

100O bushels con- 13 g I-"*"r^77

tain pounds.. . .

(NO>0 - -

- -t :c

-"t< CO 1 '

J00 bushels con-
tain pounds. . .

u7 O o *o

i-H CO l - . o c

:i - -/. -n -t- -m -f i.-: c. t -r

-r - 1- 00 '7 00

^u-:t :i
71 < -N

400 bushels con-
tain pounds. . .

X -i
7i r^ -m :i

TO - -f I - CO i ( 00 I - 1 - CO l -
. ~ OH 71 01 0 1
X l-Ol (N i 0
r- 1 i I

500 bushels con-
tain pounds . .

71 1^ 0-1 1^ "*

01 . oc -t -t

lOCOH TO 01 71 -0 Ol

>7 . 71 . 71
TO rl rH 71 TO

200 bushe c

tain pounds. . .

-^ OO Q 00 00

x> cc x CO CO

- T l X' H O H TO TO TO
C 71 i . o
X 1 - H -H X 0 1

100 bushels con-
tain pounds, . .

I- ^ "+ > '00
-* CO 00 oc

X 01 TO -* C
-T '0 '7 7 00
-t- CO * -H f-H

i. Ton of 200ol

pounds contain ..-
pounds, Ig

-o-

oo cc

X X

1

CO 74 71

-T 71

O i-i

c
) pounds con-l^" w " ^ 3. =2

c c
I

TO

-r .

x

0 1

x

X

tain pounds, . . j2

n
io

-7 O O CO O O CC

.00

parts

CO it?

|TO TO 1- -T

:o to -f

, |X> 71 ifl

5?

-r K

T 1 1 1

X X

|3

i-7

O

3

-

TT

5 <

..s :'

.a

- DD
s ^ -

oqqoOhgg

Of Georgia,

739

500 bushels con-
tain pounds ,. .

~i

1000 bushelscon-
tain pounds, . .

S '. i : T 7 1

! - '7 ~.[

i- I- N

:?

L ~

r ti :

/ s i - i -

/ i - - .-.

BC i - i i

71

-

: i
. : i - / ?i

<

". ".
. . / i _

s: t i -

- -.' -r

'-

400 bushels con- g 8 _:

tain pounds, . . j ,-- '"

-

go

- >

to cn

. Ci C > 7

i - i - / ufi
O CM CO

800 bushels con-gjg -
tain pounds . . 111!"'

1- o

GO

CN 7i -r
;c ce

71 71

CO

200 bushels con-
tain pounds, . .

7 1 I 7

z c

X X

O I

'7 71

SO t*

71 -t

CO GO

'7 71

100 bushels con-
tain pounds, . . .

71
I 7 JC

tO

71

h <N

5: ::

O I -<
I- GC CM

o

2000 -

1 Ton of .
pounds contain ,~
pounds g

o o

o o

tO i

o o
o o

T7

o o

CO CO

en cc

: : :

~ 71 x

p-H O CM

tO

I-

oi

o o

1000 pounds con- -. =i -.
tain pounds,. . S~

to c

i-i 7-1

O I - -+ I ^

71

z z z
X -~ -r

l^ 1 I

100 parts contain ^

'7 r-i

- :

'7 O

7! :?

tO 1-H

H Ol

71

I - X 7 )

C

tO o

r- 71

. oa sc

X X ~r

O I- r-

l^ CO CM

b-OOCi-COOOOO

^ ^

U

33

-

DQ

X

H3 a

3 *>

^ftcs

Ph q x 5 ^ X <; ^

r40 Tertiary Linn Formation [October,

This bed of White Shell conglomerate will yield when
burned 955 pounds of Lime to the tun, suitable for building
as well as for agriculture.

This specimen, as well as the preceding one, Xo. 9, was
selected from the base of the hill where the formation is

exposed, and at this point streams of water issue, bearing
down in their course much white sand. From this fact it
is reasonable to infer that if the lime rock is taken from the
interior of the hill, it will contain much less sand, and will
yield proportionally more Lime.

III. Shell Limestone of Washington Count)/, Georgia.

The Central Hail Road passes through the Eocene forma-
tion in Screven, Burke, Jefferson and Washington counties,
and many fine deposits of Shell Limestone and Marl may be
seen along the route, especially in Jefferson and AVashing-
ton counties. We shall, at present, present the results of
our examination of the deposit in Washington county, near
the Station Tennille, Xo. 14, Central Rail Road. We have I
selected the deposit in this locality for an early examination
and report, because it yields Lime of an excellent quality for
architectural as well as agricultural purposes, and because it
is inexhaustible, containing lime sufficient to supply every
planter and architect in Georgia. I am indebted to Samuel
0. Franklin, Esq., of Tennille, for the opportunity of exam-
ining the durability and finish of the plaster made from this
Lime.

The Station Tennille, near where the Shell Limestom
found, is the most elevated point on the Central Rail 1 !
between Savannah and Macon, being 465 feet above tide-
water, 244 feet above the station ten miles above; 279
above the Oconee River, 12 miles above; 174 feet al
Station Xo. 1*2, ten miles below; 285 feet above the Ogeechee
River, and 1(38 feet above Macon.

SECTION at TENNILLB.

Surface soil, vegetable mould, sand and claj . 6 to 18 ln<

Yellow and Red Clay and Sand, 5 feet.

Joint Clay L2 "

Coarse Sand without Clay, . . . 22 "

Solid Shell conglomerate, . . . und ined.

At the depth of 51 foot, an abundant supply of water is
obtained.

Upon the plantation of Mr. Sneed, one mile and a half

from Tennille, the Shell Limestone crops out at the surface j

and the sides of several hills which I examined were covered
with fragments of oyster shells. These shells, bleached
by the sun and acted upon by the weather, resembled the

shells which cover the surface of the islands of our sea-coast.
The surface shells were easily crushed, whilst those tying
In the streams, and which had been washed out of the
sides of the hills, were of flinty hardness. Beneath the bed
of oyster shells is found a solid conglomerate of shells and
star fish. In some localities, sharks' teeth, and vertebra1 and
ribs of cetaceous and various extinct vetcbrate animals are
found.1*

The streams have formed subterranean passages through
these hills of Shell Limestone.

In some places, it is possible to pass entirely through the
hills in the tunnel formed by these streams. The water
flowing in these streams is limpid and cool. The beds of
the streams where they flow over the solid shell rock, are
paved with fossil star-fish, which being harder and more
compact than the surrounding shell conglomerate, resist
the action of the water, and stand out above the lime rock.
In other places where the loose sand accumulates, sharks'
teeth and fossil bones are found, having evidently been
washed down by the water.

The Shell Limestone can be obtained in inexhaustible
quantities from the sides of the hills, without any excava-
tion, and without suffering any inconvenience from an
accumulation of water.

742

Tertiary Lime Formation

[October,

Cj O

0

33

o

-~

O

-r-

s

~

o

-

f-j

TJ

3

<3 m-

-M

o

o

T)

-,

?C

+3

-

rn

O
CJ>

c

, 1

~

H

ch

H

H

c3

-

O

U
^

/.

B

c-j

0Q

>

fci

Cj

P"

ft.

^

i |

O

a

o

PI

l

--

o

_

-~~

o

u

;_

^_J

l

QQ

no

7

o

-

t

H

~.

S

00

OJ

z

6

fc

00

m

u

6j

,

4)

30

r/7

o

O

^>

-

o

p

o

o

a

3

03

CO

o

-t->

:

.1 1

i_

hh:

1000 bushels con-

0

-o ino)

C CO
O '-"0

i - r co

tain pounds, . .

/ 90 00 CM

O

90

- ~. 90

o o

"-"O

.

500 bushels con-

ON

o

>-C o
OO i-0 CO c

tain pounds . . ;

Oi *h CO -1<

0 O r-> r-l

01 01

t 1

0 01 -p ,
01

CM Ol

. 25

.

400 bushels con-

CI

~f -f r-H O

o
CN CO

z so c

CT 1^ CM

tain pounds,. .

1 CC

i-h rH
71

~ X M

t "W

U.d

300 bushels con-

X X

o o oo o

- o o

iO >~ 1-

d

tain pounds,. .

'O HO X

O Ol

ct cc ci

o

r 1

c

CP CO

o

200 bushels con-

CM I-H

1- 1- >0

o
CO oo

TjJ CO

co oo o

tain pounds, . .

CO OCC "3

O OO

Ol T-H

/<

s

CO

<

oo x.

IQ

100 bushels con-

o

X SO CN

o

CO

I- cc

t I uO I ~ 00

tains pounds. .

hOOO^

I-H "tf

c

o o

0

X CM (M CO

o o

1 Ton of 2000

r-i iO o

O CO

** CO

B

pounds contain

o t co ua

CO o

co

CC X CO

Ol .

^

O 00

/.

o o o o

o o

[g

-t1 a: x

CO O

J

1000 pounds con-

O 3 CM

z. CO

1 CO

J

tain pounds, . .

ifl CO 00 O*

i-h o

oo

i.O CC

r-H -Hi

H

iO Tf

o co oo oo

tC

00 i i

cc iC oi Oi a

,~i~ c::o

|

100 parts contain

00 CO CO CN c

CO

a r-i .o co
es

oo

-< o o o i

ii ^ *^ - -

C

I I * .

fc

72 *
. CJ * ss

rT3

CO
CO

'3

<

1*

.2

-:

* ir ^^ ' zz

' m

^
fc

5 S-

^

-4

"~ * B S

CM <s> e-
CM .2 '|

*

C3

p
'3

2 to t

1

? a

}

a

3

a

. -

B r

p

. s

1 ^ -*-*

3 ^

5 IM

p

. o

o t> .8

. 0 O

o 3 c

J r,

'^co ^

o c

5 O p a s

: 'S "5.2 o

* S S rt

3 :

j a

:

Icca

3>

3860.] Of Georgia. 743

This Shell Limestone will yield L030 pounds of excellent
Lime to the ton. Vov agricultural purposes it will yield
1837 pounds of Carbonate of Lime, and \-\ pounds of
Phosphate oi' Lime. Ii ishighly probable that au extende I
and careful search would resultin the discovery of deposits
much richer in the Phosphates. We would look for an
accumulation of the Phosphate of Lime in those deposits
which are rich in the remains of vertebrate animals. We
\vi!l in the next place consider the relative value, eifects and
mode of application of the Marls and Shell Limestone of
Georgia. It will be impossible apori the present occasion
to do more than present general and well established facts
and conclusions.

The whole subject will be fully and carefully discussed in
the large Report, which we expect to present to the "Cotton
Planters' Convention" when the Agricultural Survey is
completed.

TV. Comparison of the Shell-Limestone and Marls of Georgia
with the Limestones and Marls of Europe, and with the
Limestones and Moris of Massachusetts, Rhode Island,
n ntth- Carolina, Alabama, Arkansas and Kentucky.

The following tables will present comparative views of the
chemical constitution of the Limestones and Marls of Europe,
and of several States where similar deposits have been care-
fully examined and analyzed by reliable chemists.

In the selection of the materials for the tables of the chem-
ical constituents of the Limestones and Marls of Europe, and
of the United States, I have impartially chosen the results
obtained by the most reliable observers, and have carefully
stated n<t only the observers name, but also the titles of the
works in which the results were originally published.

In the construction of these Tables I have made no omis-
sions, but have embodied all the results obtained by each ob-
server. These are not, therefore, selected observations, isola-
ted, and partial, but entire series of observations, conducted
by the various chemists named. I believe that in this way
alone, can fail- and impartial comparisons bo instituted between

744

T( rtiary Lime Formation

[October,

the chemical constituents of the Lime-formations of Georgia,

and of other parts of the United States and of Europe. We
are fully aware that many of the results embodied in these
Tallies, rehire to formations of different Geological ages, from
those of the Eocene of Georgia; and this is precisely one of
the results which we wish to accomplish. By this comparison
we wish to present in one general view, the chemical consti-
tution of the Lime-formations of various Geological ages.

Every one will admit that this is the only just way
of testing the relative value of the Shell-limestone and Marls
of Georgia.

Tabhk I. Chemical Constitution of the Shell-Limestone of
Georgia, showing the percentage of the various ingredients.

OXE HUNDRED PARTS CONTAIN.

'><

f.8 3

^8 3

T. a <.

g-S <

o -J,

S^s

= ~ ~-

~ _et

5'S.

a =

e Shell
miles ea

vt inn of

e Shell-
miles ea
ation of

0 S. 71

= <- .-

2,o 1=

c Shell-

J miles e
ation ot

c -

c-S-t^

CO ( 1

9 r-

'-.' ~- r"

9C*

meston
of Cent
. V. Jor

Cm

imestoi

t of Cen
ipt.M.IM

imeston
t of Cen

ipt.M.M

n o

*^3

5 2?

20 L_j

2 9

e. i;
tral
cCu

a g ?

! <~>

3-

5 -

87 74

00 . o

92 21

71 93

80 07

47-760

1 Percentage of Quick-lime

51 860

49.192

40 282

44 843

( Phosphates of Lime and Magnesia

) Percentage of Lime in the Phosphates..
( do. Phosphoric Acid do....

0.628

0.933

0.426

1.181

0-250

0.328

0.506

0.230

0.637

0.135

0.298

0.427

0.196

0.544

0.115

Carbonate of Magnesia

Trace

0.770

0.028

0.009

2.220

Sulphate of Lime

0.300

0.103

0001

0.004

Trace

Chlorides

0.015

0.005

0.005

0.009

0.019

Trace

Alumina

1.170

Oxide of Iron and Alumina

0.266

1.248

0.694

0.876

Silicates insoluble in Hydrochloric Acid..

4.500

4.552

19.062

4.01S

0.393

Silicous sand

0.933

4.062

5.466

13.081

10.708

Water as moisture

0.300

0.117

0.842

0.681

0.214

Of Gkorqia.

745

TaIble 2. Chemical Constitution of the Marie i
Bhowing tlic percentage of the constituents.

>f ( reorgia,

Carbonate of Lime
Percent, of Quick-
Lime

Phosphate of Lime
Percentage of Lime
in the Phosphates
Per rentage of

Phosphoric Acid
Carh. of Magnesia
Sulphate of Lime..
Sulphuric Acid. . .

Chlorides

Organic. Matters.
(Humic and Ulmic

Acids, &c

Oxide of Iron and

Alumnia

Silicates Insoluble

in Hydrochloric

Acid

Silicious Sand

Water as Moisture.

_ - -.

- -

3 OS
OH*

aria
Cenl
f J.

^ -,

^

e-< -.

<^ =:

2 ~=^

0 HH =

3 P (C

B '- -

-D -.

. ?r

' ~ %

v: r. c

?

e?S

' ' ba

- g :

: ~_ =

: "2.3

r -

i BO

3 a

BK|PoS!

g 22. g -_ r. - z

PS *ft

--

WS

ST"- r c

o 5

a 3
5*2 '

43.435

43.023

9.739

2.083

6.808

42.389

15.473

19.799

24.282

3.649

29.993
G 465

5.454

0.615

1.167
0.292

3.812
0.822

23.738
0.218

8.665

0.348

11.087

0.446

1.972

3 494

0.332

0.15S

0.111

0.118

0.1SS

0.240

1.677
0.270
trace
trace
0.01-1

2.971
0.841
0.002
0.001
0.0J0

0.2S3
0.030
trace
trace
0.120

1.398
1.140

0.131
0.009

trace
trace

2.912
1.329

0.378
0.029
trace
trace

8.221
3.766

0100
0.157

trace
trace
trace

0.161
trace
trace
trace
0.086

0.206

trace
trace
trace
0.107

7.190

0.265

2.205

2.005

2.565

31.941
8.055
5.714

40.17S
5.620
3.100

32.190
47.170

6.62S

) 28-409

80.211

23.346

22.900

8.102

42.662
16-942
21.856

54.594
21 680

64,714

746

lertiary ZAme Formation

[October,

Table 3. Chemical Constitution of European Limestones.*

100 PARTS CONTAIN.

Near Innsbruck 67.

do do 52.

Kahl on the Spessart 49 .

do do do 60.

Annaberg, Lower Austria.. . 88.
Muthmannsdorf, do |S9.
Uroisbach, do

do do

Kanck, Lower Austria 84.

do do do

Eppan In the Tyrol 85.

Kudolstadt In Thuriuga.... 95.

do do 93.

Ilmenau, (S'inkstein )..- 92.

do do 90.

-; ta
~ .

-

00
60
00

10

I!

Parteraion in Carlnthia...

do do

Seisser Alp. Tyrol

do do do

St, Triphao in Switzerland.

do do do

Roos. Moos- Aim, near Isctil
Steinabruno, Lower Austria, 95
Castle- Rock, at Staatz, do 94

Hottinger Alp 97

Innsbruck 97

Island of Ltssind, Dalmatia >4
Mundi-Rock in the Tyrol.. i'J6
Predazzo, in the Tyrol 57

8.87

3.70

5.10

4.10
4.90
3.00
8.20
4.14
3.56
2.40
2.27

2.12

2.20

0.43
1.20

8.00
3.60

3.17

tra.

2.00

2.40

4.00

S 20

0.80

4. on

1.10

6.40 10.80
7.20 14.00
1.80 2.80

2.00

1 . 66
1 . 66

3.60

2.20
2.86
2.42

tra.
2:00
1.20

00,3.).'''

Predazzo, in the Tyrol 58.

l"r ,111 llvoli, near Rome 94.

Chumlis, above WyaBenburg,

in Switzerland

Untersburg, near Salzl

Nickolsburg in Moravia 60.

do do do

Great Oetacher, Austria 87.

King's Tombs, near Thebes 39.

d, in Kent 90.

Island of Rugen 91.

Meudon, near Pans 93.

do do 91.

Island of Heligoland 94.

rgnear Aix-la-Chapel 79.

Lewes, uear Brighton 88.

' (it.

Valley 91.
Austria 89.

Koflach, in Styiia 54.

Brunnam Walde 48,

1 !bain 79,

Bridge in the Grisons 7*

Fromme in Saxony 59,

Stuttgart ' 66

Western Siss Alps 64

do do do 66

2.W ).

2.001

-

60 37.21 2

00 2.078,

60 2.073.

2.1 2.078.

(0 2.112.

40 2.112.

00 2.17 1.

2 . & 1

1.722,

1.17 2
1.'2 2
1.4J 5
12.601

1.45 2

1.4- 6
1.17 1
1.44 2

1.781

4.00
5.60
3.40
1.80

2.40

,40 2.00
.00 4.00

.00 l-.oo
6O30.S3

Table 4. Chemical Composition of Eropcan Marls.

100

PARTS COXTA1X

C-1

~

-

oo

3

~

~T.

- er

00

c

in

: <p

: 9r

w 1

7?

o

7?

: *ti

'

1 '

; u:

Clayej

< I

-

QQ

*

: c-

: c
: =

C7^

; %

o

Carbonate of Lime,

Carbonate of Magnesia,

Phosphate of Lime,

Nitrate of Lime,

Organic Matter,

Sulphate of Lime, Gypsum

Cloride of Sodium, Common Salt..
Potash and Soda combined with

Silica, '

Alumina

Oxide of Iron,

Magnesia

Sulphuret of Iron

Quartz Sand and Silica,

35- 00

1.35

2. 30

0

01

0

60

0

06

0

03

0

0.r)|

0

40

4

20 1

trace.)

s.el

3-3 00

18.20

IS. 10

0 . 90

3.80

j . 50

0.50

0 . 50

0.70

20.5(1

0.90

2.10

0.10

trace.

trace.

trace.

trace.

1.60

0.80

1 0 . 00

8.40

1.90

1 . 90

6 70

3-20

trace.

0.30

0.30

7.30

2.30

5S.4

73.4

8.20
3.00
1.20

0.50
0.10

0.70
3.10
3.80
0.30

13-30
2.60
1.20

trace,
trace.

0.20

1.0

6.50

7.10

71.1

Analyzed by Holger, L'.ebig and Kopps, Annual Report on the Progress of Chemistry, &
Vol. IV. p. 562.

Of <,<

717

Table 5. Chemical Composition of the Limestone
Massachusetts, according to Prof. Hitchcock. Geology oi
Massachusetts, vol. L, p. 80, 81.

loo PARTS I "M ain.

LOCALITY.

^ 1

-

/.

-

-

o

-

^'?

3

R

o

- o

y.

z

p
o

o

. p

:

: o

o

5

1

p

tr1

11
"J
o

'

3

3

Pr

, Adams, Crystalline White,

Lanesboro, . do do . .

West Stockbride, do do ..

do do do do . .

Lanesboro, best for Marble

i Corner, White Crystalline,

do.

do.
do.
do.
do.

do.

do .

Girard College

Hancock Greyish

Worthington, White
feernardston, do

Whately, Grey,

do do
Southampton, Grey
Walpole, do

Attlcborough, do Compact, .
Norwich, do Micaceous,

Sheffield, White Crystalline,

Quary,

Egremont, White Crystalline,

Shefiield, Dolomitic Granular,

do do Marble,

Lanesboro, Grey Marble

New Ashford, Flexible Marble,

New Marlborough Crystalline, Dolomitic,

do do do do ... .

Tyringham, South part, Magnesian,

do Northwest pair, do

Becket, Southeast part, do

Pittsfield, Grey, tine Granular,

Williamstown, Saddle Mt

do Grev, near the College,

199.60

I'.iS 10

98.6*7

96.] !

87.32

93.38

99.86

. 98.88

.66.00

< 64.66

1.16
0.47
2.28
1.20
3.66

B.01

38.40
70.80

94.60
53.80

92.80
58.04
54.87
93.60

1/20
40.40
40.61

-i 5-50
,81.8016.20

54.24 44.28
,'55.45 42.76

54.34l44.24
, 61.88 82.66

58.31 28.61
, 54.60143.92

55.7,9,42.96
,r.2.:;i 32.79

trace

0. I"

[race

0.60

0-1 1

iu;n

0.08

0.78

0.22

[.89

0.26

11.25

0.57

2.49

0.15

o.i-i 2

1.00

34.00

1.64

28.79

61.60

29.70

5.40

46.20

2.20

6.00

1.201

0.38

4.141

0.60

0.301

0.60

1.40

0.59

0.89

0.86

0.93

0.67

0.75

0.46

4.10

1.24

11.84

0.55

0.93

0.47

0,78

0.74

14.16

2.74 56.78
2.69 55.66
2.67.54.94
2.81 55.25
-'.74 58.82
2.69|48.90

2.67j."i2.2,.t
.
2.72 55.09
2.72'36.97
136.21
2.93 21.50
2.80,39.27
2.71 52,9.8
2.79 30.13

2.75'54.77
2.69 51.97
2.84 32.70
2.83'30.73

2.76 52.42
2.6845.81
2. M 30.37
2.88 31.05

2.77 30.43
2.82:34.65
2.S4 32.65
2.86 30.57
2.79 31.14
2.82(29.29

743

Tertiary Lime Formation

[October,

able 5* Limestones of Massachusetts, continued.

LOCALITY.

o

Q

Tj

%

co

pa

_ g

T3

5 5

o

O

o

X

en

P

Qi

c"

c

n

5

Q
3

-

"

K

3

-.

. -

r

n

77
25
58
89
24
37
20
82
88
68
-I
65
19
35
.75
.til
.47
50
.29
.93
.63
,84
30
38
81
35
26
71

10

Great Barrington, Clouded Marble, 00.30 38.

Compact Limestone, Agawam, J30.8l'l8.

do do do : 20.04 13.

Argillaceous Limestone, Ashfield, 155.16 22.

Micaceous, do Ashfield, J4G.85 1.

do do 45.131 3.

80.72| 2.
50.82 38,

do
Newbury,

Lanesboro
Lee

0.65! 0.961
5.53|45.33
0.51 54.00
7.07 15.56

1.55 50.001
2.70 48.64|

54.8 ! !

Dalton, 1 56

Bolton Quarry, Crystalline, 01

Chelmsford Quarry, do [56

Stoneham, White Compact, 59

West Springfield, Grey Fetid, J93

Sprinfigeld, Chicopee Compact Septaria, 46

do do Fetid Grey, 86

do Cabotville, Septaria, 43

Middlefield, Coles Brook, White, 56

Middlefield, Coles Brook, White, J88

Blanford, White, J51

Littleton, White Crystalline, 54

Sherburne, Bowlders, White, |60

Concord, S. W. part Grey, 77.

West Natick, Grey Crystalline J72

West Natick, Grey, finer specimen, |56

West Compact, Yellowish, Railroad Cut, . . . .54

West Compact, '61

Claystone, Hadley, 56

do North Adams, 153

do West Sprigfifield, 148

58 43.
80 27.
52 39.
28 15.

07 1
00
38
71
48| 0.90
35

0.72
0.67
0.22

0.35

0.90
1.21

80

09 '39.

25 31.

02] 9.

Go 39,

70 43.

43 29.

33 j 1.

10 7.
iotj.81|39.uoi
54.20 0.00

5.02

8.00
4.01

20
18.1 2

1.20

3.20

23.80

5.00

20.97

|l3.20

3.39 13.57

1.1211.07

0.15 1.92

0.91
0.51
2.30

00

601 1.
401

20

7.95
1.46
7.37

1.19|19.83

120.40,
1.37 2.74

4 5. 'JO,
1.2725.25

|43.s0
145.20]
151.60

2.84 33.

17.
II.
30.
26.
25.
45.
2.81 31.

2.77 32.
2.86*31.
2.80134.
2.85,31.
2.84 33.

2.73 52

2.74 25
2.73 48

2.78 31,
2.7149,
2.77 28
2.87130

33,
,43.

2.75 l"
M,

2.68 30.

34.

|31.
2. 60 1 30.
2.68127.

Table 6. Chemical Composition

setts according to Professor

Massachusetts, vol. 1, p. TO.

of the Marls of Massachu-
Hitchcock. Geology of

LOCALITY.

-

I 5

: c

o.:
0.6

M.-
O.I

1.0

1.1
1.0
1.2
1.0

0. i

3 o

re ~

: w
:
: o

73^4

l.;.o

31.8
86.4
64.8
74.8

93 i

86.5

8-3.6
64.4
il.T
28.0
12 3

1

- -
X _
-'- -

, c_

i"lfi

tra.

V.i,',
tra.

i".86

1 m

DO

9

o

2.

O

-

4.S

5.1
0.1
8.1

1.7
1.9

1.-

i.e

2.6
0.8
8.0

a ""

: c

; <r
ffl
4.6
8.9
8.8
3.0
8.2
5.0
2.1
.-> -^

:.';

4.4

9.5

GO
g

n

a

36.6

59. S

.3.01

25.2

14.7

0.8

2.:

4.4

5.f

9.:

17. 5

75.7'

64.51

78.8(

1

SI 2

' >

; ~

Ts

1.7
8.0
1.9
2 *
l.*6
0.4
1.4
1.6

1.0
2 9
2.3

0.7
,3 0

Do

'. r>

: 9

' 2

l7<2

REMARKS.

5U feet thick.

do. .North-east of -the Village

do. do. do

Pittflfleld, oast of the Village

do. B.W. do. do"

West Stoekbridge

Lee 8e gwkk & Co'b Mills

L. Bassets bed near surface

do. do. 10 feet below surface

Sulph. of Lime 1.5.

1.82 4 feet thick.

[watari

1.61 Exposed t" running
1.89 9 to 12 feet thick.

1*75

Sedgwick's Mills

Farmington, Conn

2.0 Sulph. of Lime.

"do. ' North Adams

::::!

do. Springfield

7.6(2.86

79.2ll S.8l

I860.]

Of a

'49

Table 7. Limestones of Rhode [sland."

LOCALITY

Cumbi rland Hi '.. l .

do do

Johnston, Mr. Brown

do Mr.Je kins

North Provldenee

ewport Harbor, Lime Islands..
North Providence, Lime Quarry

Bnolthfleld, Harris Rock

Short-. Dear Fori Adams

Bmlthfleld, Harris Quarries

do HairisRock

do Dexter'a Quarry

do

do

do

Harris Quarry
Harris Rock..,

do do ...

do E. Angell.

VARIE'J V.

white. Greenish Granular

Green Stone, (( .0 ater)

h ipota and

crystalline

White, compact, sub-i rystalline. .
Stone-white and Green I
hlue and Bud

Stone-white and compact

Rhomb. Spar

v. ;i"\. bun colored, compact

Soft K'ik

First Qualltv Hard Rock

White, granular and crumbly.. .
t. w bite, Insoluble matter,

in aclcular crystals

Btone-whl e, coated, with talc and

crystalline

1st quality raft blue stone. i li blue
and while stripes, ditto. ..

Crystalline and granular

tear light blue stratified and

crystalline

bite and crystalline

56 .1 II . i

i.2 0.8

1.2 7.01.M
88.6 s.:,

.MM
U.4M

92

37. 12.8

97.61 1.

i a

/

31.1

2.27

i.a

82

44.4

6.8

28.7

I

68.4 J.CO:;

49. 2*715
64.91

'Geological and Agricultural Surrey of Rhode Island, by Charles T. Jackson, M.D., p. -246.

Table 8. Limestones and Marls of Maryland. *

100 PARTS CONTAIN'.

ef

o
5 I i o g S of j c g,

P I 2. 82. w O S

NAMES AND LOCALITIES

^ i ' ft ' 2 o I Hii

2 I : s : - = i ? :

"

: ; : : : : ? i : i :
Limestone, PipeCreek, Uarrolco.
Limestone Long Green, B a 1 1 i-

more co.,

Limestone, Howard county,....

Mail .'

Marl, near Fort Tobacco,

Coral Marl, Talbot count v,

Coral Marl

Fresh Water Marl,

r1
B

o

Q

g

&

c

g

o

ow

2

o

3

o

V.

o

pa

x -

Q

o

>

ft a

gp

:

a.

- =

.

. S3

(5

.

. 0

p.

.

f

;

o

;

1

53.40

48.17

1.131 1.90

0.40

86.73 35.9*7

6.25i 3.30

17.75

35.2*?

29.41

1.76 8.39

25.17

26.5

2. 7<>'

66.5

1.301

12.91

9.45

55.73

2.07

26.91

3.07'67.54

26.13

11.62 55.58

5 2. .5 3

41.29

1

1 6.16

2.90
| 6.67

[trace

* First Report of Philip T. Tyson, State Agricultural Chemist to the
House of Delegates of Maryland. I860, p. 71, 81.

750

Tertiary Lime Formation

[October,

Table 0. Chemical Composition of the Limestones and
Marls of South Carolina.*

100 PARTS CONTAIN.

NAMES AND LOCALITIES.

H...

do do do..

do do do..

Marl Pit, Cooper River

Limestone, from Limestone Springs

Crystalline Limestone. Saluda, Laurens Dist.

Limestone, Garhngton's Quarry,

do York

do do Harden' s Bed,

do do

do Brasstown Creek. Pickens Dist..

Marl from Tilly's Lake. Waccamaw ........

do do. Black River, Sumpter,

do do do

6 miles S.E. of Darlington C

do do

do do

Dr. Holmes

Pooshee.. .

Bees' Ferry, on the Ashley River,.

Combahee River

Thomas Parish., near the Coast...

Wadmalaw

Marly Limestone from Wilmington, X. C

Argillaceous Chalk Marl. Mr. Dixons" Plan'n

Greyish White Chalk Marl. Drayton Hall. ..

do do do do Goose Creek, b. C.R.

do do do do Ehvood, Cooper R. .

do do do do do do do

Yellowish Grey Chalk Marl, (Green Mar!)

Ashley River. 14 miles of Charleston

Yellowish Grey Chalk Marl, Church Creek..
do do do Pen Pen on the Ashepoo.
do do do do do

do

do

do

do

do

do

do

do

do

do

do

do

do

do

do

do

do

do

do

do

1.00
0.50
0.50
0.50
trace.

T.Oii 16
2-56110
1.2016

if

SD O

2 B

1.40

9.5S
2-12

C

2S.00
29 . OS
34.41
30.43

O.J1

4.5C

2 5<

9.01

5-Ofl

15.00

9.51

0.5

16. 50

trace.

15.00

9 . 60C

0.4

15.01

0.5

5 00

1.50

5 - 50

0 50

9-(Ji

4.00

25-51

4.00

3. 00

1 -Of

2.80

4.7-'

200

1 00

8.60

0.41

9.20

trace

2. GO

0.4G

6. SO

0.8C

8.80

0.80

7.00

0.41

2 47

0.GC

6.09

2.00

*As determined by Professor Shepard, Dr. Smith, and Prof, M- Tourney.
Geology of South Carolina, by M. Tourney.

Of Georgia.

Table l".- Per centage of Carbonate of Lime in the Shellj
Limestone and Marls of South Carolina.*

NAM l.i AND LOI M LTIES.

-

n Llfl - \M( i.or \i.ri n;s

- n

11

CRETACEOl s MARL.

Peedee River

Birch Ferry, Peedee River Bottom,

- do do" do do 8 feet from

Bottom,

do do do do 10 feet from

Bottom

do do do do 12 toot from

Bottom

Mouth of Jeffrey's Creek, Surface,
do do Willow Creek, do. . .
do do do do Marlstone,. .

Binghams, on Stage road

:t> upper part,

Giles Bluff

do do next to low water,

do do Marlstone

Meyers I, and

do do

Gibson's Bluff

do do

Brown's Upper Ferry

Stony run, (i* orgetown

MARLS ON LYNCH CREEK.

Sparrow Swaui]), at top,

di> do 3 feet deep,

do do G do do

do do Marlstone

Henry Hams, Sparrow Swamp, 5 ft

Lynch Creek, top,

do do >; tret deep,

do do "> feet deep

EOCEXF AND MORE RECENT
MARLS.

MAUL AND IfARLSTOKS OV SAVANNAH
RIVBB AND TRIBUTARIES.

Shell Bluff, white compact marl

do do darker,

do do Harder, ,

do do Stony .Marl, ,

do do Concrete Shells,

do do

do do Cream Colored Marl

Lower Three Kuns,

86

51
66
45

82

42
14
B6

B4
76

-j
10

15

Sav. River, abo\ e Three Runs,. . . . U0

Lower Three Kuns

do do do 82

win.KV EtTVEB LND 1 BIBUTAB1E8.

Brisbane's Landing 64

do do 7 1

do do G

O'Neal's handing, 7'i

Drayton Hall,

Ferry, 50

Magnolia ,".",

<ii eer's Landing 52

Pringles 7.~>

Catteil's Bluff 52

do do 78

Cohen's Land 62

.1. A. Ramsay's hand 67

Cedar Grove, 76

Oak Forest :;.;

W ssamasaw Swamp, 72

Indian Fields, 17

do do 50

ABTBSI \N WELL, CHARLESTON.

120 feet below the surface 1;.",

do
do
do
do

do
do

do
do

do.
do
do

do

Gillett's Mills,

do do

Sav. River, above Three Kuns,

60

74
62
64

62
22

G-i

92

L35

do

do

162

do

L80

do

200

do

do

227

do

do

258

do

_'7<>

do

274

do

282

do

do

do
do

do
do
do
do
do
do
do
do
do
do
do

do

do
do

do

do
do

do
do

do
do

do

do
do

do,

do.

do.

do.

do.

do.
do.
do.
do.
do.
do.
do.
do.

44
58>

COOI'EK BIVBR.

Grove, Dr. Ravenel's, . .

Mulberry, Dr. Millekin's' |G0

do do. 76

do do 12

Lewisfield Simon's

Point Comfort, R. \V. Ropers 79

ISteep Bluff,

Rectory,

.Monk's Corner Road,

Near Santee * 'anal,

Isaac Porchers,

' do do

Near Santee Canal,

.0
95
31

Gl

-?Xote. Determined by Mr. Ruffin, of Virginia- Report of the Agricultural
Survey of South Carolina, by Edmund Rufiin- See also Geology of South
Carolina, by M. Tuomy.

752

Tertiary Lime For/nation
Table 10 Continued.

[October,

SANTEE RIVER.

Balls Dam

Old Jamestown Landing,

Lenucls Ferry,

do do".

Williamsburgh,

Eutaw,

do

Rocks Creek,

Nelsons Ferry,

Vance's Ferry,

do do."

Hale's Mill,

do do

Stout's Creek,

Edisto River

Binnaker'a Bridge, ,

Johnson's Bridge,

do do

Walker's Brigde,

do do

Caweaw Swamp,

do do

LITTLE SALKEHATCHIE

Dowling's Mill,

Cedar Spring,

Ashepoo River,

NAMES AND I.OCAI.ITIKS

91
66

93

97

04
88
94

90

51

20

36
38
36
31
87
62
26

7
73
92

Huapa Creek,

do do

PLTOCENE MARLS.
Giles Bluff; Peedee,

do do do do

do do do do

do do do do

Godfrey's Ferry,

do do*.

Gibson's Landing,

do do

Witherspoon Bluff",

do do

Goose Creek, Dear Cooper River,.

do do do do do...

Swift Creek, near Darlington C. H.

do do do do do

do do do do do

do do do do do

POST-PLIOCENE, OR COAST

MARL.

Doctor's Swamp, Johnson Island,.

Stone Creek, Edisto Isld,

do do do do

Edisto Island

Distant Island,

16

7-
60
64
66
69

81
74
62
U
82
B0
64
69
63
64

Chemical Analysis of Shell
according: to Dr. David Dale

Water, - _ -

Insoluble Silicates,

Carbonic Acid,

Peroxide of Iron,

Alumina,

Lime,

Magnesia,

Phosphoric Acid,

Potash,

Loss,

- 1.8

- 8.49
- 2.7

3.6

- 2.0
2.9

1.2
0.45

- 0.05
0.45

100.00

Marl, Green county, Arkansas,

Owen. *

The insoluble Sicates consist-
ed of
Silica, - - - 72.8
Alumina, tinged with
Iron, - - - 6.8
Lime, 0.8

Magnesia, - - 0.3
Potash, - - - 0.9
Soda. - - 3.2

- trace

Manganese.

84.8

* First Report of a Geological Reconnoissance of the Northern conn
ties of Arkansas, 1857-58, by David Dale Owen. Little Rock, 1858,
p. 27.

Anaesthesia and Ana 758

1 zesthesia and Anaesthetics. By Edward EL Squibb, M.
D.,of Brooklyn, N. V.

The condition of insensibility to pain belongs exclusively
to the brain proper, or to thai part of the nervous system
which provides for sensation and voluntary motion ; and
is effected when not the resull of mechanical injury, inva-
riably through the agency o\' the circulation. It therefore
follows upon this, and upon the circumstance that the ner-
vous centres of organic life exercise no primary function
oi' ordinary sensation or voluntary motion, that the special
agents resorted to for anaesthetic purposes should not only
be directed especially to the sensorium, hut should be
diverted as far as practicable from the remaining portions
of the nervous system, in effect. But, the circulation car-
ries the anaesthetic agent everywhere, and with the elements
of vitality and molecular reproduction must convey and dis-
tribute this powerful agency also ; and hence the special
agent for effecting anaesthesia should not only act directly,
promptly, and transiently upon the sensorium, hut should
be, as far as possible at least, innoxious elsewhere. In short,
it Bhould suspend the functions of the sensorium without
liability to interference with any other organ or function.

Such an anaesthetic effect is produced perhaps in the
greatest degree of perfection by a certain amount of con-
cussion of the brain, which sometimes results from acciden-
tal violence ; and the effect is most perfect here, because
it is produced directly upon the brain without any contam-
ination of the circulation with foreign influences : and the
circulation thus left free for the performance of its normal
functions not only preserves the organic life intact during
the temporary abstraction of the presiding sensorial func-
tions, but through its reparative agency quickly remedies
the shock, and restores the brain to its normal condition.

The next most perfect anaesthetic effect is that, to which
a small proportion of persons are susceptible, wherein the
sensibility to ordinary impressions of pain or injury is sus-
pended or overpowered through .concentric nervous effect.
Whenever the balance of nervous power is so disturbed as
to reverse the current of the nervous batteries (so to speak),
as in the so-called mesmeric condition of certain persons of
feeble nervous tone or energy ; and in the high degree of
nervous excitement to which others are liable through
agencies that act altogethor from without, the aesthetic
functions of the sensorium, are altogether suspended, as in
48

754 Anesthesia and Anaesthetics. [October,

catalepsy, or arc bo impaired that serious injuries are un-
consciously received.

The elfect, however, in both these classes of cases can
never be utilized if from no other cause than because it is
independent of the circulation, and all other practical
means of production, maintenance, and control. The cir-
culation therefore becomes indispensable as the means of
introducing the anaesthetic agent, and of controlling its
effect; and the collateral circumstance that the circulation
must inevitably carry the agent to parts where it is not
desired, and where it may become noxious, must be taken
as a drawback, and a most important indication in both the
selection and management of the anaesthetic to be used.

From these circumstances, and inductions taken as points
of departure, it is not difficult to deduce the indications in
the use of anaesthetics as being, first to suspend sensation
and voluntary motion ; and, secondly, to do this with the
least possible interference with the functions of organic
life. These points admitted, and kept prominently in view,
will, with a little reasoning, render the management of
anaesthetic agents very simple, and will make the accidents
and mismanagements more intelligible and more easily
avoided.

These accidents are, first in importance as well as in fre-
quency perhaps, some form or degree of asphyxia. All
the vapors used for anaesthetic purposes are irrespirable.
That is, they do not contain oxygen in a condition in which
it is available in the lungs for renewal of the blood. Just
in proportion, therefore, as the vapor is introduced is the
normal quantity of air diminished, and the proper oxvda-
tion of the blood prevented; and the ratio of this propor-
tion is as inevitable in the effect upon the powers of life as
it would be if carbonic acid or water, or any other irrespi-
rable medium was substituted even up to that proportion
which produces spasmodic closure of the glottis. It has been
not unfrequently noticed, in what the writer believes to he
the mismanagement of both the common aaestheties, that
the administration has commenced with a proportion of the
vapor so large as to produce this spasmodic closure of the
glottis. Under such circumstances, if it was possible to
keep up such a proportion throughout the struggling of
the patient, the spasmodic closure would doubtless be

.-tent as it is drowning. But when from withdrawing
the Bponge a little, or from the displacement of it in strug-

I860.] Anaesthesia "ml Ana

gling, the proportion of air is increased, the glottis La relax-
ed again, and the imperfed respiration goes on quickly to
a point when, from the undue, Budden and depressing effed
of the anaesthetic on the nervous centres, the glottis n<> Ion*
ger responds to the action of the irritant, and the vapor
- freely into the lungs, no matter how strong or how
small the proportion of air mixed with it. The pnlse and
respiration then give the indications to suspend and reapply
the anaesthetic, and it becomes a matter of time, endurance
and of management as to how far the powers of life are
taxed.

It is, therefore, not a question as to whether aeration of
the blood is to be interfered with at all, or not, since some
portion of anaesthetic vapor is indispensable, and since that
portion must exclude a corresponding portion of the air ;
out the question is rather, how for the due aeration of the
blood may be judiciously and safely interfered with; or in
other words, what degree of asphyxia is justifiable and pro
per in the management of anaesthetics ; and the natural
conclusion is as practical as it is logical, namely, that the
least possible degree is safest and best, and that the inter-
ference should not be hurriedly induced, or maintained a
moment longer than is absolutely necessary.

If suspended animation from the circulation of venous
blood in the brain was to be resorted to for anaesthesia, it
would be necessary to immerse the patient at intervals in
water, carbonic acid, or other irrespirable medium, in order
to maintain the condition ; and the risk of fatal asphyxia
would be here much more apparent, though really not very
much more imminent than in the nearly parallel case
wherein the irrespirable vapor of ether is substituted
throughout a clinical lecture, with the antagonistic stimu-
lant effect of the operation postponed till near the end ot a
long period of insensibility. The position that the insensi-
bility in ordinary anaesthesia is due to the circulation of
unrenewed blood in the brain is, however, only true in part
at the utmost, and this introduces another of the accidents
that may occur in the management of anaesthetics.

If it were possible to separate the true desirable anaesthe-
tic effect from every vestige of asphyxia on the one hand,
and from all direct interference with the functions of or-
ganic life on the other, it would probably be found to con-
sist in a simple specific paralysis of the nervous ganglia of
sensation; and the desirable degree of such effect would be
that which did not at all overreach the object. By over-

756 Anaesthesia and Anaesthetics. [October,

reaching the object however, whether it be by a too pro-
fuse, or a too prolonged use of the agent, the result must
be injurious, since suspended function is but one step in
the catenation which leads to disorganization and death,
and that step once passed, the others may be accomplished
insidiously. Such an hypothetical position is, however,
only assumed to show that there must be a condition of
hyperamesthesia, or excessive amesthetic effect that sueh
a condition is hurtful and unsafe, and that it should be
avoided by skill in management, no matter how safe the
agent used may be considered.

That such conditions do not occur without washing
through the failing functions of organic life, is the fortunate
result of the harmony and dependent action of the nervous
centres, and these functions of organic life are commonly
and very properly watched, as the means of control in the
administration of anaesthetics. But apart from the fact that
a most hurtful and dangerous degree of asphyxia may be
induced suddenly, and while both pulse and respiration are
spasmodically kept up by the stimulus of the first effect
of the agent used, there are grave accidents which occur to
the centres of organic life, both by reflex action from the
brain proper, and by the presence in the circulation of such
powerful depressing agents. Blood overcharged with ames-
thetic vapors, and particularly when imperfectly aerated
and slowly circulated, must necessarily fail of its due im-
pression upon the cardiac and respiratory ganglia, and pa-
ralysis of the heart, or muscles of respiration are, therefore,
the common fatal accidents of anaesthetic practice.

All these circumstances lead directly to the conclusions,
first, that anaestics should be given slowly and carefully,
with free, unlimited admixture of air, so that there should
never be any choking or spasmodic action of the glottis.
Secondly, that they should only be given at the time when
the effect is needed, and be abandoned the moment the
necessity is passed. Thirdly, that not only should the pulse
and respiration be watched carefully during the whole pe-
riod of insensibility, and be kept as near the normal stan-
dard as possible, but the slightest amount of blueness or
lividity should be regarded as an indication of asphyxia,
and be promptly responded to by a more free admission of
air.

In the choice between the two anaesthetics in common
use, one or two points are deserving of attention.

i860.] Anaesthesia and Anaesthetics.

<.)

Chloroform is much less Liable to produce cyanosis or
asphyxia, because it is effective in much smaller quantity
than ether, and docs oo1 therefore displace so much air in
the respiratory process. The writer has never noticed any
degree ofblueness from the use of chloroform, but has often
seen it in the use of ether. On the other hand, unless
chloroform be given witn for more care than is necessary
with ether, it is. from its greater efficiency, much more
liable to produce hyperansesthesia, and to paralysethe hearl
and respiratory muscles. Hence chloroform, under ordi-
nary circumstances, must be considered more dangerous to
life, because its greater efficiency and activity, while they
render it less liable to produce asphyxia, render il more lia-
ble to produce the other accidents of anaesthetic practice.
The balance against it is, however, more applicable to iis
common and indiscriminate use than when applied with
tbe care and precaution indicated in the foregoing remarks ;
and there is probably quite a large class of cases in which
it cannot judiciously be replaced by any other agent, as, for
instance, in parturition; in uremic convulsions of gestation
and parturition: and, in short, whenever an intermittent
and prompt effect are desirable, and the due precaution^
can be rigidly observed. In careful practice, with ordinary
good judgment and observation, it has, in the writer's opin-
ion, the advantage over ether in every point except the
single important one that, in rare instances, it is liable to
produce sudden fatal paralysis of the heart.

Ether lias been regarded as so safe an anaesthetic, that it
is scarcely admitted as susceptible of doing harm; and the
impression is very common that it can never endanger lite.
That either of these propositions can be accepted admits of
great doubt.

Ill the asphyxia from drowning, if the immersion be of
short duration, and if the muscular system has not lost its
vital tonicity, it is usually only necessary to re-establish the
respiration and circulation for a short time, by artificial
means, to restore life. If that drowning be prolonged, how-
ever, by repeated short immersions, so that the same ineffi-
cient condition of the circulating blood be brought about
during a half or three-quarters of an hour of struggling,
and with depressing influences from other sources, as of
previous disease or injury, so that the powers of endurance
are worn out, and passive exudations are permitted to accu-
mulate and obstruct the pulmonary air cells, the result

758 Ancesthesia and Anaesthetics. [October,

would probably be very different. A condition of vital de-
pression would be established which might very slowly go
either way in the balance between life and death, but which
would probably, in case of other coinciding influences, as
after a serious surgical operation, ultimately terminate fatal-
ly. The partial asphyxia produced by a prolonged etheri-
zation is a nearly parallel case under ordinary circumstan-
ces; and here, as in other instances, pernicious influences
may be masked by the complication and remoteness of the
results.

So strongly has the writer's attention been drawn to
these circumstances, by seeing and hearing of the profuse
and wasteful use of ether, that it is a prominent object of
this article to invite the profession to a closer scrutiny and
observation of the effects ; and if two or three fluid ounces
of ether be found to produce a safer and better effect than
double that quantity, an important point will have been
attained.

The method of administering ether adopted by some
close observers is one which appears well adapted to ensure
a due admixture of air. A folded napkin is rolled into the
form of a cylinder, or truncated cone, and secured at the
overlapping edges by two pins. The larger end is made
wide enough to cover the nose and mouth, the nose fitting
into a notch, where the two edges of the napkin at the
widest end fail to overlap. The opening at the small end
should be at least one and a half inches in diameter, and
the larger the better. If anything be needed to give stiff-
ness and form to this cone, a piece of pasteboard laid
between the tolds of the napkin before it is rolled up, will
accomplish this purpose. This cone is held in the hand of
the person who gives the ether, and as a matter of economy
it may be removed from the face during each expiration.
About two fluid drachms of ether is poured upon the inside
of the napkin at a time, and renewed as ofte,n as may be
requisite.

In the administration of ether for anaesthetic purposes,
at least three well marked stages are commonly observable,
and the duration of each varies very much with the tem-
perament of the individual, the condition of the stomach,
and the quality of the ether used. One of these stages,
namely, that of excitement and delirium, and the only
troublesome one, has been hitherto supposed to be shorter
in proportion as the ether contained less alcohol ; but some

I860.] Perchloride of Iron in Epistaxis, 769

very recent observations made by the intelligent Eouse-
Burgeon of the New York Hospital, \h\ Weir though as
vet very limited in number would appear to indicate thai
the point of maximum, or best effect in this respect, may
be overreached, or that a determinate small proportion of
alcohol in the ether may be useful. At least, Dr. Weir has
been very naturally led to this inference by the effect of
giving a small amount of brandy before the anaesthetic;
and subsequently by the use of alcoholic ether. He, how-
ever, states distinctly, that as yet his observations are nor
sufficiently numerous to be relied upon. An occasion;! 1
accident in the prolonged use of ether, for the mention of
which the writer is also indebted to Dr. Wier, is the occas-
ional occurrence of a smart, ephemeral, irritative fever,
which follows within twenty-four hours. In view of the
circumstance that the local effect of ether is irritant to the
extent of producing vesication when confined upon delicate
surfaces, it may be easily understood that its application
over the large and delicate mucous lining of the bronchial
ramifications, throughout an unusually tedious and difficult
operation, might produce a transient infiamatory effect.
In conclusion, the writer is aware that the character and
drift of these remarks are directly at variance with the
teachings of some very high authorities, who regard the
anaesthetic condition as one of dead drunkenness, and who
advise the rapid and copious administration of the ether, in
order to reach this condition in the shortest possible time.
It appears singular to the writer, that those who are in
the daily habit of making the most delicate distinctions
in diagnosis, should fail to discriminate between the effects
of poisonous doses of alcohol and the desirable condition
in ordinary anaesthesia, since they certainly do not much
more nearly resemble each other than the coma of narco-
tism resembles natural sleep. American Medical Times.

Perchloride of Iron in JEpistaxis, etc. Undiluted solution
of perchloride of iron injected into the nostrils, it is said,
will stop the bleeding, when all other remedies fail, in this
common but occasionally alarming affection. If the first
application should not prove a lasting remedy, it may be
repeated. In obstinate bleeding, from punctured or incised
tonsils, the application of this powerful and efficacious styptic-
has stopped the hemorrhage when other means have tailed.

760 Mammary Abscess [October,

Mammary Abscess occurring during Lactation. A Lecture

delivered in the University Medical College, Xew York,

by T. Gaillard Thomas, M. D., Physician to Bellevue

Hospital.

Anatomy of the Mamma?. The lacteal glands, or mammae,
are composed of numerous follicles grouped together ; form-
ing lobules, which penetrate to different depths into the
structure of the organs, and give them the character of
racemose and conglomerate glands.

Each lobule has its own excretory duct; this joins those
from neighboring lobules, and in this way growing larger
and larger, until they become reduced in number to fifteen
or twenty capacious canals, they pass upward, to end at the
nipple by as many small mouths. These dilated portions
of the milk-ducts or lactiferous tubes are called reservoirs,
and, although not largely developed in the human subject,
in the cow will contain a quart of fluid.

Each of the lobules above mentioned is separated from
its neighbors by a considerable quantity of areolar, which
admits of the free motion of one upon the other, and serves
as a bed for the blood-vessels and nerves of the organs.
This is the proper parenchyma of the mammae, and, accord-
ing to Todd and Bowman, exists in them in "extraordinary
abundance."

It is important that you should recognise the fact that
this areolar tissue is extremely dense and fibrous, and that
it serves not only the purposes of connective material, but
that it proves protective and supporting. Passing through-
out the gland between the lobules and ducts, it sends strong
prolongations to unite with the posterior surface of .the skin,
whLh are styled by Sir A. Cooper the "Ligamenta Suspen-
soria;" and at the periphery of the gland it forms a proper
tunic, very much like the "tunica albuginea" of the testi-
cles, or that of the ovaries. In its passage throughout the
gland, this dense areolar or fibro-areolar structure forms
alveolae, or vacant spaces, which are filled by adipose tissue ;
a tissue which Cruveilhier tells us may be found at the very
centre of the glands, between the lobules, and in obese
women even between the follicles themselves. These al-
veohe do not communicate freely with each other, hence
the remarkable localization of inflammations attacking the
superficies of the gland.

The mammae rest upon the great pectoral muscles, and
are separated from them by a layer of areolar tissue, which

I860.] Occuring During Lactation, 761

enables them to move about as freely upon their bases as
they do. This layer of areolar tissue, which for conve-
nience we may style the submammary, is susceptible of
soitu' remarkable changes, not the Least of which is greal
detention after repeated lactation ; indeed, Valpeau quotes
Nelaton for the assertion that a synovial sac ("une sorte de
bourse synoviale") may form there, which is liable to a variety
Jpf effusions and inflammatory processes.

The arteries of the mammse arising from the thoracic
branches of the axillary, from the intercostals, and from
the internal mamillaries, penetrate to the interior or inter-
lobular portions of the glands, and spread themselves in a
tine network upon the ultimate follicles.

In absorbents the mammae are rich, for the investigations
of Cooper, to whom we owe almost all our knowledge of
their minute anatomy, have demonstrated the presence of
two sets ; the one superficial and subcutaneous, the other
penetrating to the interlobular regions.

The mammary nerves arise from the intercostal and tho-
racic, and a distinct connection with the great sympathetic
exists.

But to return to the ducts and follicles. Were it possible
to remove one lactiferous tube and its follicles from the sur-
roundings which we have just been describing, one extrem-
ity would be the mouth of the duct as it ended in the nip-
ple ; the other would resemble a bunch of grapes, each
lobule appearing with its numerous follicles or clusters of
milk-cells, like a cluster of grapes around one of the term-
inal extremities of the stem.

Next we will take a section of this tube and its clusters
of follicles, and examine them under the microscope. The
follicles are very small, each being, according to Sir A.
Cooper, about as large a hole pricked by a very fine pin in
a piece of paper, and by measurement giving us only the
l-200th of an inch. Small as they are, however, the power-
ful lens shows us that they are lined by a layer of delicate
epithelial cells, whose function it is to separate fiom the
blood the first food of the mammalian being. As the eye
leaves this extremity of the lactiferous twig and passcss on
towards the duct which leads from it, a stronger structure
begins to appear ; its walls show fibrous and yellow elastic
tissue, and a lining of columnar epithelium. As we go on,
the tubes increases, until, towards its mammillarv end, it
grows small, and becomes sphincteric at its termination, be-

762 Mammary Abscess [October,

ing finally closed by surrounding contracile fibres, like those
of the Dartos.

I have already informed you that at the superfices of theil
mammae the areolar tissue arranges itself in the form of a
tunic or external covering; this is further covered by a
thick layer of adipose tissue, which sometimes becomes
very voluminous, and explains the fact that fat women with
immense breasts will often prove poor nurses, since the size
of the organs does not by any means insure extensive glan-
dular development.

Viewed as a whole, the mammae may then be said to be
two glands, composed of lobules and ducts, bound together
by dense areolar tissue, in which run blood-vessels, absor-
bents, and nerves ; the mass thus formed being snugly
packed away between the areolar tissue which separates it
from the pectoral muscles, and that which forms its external
tunic, and which is bounteously supplied with an adipose
accompaniment.

Physiology of the Lacteal Secretion. Between these glands
and the uterus a direct and prominent sympathy shows it-
self from the moment of conception, and indeed is sufficiently
evident in the unimp regnated condition. Towards the
fifth month of utero gestation, an actual secretion of milk
begins, the breasts grow hard and irregular in contour,
become tumid and more or less painful ; and this state con-
tinues until the period of parturition.

After the paturient act, no immediate ienrease of sympa-
thetic influence is manifested; the breasts, indeed, appear-
ing aiFected by the sanguineous loss, the vomiting, physical
and mental suffering, and abstinence from food incident to
that process, become less tense than they were before, and
their flabby, soft, and collapsed aspect will often alarm the
primiparous mother, lest she lack nourishment for her
offspring.

On about the third day, however, the enfeebled sympa-
thies begin to manifest themselves and to increase in devel-
opment; the breasts swell and become harder and more
irregular than before, their temperature is increased, and they
become painful and tender. Xow, too, the constitution of
the woman begins to show evidences of disturbance ; the
pulse becomes quick, the skin warm and dry, dullness if
often complained of, the patient is restless, thirsty and un-
comfortable, and her attendant designates as "milk feuer"
the ensemble of her symptoms.

It', at such a period at this, a section of the gland were
placed under the microscope, we should find the epithelial
cells of the follicles larger and much more numerous than
in the unimpregnated female, and they would be found filled
with the constituents of the coming secretion, fat glo-
bules being the most distinctly discernible.' The latiferous
tubes would would be loaded with a thick, yellowish,' turbid
mixture, to which Dome has given the appellation of Co-
lostrum, and which, though upon being squeezed out is
apparently thinner than milk, has been proved by chemical
analysis to be really thicker.* Under the microscope, this
fluid shows the presence of some irregular oval bodies, each
composed of a group of minute oil-globules, imbedded in
a mass of organic substance. They vary from 1-1750 to
l-500th of an inch in diameter, and are the "colostrum cor-
puscles" of Donne.

Now let us glance at the parenchyma of the glands and
its contained vessels and nerves. The areolar tissue be-
tween these tumid follicles is swollen by reason of its blood
vessels being turgid from increased flow of blood, which is
first stimulated by the above-mentioned sympathy, and then
interfered with in its return by pressure from the distended
lobules. This pressure the strong and determined arterial
How overcomes; but the feebler venous current is unable to
do so, and a mechanical congestion results.

Between these lobules, infarcted by a semifluid secretion,
and the blood-vessels distended by an active (physiological)
and a passive (mechanical) congestion, lie the nerve fila-
ments, the results of compression of which are pain, ten-
derness, and throbbing.

You will perceive, by even this superficial examination,
that at such a time all things are particularly favorable for
the alighting of inflammatory action, and for its progress to
great engorgement and supporation. Indeed, it is not at
all to be wondered at that such a state so often produces
those pathological conditions, for the physiological action
so prepares the way for that which is pathological, that it is
hard to draw a dividing line, and say where one ends and
the other begins.

Seats of Mammary Inflammation. The parts of the mam-
line which are ordinarily affected by acute inflammation
are :

1st. The lactiferous tubes and follicles.

* Vide Lehman, Vol, 11., p. 63.

764 Mammary A Lsccss [October,

2d. The fibro-areolar tissue ; subcutaneous, interlobular,
or sub-mammary.

Inflammation of the Lactiferous Tubes and Follicles. This
species of mammary inflammation corresponds to. and is
produced by, much the same kind of cause which would
result in bronchitis, catarrh of the bile-ducts, orchitis, and
other like tubular inflammations ; and its special causes
may be enumerated as :

(a.) Exposure to cold.

(b.) Irritation from inflamed nipples.

(c.) Excessive lactation.

Symptoms. The symptoms of this inflammation* are gen-
erally so well marked in the beginning, that it may readily
be distinguished from that originating in the areolar tissue;
if, however, the case has advanced, no diagnostic differ,
will be found to exist. At its inception, it may be recog-
nized by :

(a.) Rigors and fever.

(b.) Deficient excretion of milk.

(c.) Pain upon suction.

(d.) Hard and excessively painful points in 'the breast.

(e.) Xo general tumefaction, redness, nor tendern-

(f.) Great suddenness of invasion.

This is the state that is so often found as a consequ*
of exposure to a draught, or to a shower of rain, and which
sometimes so readily passes oft* by the use of fomentations.
as practised empirically by all nurses. Should the dis<
however, progress unchecked, lacteal engorgement of the
follicles first results, then inflammation of the areolar tis-
sue ; and what was in the beginning a simple catarrh of the
ducts and follicles, soon becomes one of true mammitis
inflammation of the parenchyma of the gland.

Diofiiinsls. I wish to leave in your minds, gentlemen, a
very distinct idea concerning the essential difference be-
tween such an inflammation, commencing in the milk-ducts
and follicles, and preventing the flow of milk, from a sim-
ple lacteal engorgement, the result of non-evacuation of thai
milk which has been secreted : for the one is a comparative-
ly unimportant affair, while the other, unless well man;
will end in abscess. Velpeau describes these states synony-
mously, (or rather, confounds the two conditions;) and al-
though no man lives to whose opinion on such a subject I
would sooner bow, I cannot agree with him; for, after ob-
serving closely at the bedside, and discarding all theory, I

I860.] Occuring During Lactation. 765

am convinced that he is incorrect. With the motto, "Nut-
liiis addictus in verba magistri jurare" let me try to sustain
this view by the relation of a case of inflammation of the
milk-ducts and follicles as a result of cold.

Mrs. R., a pultipara, was sitting, four weeks after delivery
before an open window in a loose evening-dress, when she
was taken with a chill, which was followed by fever, and
pain in one areast. She was soon after seen by me, and up-
on examination, I found a hard tumor near the surface of
the organ, about the size of a walnut, and excessively pain-
ful. The pain was increased upon lactation, which seemed
to produce no diminution in the size of the swelling.

I will not detail the treatment adopted. Suffice it to say,
that after about two weeks had passed, signs of inflamma-
tion of the parenchyma showed themselves, and that an
abscess was the result. Now, what was this ? An engorge-
ment of milk? If so, why did it occur so suddenly,^ from
those causes which we know so often result in inflammation
of mucous tracts, with so much constitutional excitement,
and why did only one lobule of the gland suffer ? Was it
inflammation of the parenehyma ? Then why was there no
I heat, redness, and rapid tendency to suppuration, which
Velpeau and most others acknowledge characterize this
state? My belief is, that the mucous membrane of one
lobule, and probably of its excretosy duct, was inflamed ;
that this resulted in obstinate lacteal engorgement, which
i in turn resulted in mammatis.

We commonly have lacteal engorgement when a nursing
woman's child is taken from her ; does this, before it has re-
sulted in inflammation of the parenchyma,, ever give such con-
stitutional signs ?

But I cannot give you a better substantiation of my view
of the subject than by detailing one of Velpeau's numerous
cases, which I think will better argue in my favor than any-
thing which I can say.

Obs. VIII. "Lacteal engorgement resulting from expo-
sure to cold fifteen days after a second confinement."

The female was delivered, and did well until the fifteenth
day, when the narrator proceeds to say : "Then the patient,
who was exposed to cold, was taken with chills, and a very
high fever, which, however, lasted a short time. A severe
lancinating pain established itself at the same time in the
right breast, which was at once covered with an emollient
poultice. Two dags after the patient observed that the breast

766 Mammary Abscess [October,

became engorged, and became more and more painful." The
Dr. saw her on the first of January, one month alter deliv-
ery, and therefore fifteen days after the chill and pain in the
breast; then, he says, "the right breast presents at the inte-
rior portion a large swelling, indistinct, sensible to the
slightest pressure, with some hardness, and without cuta-
neous redness. This engorgement seemed to have come from
the interior of the breast, and to gain insensibly the external part
by following the lactiferous ducts." (The italics are all mine.)
So far, I think, you will not deny me considerable support
from this history ; but now listen to the treatment, and its
results. "Fifteen leeches were applied near the painful
spot ; on the next day the pain had disappeared, and the
engorgement, on which poultices were kept constantly ap-
plied, had notably diminished." And why did they dimin-
ish? Not because leeches and poultices can disgorge the
breasts when choked with milk, for it would be irrational
to suppose this, but because they relieved inflammation in
the follicles and ducts, and thus allowed secretion and ex-
cretion to go on, where they had been before interrupted.
These are the means by which one state may be distin-
guished from another :
Lacteal engorgement shows it- Inflammation of follicle* and

self by : ducts by :

Gradual hardening of lobules Sudden hardening of lobules.
No pain at first. Pain sudden and severe at

No chill, nor high fever. first.

Several or many lobules af- Chill, and very high fever.

fected. One or two only affected.

Xo great tenderness on pres- Great tenderness on pressure,
sure. Lactation and friction do not

Lactation and friction relieve relieve.
Breast3 full and rotund. Breasts rather flabby, except

Excretion of milk readily ex- at one spot.

cited. Excretion not readily excited.

Be it remembered, however, that lacteal engorgement

alone may produce, if neglected, inflammatory results,

(perhaps in the ducts and follicles, but more commonly) in

the parenchyma of the gland.

Mammilis, or Inflammation of the Parenchyma of the Bn<
This disease bears to pneumonitis the same relation
which inflammation of the ducts does to bronchitis ; and
as pneumonitis may result from uronchitis, or arise prima-
rilv, so may mammitis be either secondary to inflammation

I860.] Occurring During Lactation. 767

of the fiucts, or have a cause which produced it as the orig-
inal affection. As^ however, there are three distinct divi-
sions in the areolar tissue of mammae, in each of which it
differs, (in the one being accompanied by much adipose tis-
sue ; in another, containing much of the fibrous element ;
and in the third being loose and purely areolar,) we are
forced to recognize three varieties of inflammation arising
in it :

1st. Subcutaneous.

2d. Interlobular.

3d. Submammary.

In the first of these, the inflammatory action is confined
to that portion of the areolar tissue which is peripheral or
subcutaneous ; and although it may do so, does not necessa-
rily pass into that which is deeply interlobular. In the
second, the morbid process may arise externally, and pass
inward; but more commonly arises internally, and subse-
quently affects that portion of the areolar tissue which is
more surperficial. In the third, the pathological process
may be confined to the submammary tissue, and pus col-
lecting therein may evacuate itself by coming to the border
of the mammae.

Fortunately, it is not commonly the deep interlobular
areolar structure which is thus affected, but that which is
superficial, external to the gland-structure, and dividing on-
ly the most superficial of the lobules. This superficial in-
flammation is of course much less severe in its results than
would be that which is more deeply seated, in the gland
itself, or in the submammary tissue ; but, as all three are
inflammations of the same kind of structure, and this struc-
ture constitutes one of the elements of the mammae, I have
deemed it best to regard them all as mammitis, or inflam-
mation of the parenchyma of the mammae. True, a purely
subcutaneous or submammary abscess might arise without
any portion of the gland-structure being affected, but the
obstetrician will rarely meet with a perfect case of this kind ;
and as our nomenclature should apply to the rule, and not
the exception, I think that we will avoid confusion by pur-
suing this course. I have often met, during lactation, with
small subcutaneous abscesses, more particularly in the areo-
la, which evidently did mot in any way affect the gland ;
but such do not by any means deserve the name of "mam-
mary abscess."

768 Mammary Abscess [October,

In frequency of occurrence, the abscesses arising from
these varieties of inflammation may thus be arranged :

1st. The subcutaneous abscess.

2d. The interlobular "

2d. The submammary "

Causes of Mammatis. As the causes, symptoms, and treat-
ment of these three varieties of mammitis resemble each
other closely, we will proceed to investigate the disease in
its different localities as a unit, begging you to remember,
however, that much slighter injury or irritation will suffice
for the production of the more superficial varieties than
would do for the deeper seated.

The cause of mammatis are :

(a.) Exposure to cold.

(b.) Injury.

(c. Lacteal engorgement, (whether it occur from neglect,
inflammation of ducts, or aversions to nursing from sore
nipples.)

(d.) Excessive sanguineous congestion, with commencing
lactation, (physiological congestion gradually verging into
that which is pathological.)

(e.) Inflammatory affections of nipples or skin, as ulcera-
tion, eczema, impetigo, erysipelas, &c. How the first,
second, fourth and fifth of these causes may resul in mam-
mitis, it is not necessary for us here to inquire, since the
same explanation will attach to their influence in produc-
ing this inflammation, as it does to their mode of causation
in many others of like character.

The third cause, which is probably the most prolific of all
as a cause of mammitis. proves effective in this way: The
follicles and tubes becoming gorged with milk which is not
evacuated, the former enlarge into the form of irregular
tumors, press upon the surrounding vessels, prevent perfect
venous return, and thus rapidly bring about a perenchymat-
ous engorgement, which may result in abscess. Lot me,
by a familiar example, illustrate these remarks : You are
all acquainted with that disease of the sebacic follicles ot'
the face and shoulders, called acne simplex, which produces
angry upimples," as they are called, or pustules as they
really are, on the faces of those just arriving at the dignity
o\' a beard ; watch one of these through its course, and you
will readily trace these steps. First a black speck is seen,
which consists of duct enlarged at the exposed end by a
muss of sebaceous material which is retained in the unemp-

0 wring During 1. ictation. 769

tied gland. NTo redness surrounds this ; no pain is expe-
rienced; and if the gland be squeezed at Its base, ;i small
worm-like body, w ith a black tip, is displaced, and the ailair
ided. Should repletion of tin1 sac still continue, how-
ever, a roseate circle is observed around the black speck,
inflammation has sot in in the surrounding areolar tissue,
ami the second stage of this miniature disease ia at hand.
w davs after this, suppuration is fully established, and
should the mass now he squeezed, the operator is gratified
by the forcible ejection ol' a plug bathed in pus. which will
often fly out with sufficient force to establish itself to the
mirror which probably guides his manipulations.

Now this is, in parvo, the process of formation of a
mammary abscess, from lacteal engorgemeet ; i. e., 1st,
simple engorgement of the follicles ; 2d, inflammation oi
neighboring areolar; 3d, suppuration and abscess.

One circumstance (which 1 have so often mentioned
to-day) must be borne in mind as constituting a difference,
however, between the two inflammations; namely, that in
the mamime the resulting inflammation is generally in the
superficial areolar tissue, or that dividing the most external
of the lobules.

Upon observing that even inflammation of the ducts must
result in secondary mammitis before a true abscess can be
formed, the student is apt to ask, "Why make a distinction
since the result is the same in both cases V" To such a
question I would reply, "Because without doing so wre could
not get concise and accurate views of the diseases of any
organs of the body, and because in the beginning, before
one of these pathological conditions has run into, or
produced, the other, the treatment of the twro will differ."
Orchitis may result from epididymitis, and epididymitis
from urethritis, or either may arise primarily. Can any
son be given why, ergo, all three should be confounded
under the name of inflammation of the genitals ? Or why,
in studying abscess of the testicle as a result of orchitis, we
should ignore inflammation of the spermatic cord as a
primary cause, which results in- abscess by producing this
very orchitis ? Medical nomenclature is the student's
"slough of despond," and from its fettering influences
many a practitioneer has grown old with indistinct and
confused notions of diseased conditions ; and with all due
respect for so high and worthy an authority as Dr. Watson,
I must say that nothing more clearly illustrates the difiicul-
49

770 Mammary Abscess [October,

ties which surround its improvement than the sight of his
endorsement of its non-progressive state by speaking of
endocarditis, pericarditis, and carditis, all under the lead
of "rheumatic carditis," as he does in his work on Practice

But let me, in the present case, show how much is gained
by attention to the true pathology of the states we are
studying.

Inflammation of the ducts does not always end in mam
maris, even when it progresses to an unfavorable termina-
tion ; sometimes lymph is poured out into the tubes by
winch they are occluded, and such immense distention of
the reservoirs occurs from accumulation that a true milk
deposit is formed, which may contain quarts of pure lacteal
fluid, and which it is necessary to evacuate by puncture.
Dr. Willard Parker, of this city, reports a case where three
quarts were thus evacuated by a first incision, and three
pints by a second one ; and Scarpa tells of a still more
remarkable one, where the distended breast measured
thirty-four inches in circumference, and rested, when the
patient sat, upon the corresponding thigh ; a trocar being
introduced, ten pints of pure milk poured off in a continuous
stream. Xow, how could you understand this condition,
without being acquainted with the distinction as to the
origin of mammary inflammation, which has here been
made ? Xot only may milk be thus collected in a cryst-
like dilation of a duct ; the watery portions may be absorl ed,
and a caseous tumor, or "butyrous tumor," (as styled by
Gross,) be formed, and under such distention the duct will
sometimes rupture, and the distending material be infiltrate J
into the areolar tissue of the gland.

Pathology of Mammitis. As I have endeavored to show,
no true mammary abscess can occur unless there be inflam-
mation of the areolar tissue of the breasts. Such inflam-
mation progresses through three stages, giving in each the
following morbid appearances : If a breast be examined in
the first stage, its blood-vessels will be found distended, and
gorged with blood ; red corpuscles will be discovered packed
closely together, and choking their little canals, and a sti
(marked during life by heat, swelling, redness, and pain,)
will be found existing.

Very soon, unless this congestion be relieved, an effusion
of lymph takes place into the areolar tissue surrounding
these vessels, and instead of having that appearance which
gave it, according to early writers, the name of "cellular

I860.] Oceurmg During Lactati 771

tissue," it is firm, and cuts like a solid tumor. This con-
stitutes the second stage, or stage of effusion. If this stage
be left to itself, v.tv soon suppuration will occur; and if
examined in tliis, 'in third stage, pus will be Been insinuating
itself into the meshes of the areolar tissue, perhaps passing
between the ducts and follicles, and often forming sinuous
hassages throughout the organ. In one point this pus col-
lects, advances towards the surface, distends the skin, gives
to the finger the Bense of fluctuation, and constitutes the
much dreaded "broken brast," the mere mention of which
will make your parturient patient shudder with apprehen-
sion.

Prognosis of Jkammitis. As you will see by the sequel, I
believe that in many cases this disease may be prevented
when threatened ; and fortunately, after its first stage is
fully established, it may be readily cut short in its course.
Xaw more ; if proper means are at once adopted, and per-
sisted in, failure, so far from being the rule, will constitute
the inglorious exception. *

Even when effusion has occurred, and we recognize the
second stage, the prevention of abscess, though more diffi-
cult, is still quite possible ; the exuded lymph may be taken
up, the choked-up currents of the vessels freed from obstruc-
tion, and resolution, or return to health, be attained.

AVh en the presence of pus is once ascertained, there is
no more room for hope of prevention, for the evil is already
upon us, and all that we can do now is to extricate our pa-
tient as soon as possible from it, and protect her from its
resulting waste of strength.

The prognosis, as regards, recovery after the discharge of
the purulent collection, is, of course, favorable, but you will
sometimes reduce even a strong and healthy woman. Ema-
ciation, extreme dubility, night-sweats, hectic fever, and the
whole dread train of symptoms which mark phthisis pul-
monalis, will in succession appear, until the poor sufferer,
worn with pain and bankrupt in hope, will pray for death
to relieve what the art of man seems impotent to cure.
True, this picture is one of a badly-managed case ; it is the
story of an unfortunate who has confided in one who is un-
prepared to give her that aid which his art through a more
capaple disciple might render ; but believe me, that it and
in evidence of the fact that my coloring is not too high,
hear what others have said in describing it. Dr. Rams-
botham says, " if the drain continue for any length of time

772 Mammary Abscess. - October,

after the evacuation of the pus, a gradual loss of strength,
appetite, and flesh is observable ; distressing rigors occur
daily ; the patient obtains but little refreshing sleep, and is
annoyed by profuse nocturnal perspirations; sometimes she
is harassed with sickness, more frequently with obstinate
diarrhoea." Again, he says, " The body has been known to
dwindle to a mere shadow. In some instances, the patient
has sunk under the debility induced." Dr. Gilmour, in an
Essay in the Lancet, says, "I have a patient under my care
at present, aged twenty-three, with sinuses in one breast of
six weeks' duration, who presents all the appearances of a
person far advanced in phthisis ;" and Benjamin Bell al-
ludes in strong terms to the "pain and misery to the patient
in such cases."

Avery curious and important result which sometimes fol
lows the formation of these abscesses, is that exerted upon
the brain. Sometimes the patient becomes furiously deliri
ous, and the. symptoms lead us to a diagnosis of puerperal
mania, when the slight collection of pu3 is the cause of the
mental aberration. The acute observation of Hippocrates
did not allow him to overlook this fact, as is clearly seen by
the following passage : u Mullierbus quibuscunque ad mam-
mies sanguis colligitur insaniam stgniftcat." (Opera, 1588, torn,
i., lib. v., aphosism xi.)

Ramsbotham relates the following case in corroboration
of this fact : " I was once sent for to see a woman, on the
third or fourth day after delivery, in a state of the most
furious delirium that can be conceived, which had come on
rather suddenly. She appeared laboring under the most
acute phrenitis, and in the most urgeut danger. A copious
bleeding seemed absolutely indicated, but on examining
the breast (as should be done in all puerperal diseases,) I
found them both very large and tense, and the surface red;
fluctuation was distinguishable in each ; it was evident that
they had both suppurated, and probable that the violent
symptoms depend on their condition. They were freely
opened, and in less than an hour the patient had recovered
her reason."

Symptoms. In those rare cases which we see mammiti
a primary disease, it may be differentiated from inflamma-
tion of the tubes and follicles by the following signs :

(a.) There are ordinarily no rigors seen in the beginning.

\b.) The induration is not so localized.

(c.) There is much less pain.

18G0.] Occurmg During Lactation. 773

(</.) There is a greater tendency to suppuration.

le.) *There is more eternal red]

If.) There is no pain in lactation.

There is no obstruction to the lacteal flow.

When, as is generally the case, mammitis is a disease
Hilary to lacteal engorgement, we have these symptoms
in connection with those dependent on that condition.

Means of preventing Mammary Abscess. Always make it
a rule, in visiting a female who lias been recently delivered,
to examine the state of the breasts, at each visit, or at any rate,
at each visit subsequent to that made on the third day, and
previous to that of the ninth.

If trouble is pending, you will generally find evidence of
it upon one of these six examinations. "When you dis-
cover the existence of any symptom which presages mami-
tis, never leave its treatment to the nurse, but take the
management of the case into your own hands, and allow
of no experiments, no suggestions, no interference, any
more than you would if the patient's lung or liver, instead
of her breast, were inflamed. Do not underrate the results
which may accrue from your neglect; I have seen many a
lady who dreaded mammary abscess much more than she
did the pains and dangers of parturition.

You will, in the course of practice, too, find, many a one
who will suffer the penalty of confiding to the empirical
treatment of an ignorant, uneducated nurse, (trying, one
after another, all the plasters, unguents and lotions which
every nurse has found to prove specific in her experience,)
until, too late, she informs her physician of her trouble,
states with evident surprise that she has been rapidly get-
ting worse under treatment which, in the nurse's hands,
had worked such miracles before, and prays him for that
relief which it is now out of his power to give, in prevent-
ing an abscess which has already formed.

I am careful to guard you upon this point, because many
nurses seem to regard the management of the breasts as
their especial prerogative, and to believe that while they
deferred to the doctor in his proper province, the conduct
of the labor, in the cure of the breasts and the baby; his
skill is entirely dwarfed by a comparison with theirs. This

* Dewees says just th? contrary, but my statement agn ss with those of Vel-
peau, Rambotham, arid others.

774 Mammary Abscess. [October,

is not singular, but what strikes me as wonderful is, that
many physicians seem to agree with them.

Let me suppose that you are called to a lady who, during
her first promenade aftei confinement, has been caught in
a shower, or exposed to a draught of cold air ; and who has
just after had a chill, followed by febrile action; and that,
upon examination, you find a hard, irregular, painful tumor
in one of her breasts, that the flow of milk is very much
diminished, and that suction produces pain. When indica-
tions would present themselves for fulfilment regarding this,
as you would do, as an example of inflamation of the tubes
and follicles ; of the gland-structure proper ?

They would be, 1st. To quit the catarrh, which has
ailected the ducts and follicles.

2d. To prevent accumulation of milk.

3d. To diminish vascular supply to the breast^, and
moderate the general circulation.

The first inclination may be met by refrigerant applica-
tions to the breast, and none has gained so great a populari-
ty as a mixture of vinegar and water. Simple as this is, it
answers the purpose admirably ; but for to act as it should
do, as an evaporating lotion, it should be frequently renewed;
for even if applied cold, it very soon takes upon itself the
characters and functions of a fomentation, rapidly absorb-
ing warmth from the heated breast.

It is really curious to see how this simple prescription,
like so many others, has worked its way down to our times
from remote periods. Paulus ^Egineta "squeezed a sof
sponge out of tepid oxycrate, applied to the breasts, and
bound it on in a proper form, (Syd. Soc. Ed., Vol. I., p.
p. 540;) Moschion, a cotemporary of Xero, advises vinegar
and water; Van Swieten, in his commentaries, speaks
highly of Moschion's method; and Dr. Gilmour accuses
Dewees of gleaning the hint from these ancient sources,
and not accrediting them with the same. I do not myself
believe that this answers any better purpose than a cloth
soaked in cold water, and repeatedly renewed.

To fulfill the second indication, let the breast be gently
rubbed toward the nipple with olive oil, and the follicles be
gently squeezed while this is being done, so as to force the
imprisoned milk through the tubes, or to stimulate the ab-
sorbents to its removal. (Of this method of evacuating the
breasts I will speak further anon.) If the milk cannot be
thus removed, it must be done by the child, a pump, or,

B60.] Occurring During Lacta 77 5

wfcal is still better, by the mouth of the nurse.
For the accomplishment of the third indication, le1 the

bowels be freely acted upon, and the heart's action reduced,
l>v a faline cathartic.

R\ Sulphatia magnesire, . . Jiss.

Tr. Aconiti radicis, (Fleming,) mvi.

Antinionii e1 potass, tart., . gr. \.

Acidi Bulphunci arom., . mxxx.

Aquse aurantiiflorum, . rSl i i . M.

S. One-third to be taken every three hours, until the
bowels are freely acted upon.

This treatment, continued, if necessary, for two or three
days, and the patient being confined to strict diet and al-
lowed very little fluid, will generally meet our expectations.

If the case has commenced as one of mammitis, or if
that condition has superadded itself to the last, the treat-
ment should differ somewhat. As a primary disease, how-
ever, I believe that you rarely meet with mammitis; it is
almost always secondary to the condition just mentioned,
to lacteal engorgement, or to some other. Should it he
found to exist either as a primary or secondary affection,
the indications, although very similar to those in the last
case, will be best accomplished by other means.

A number of leeches should be applied to the breast, or

just below it, the bleeding from their bites freely encour-

1, and after their removal, a cold saturine lotion applied,

which should be carefully renewed whenever it becomes

warm.

1 am not in the habit of recommending to you special
prescriptions, and that winch I subjoin as a local applica-
tion, I do not insist upon at all, but merely offer it as an
example of the class which, will be appropriate. The indi-
cation is the important point, and if you know of any bet-
ter means of fulfilling it, employ them.

1$. Ace tat. plumbi, 5i

Tr. opii acetat., 5ii

Aceti,
Aquae, aa gvii. M.

To be applied cold, and renewed whenever it becomes
warm.

The bowels should then be freely moved by the prescrip-
tion given, or any other which may be preferred, and a feb-
rifuge and refrigerant employed such, for instance, as the
following :

776 Mammary Ah, [October,

]J\ Totassae nitratis, gii.

Antimonii et potass, tart., gr. i.
Tr. verat. viride, mi.

Aquae, 5iii. M.

A dessert-spoonful every three hours while there is fever.

In addition to this, the milk should be carefully drawn
by suction, or a pump. "While in the case of inflammation
of the ducts, rubbing will be better than suction for the
evacuation of the milk, here the latter will be found far
preferable to the former, which is liable to injure the areo-
lar tissue, which is already in a state of disease. And last,
(but not least,) do not let the inflamed organ hang and drag
upon that very tissue which is the seat ot the inflammation,
for its support; but pass a broad band of adhesive plaster
beneath it, and carry it up over the shoulders, to act as a
sling. A handkerchief will answer the same purpose, but
not near as perfectly. The last direction is one of no slight
importance.

So much, at present, for the management of a commen-
cing case of mammatis ; that is, of a case in the first stage
of inflammation. Before proceeding to speak of the treat-
ment of its second and third stages, it is my desire to draw
your attention to the treatment of one of its causes, which
is of too much importance to be passed unnoticed longer. I
allude to lacteal engorgement, occurring as a committant
of congestion, or as productive of it.

In this condition, if active congestion have not occurred,
our chief aim is to prevent it by prompt measures, for it
will soon appear if not thus warded off.

The indications presenting themselves in such a state are:

1st. To evacuate the distended follicles.

2nd. To diminish the amount of secretion.

3rd. To lessen vascular supply to the breasts.

As soon as vou recosrnize the state of lacteal en^or^e-
ment, attend to the first indication by having the breasts
drawn by the child, a pump, or the nurse, ami having them
well rubbed towards the nipple, the hands being covered
with olive oil or glycerine. The oil is used merely to facil-
itate the rubbing, and not for any specific action ot its own;-
therefore, do not use oil medicated with camphor or any
other substance, which may bring out a very disagreeable
eruption, render the child averse to taking the nipple, and
make the application of leeches, which we may su
quently wish to apply, almost impossible, on account of

I860.] Occurring During Lactation. , 111

their repugnance to the medicinal substance used. The
robbing should be practised for fifteen minutes out of every
two or three hours, should the breasts till in thai time; and
although at first painful and disagreeable to the patient, it
will soon be asked for, and relied upon by her, as a means
of relief.

But its practice requires some skill, and a great deal of
tleness and perseverance. You will often have to ex-
plain its modus agendi to the nurse, and will do well on the
first occasion to perform it for yourself. After rubbing for
ten minutes sometimes, you will see no flow of milk follow,
but at the end of so long a time will often be gratified by
the accomplishment of all you desire.

When practiced as it should be, this is one of the most
effectual means with which I am acquainted for preventing
abscess from this cause, and in the Dublin Lying-in Hospi-
tal is (or rather was in 1853) relied upon almost to the ex-
elusion of all other local means.

At this time, that is, before any inflammatory action has
been set up in the areolar tissue or follicles, and when sim-
ple lacteal engorgement exists, warm applications should
be made to the breasts, one of the best of which is a sponge
or bit of linen, soaked in warm water and covered by a cap
of oil silk, made to fit the breast.

But you may ask, Wiry apply cold in the two diseased
states just mentioned, and warmth here? The reason is
this : in the first stage of inflammation the vessels are dila-
ting and becoming choked with blood, and you should do
all in your power to brace them up, give them tone, and
prevent the morbid process. Here, however, you have no
such state ; you wish simply to seethe the tense organ, and
to relax any contraction which may exist in the milk-duets.
It is a fact well recognized by anatomists that the milk-
duets, at their termination in the nipple, are surrounded by
contractile or dartoid fibres, and it is highly probable that
these, under irritant influences, spasmodically contract, and
prevent the escape of milk. The American editor of Rams-
bo.tham's System of Obstetrics expresses such a view on p.
481 of that work, and I have seen several things which led
me to the same belief. Now, warmth relaxes this and any
other vital contraction which may exist in these ducts, and
thus favors excretion.

To fulfill the second indication, viz : the diminution of
the secretion of the breast, act freely upon the alimentary

778 Mammary Absc [October,

canal, restrict the diet, give little fluid, employ antigalcatics,
and resort to compression of the gland.

The two first of these methods for producing the desired
end are very valuable ones, but will require no farther allu-
sion than that which has already been made to them in this
lecture, and we proceed to consider at once those antiga-
latics upon which we can rely. The first is iodide of potas-
sium, given in full dose ; the second is the extract of bella-
donna painted around the nipple. These two remedies
have found great favor with the vast majority of those who
have tried them, and although I have seen them both fail in
checking or even in diminishing the secretion, I have much
oftener in my own practice observed that benefit resulted
from their use. I therefore advise you to treasure them in
your memories, as means which will prove most serviceable
in time of need.

The third indication will be- fulfilled by means already
mentioned in the treatment of the first stage.

Do all these means ever fail when properly and persever-
ingly applied; and does the obstetrician ever see his best-
directed efforts end in disappointment? I regret to answer
in the affirmative, but at the same time express the belief
that such failures will be very rare, unless he has to deal
with a very unchangeable patient, or with a case which had
advanced before he saw it to the second stage of mammitis.
Should this stage have arrived, however, before the case*
came under his care, or in spite of his efforts to ward it off
by checking the first stage at its inception, he is by no means
without resources which may result in prevention of the
third stage, which is the greatest misfortune that he fears
under the circumstances.

Treatment of the Second Stage of M lis. The second

stage of mammatis consists in an effusion of lymph into the
areolar tissue of the mamma; may be recognized by great
hardness, pain, tumefaction, redness and heat, and may well
be dreaded as the precursor of abscess, unless its progress is
checked and suppuration prevented.

All those means which have been detailed as applicable
to the disease in its first stage, are to be preserved in this ;
but should we find that, in spite of them, the case progres-
ses steadily towards the dreaded result of abscess, no time
should be lost, but pressure should be established, with a
well-founded hope of successful prevention.

It is now about fifteen years since Trousseau and Contour

I860.] Occurring During Laciation. VT!>

published an essay on the treatment of mammary abscess,
by compression, bringing the subject prominently before the
profession. It was n<>r original with them, however, for ac-
cording to Dr. das. Gilmour, oi' Liverpool, in an excellent
articles on this subject in the Lancet, already alluded to in
the works of I leister, and its use may be found alluded to
in the works of Pearson, Smellie, and Cooper, [nthiscity
I know of no one who has so systematically resorted to this
means as Dr. S. Conant Foster, who published an excellent
article upon it some four years ago in the New York Journal
nf Mali -un'.

In obstinate lacteal engorgements it is very serviceable ;
even after pus has begun to form, it relieves pain, and al-
though it does not prevent the coming abscess, seems to
prevent the passage of the pyogenic process to larger parts
of the organ; but in the second stage of mammatis, where
>rgementis ending in effusion of lymph, it is certainly
one of the greatest boons with which either patient or ac-
coucheur could meet.

I have myself repeatedly employed it, and never without
being not only pleased, but surprised at its results. Equa-
ble pressure overcomes the tendency to congestion, keeps
the distended follicles closed, and stimulates the absorbents
to great activity. Do not let any theoretical objections pre-
vent you from employing this means, and believe me that
you will find it one of the most precious resources which
you can bring to your aid.

The means by which pressure is best affected is by adhe-
sive straps from 15 to 16 inches in length, and from 1 to 2
inches broad. Suppose, by way of illustration, that the
right breast is to be compressed, let the end of the first strip
be fixed in the right axilla, and then being drawn tight, let
it be carried over the lower border of the breast, and its
other end attached to the lower border of the breast on the
other side. Then let the second strip be fixed at the upper
border of the left breast, and this being firmly drawn over
the lower border of the right, or diseased breast, let it be
fixed so that its lower end will be attached to the right side,
about three inches below the origin of the first.

These two strips should be longer and wider than those
which are to follow, for they are to give support to the or-
gan. Shorter strips may follow these, crossing each other
as these have done, until the entire breast is shingled over,
as it were, with the compressing covering. The particular

780 Mammary Abscess [October,

arrangement, however, is a matter of secondary importance,

as the ingenuity of any one will be sufficient to teach him
how to accomplish the desired end. Compress the breast
as you like, the principle is what I wish to inculcate.
Should you desire a more powerful compressing agent than
the straps, a most excellent one is offered you in compre
sponge, as recommended by Dr. Batchelder. Having com-
pressed a piece of sponge by heavy weights, place it on the
breast, apply firmly a roller bandage, and through this wet
sponge. Absorbing water, it will soon swell, and give you
a powerful, safe, and equable means of compression. 1 > v
this very ingenious means the hardest tumor will disappear,
and the breast be rapidly reduced in its dimensions. The
sponge employed may be small and numerous, compressing
the different parts of the organ which require such treat-
ment; or one large disk of sponge may be prepared, with
a hole for the nipple, which will act upon the entire organ
at one.

This was the method employed by Dr. Foster in the a
related in the paper alluded to.

You will often find, in a few hours after pressure has been
applied, that a tumid, hot and painful breast vail change its
aspect most essentially ; and even while the straps, or sponge
and bandage, are performing their function, the milk can
be drawn by suction, the nipple being of course left uncov-
ered ; and the adoption of the plan does not prevent the
continuance of other means, as saline cathartics, antigalac-
tis, dieting, &c. Pressure, indeed, only takes the place of
friction, which has failed us, or which we cannot employ,
from the restiveness of our patient, or the pain which it
induces after mammitis has been alighted.

When pus has formed, nothing more can be done than to
encourage its discharge, and for this purpose a soft poultice
should be applied. So soon as the abscess shows a tenden-
cy to point, let it be evacuated, and then let the whole breastj
be supported by strapping, only a space around the opening
being left free for the application of a small and light poul-
tice. The straps, now applied, will prevent the formation
of sinuses, will force out all the contents of the abs<
and cause a rapid absorption of surrounding effusion.

Should obstinate sinuses have formed, which will not
yield to the means mentioned, let them be dilated by
sponge-tents, injected with dilute Tr. of iodine, or with
simple warm water, and firmly compressed by means of
compressed sponge and a roller bandage.

18G0.] 7>V and Pneumonia, 7v 1

Iu reference to these and other chronic purulent dis-
pharges from the breast, I must guard you against the pro-
longed use oi' poultices. Like other very useful means,
they are often abused; ami if persevered in after the proper
lime, will tend to weaken the diseased tissues, and eneoiir-

wrethe continuance of the exhausting discha
* In the medical journals oi' the day yon will see many
kinds o\' treatment extolled, and the proof of their efficacy
which will be adduced will be the fact of their having pre-
vented mammary abscess in women who have been deliver-
ed oi still-born children, and have not nursed. Now, this
reason is fallacious, for it is very rare that abscess occurs iu
such eases, and the prevention is entirely imaginary; the.
appearance of threatened abscess having vanished "post
hoc" but not "propter hoc." I have never seen an abscess
of this kind occur in a woman who had not nursed, al-
though I know that they sometimes do so.

In concluding, I will give you a resume of the m.eans to
he adopted for the checking of a commencing mammitis,
without which no abscess can form, but which is very sure
to appear as a secondary result of uncontrolled lacteal and
sanguineous engorgement.

1st. Evacuate the inflamed breast by the breast-pump, or
by suction by the child or nurse, the last being decidedly
the best method.

2d. Diminish vascular supply, by saline cathartics, nause-
ants, direct sedatives, topical bleeding, and cold applications.

3d. Diminish lacteal secretion by strict diet and antiga-
lactics.

4th. Aid in the accomplishment of all these ends, and at
the same time cause an absorption of effused lymph and

'urn, by firm and equable compression.

5th. Xever let the inflamed organ hang, but always sup-
port it by means of a long and broad band of adhesive plas-
ter passing nearly around the body, and thence under the
breast.

6th. Avoid poultices and warm fomentations.

Notes upon the Causes of the Distinction between Bronchitis

and Pneumonia.

During the ten years that I have taught the substance of

the following remarks, I have vainly sought in the greater

part of our classical and special treatises the necessary data

to solve the question about to occupy me. A simple inspec-

782 Bronchitis and Pneumonia. [October,

tion of these works explains the cause of the deficiency
for it is easy to perceive that their authors have studied th<
results of the alterations occurring in the tissues withoul
possessing any exact idea of the character and reciprocal
relations of the elements normally composing those tis-
sues. In the case ol the lung, for example, they sum up
its general structural characteristics Dy saying, that, when
once the bronchi enter the substance of the lung, they
rapidly lose their firmness in consequence of the disappear-
ance of the cartilaginous rings, and, becoming at length
entirely membranous, are lost in the pulmonary cells or
vesicles, hence often called "bronchial terminations." They
further assert that a mucous membrane, constituting the.
essential portion of the respiratory organs, is continued in
a uniform layer from the larynx to the extremities of the
bronchi, and that this layer, somewhat thinned, exists alone
in the pulmonary vesicle. According to some, the vesicles
are separated from each other by the interposed cellular
tissue according to others they are in contact, and the
dividing wall is homogeneous in its structure.

While, relying upon these statements, I considered the
phenomena from this point of view, I was astonished not to
see bronchitis invariably pass into pneumonia especially
that form of bronchitis known as capilliary, in which symp-
toms of asphyxia are superadded to those of intensely acute
bronchitis. (The asphyxia is caused by a change in the
secretion of the bronchi, which becomes muco-purulent and
very viscid.) Yet nothing can be more distinct than the
pathological lesions, or the symptons that characterize these
two affections. It may be said that the general state of the
patient, the nature of the cough, the signs derived from
auscultation and percussion, and the character of the ex-
pectoration in the two diseases, have no resemblance. No
two things can be more distinct than they, and nothing
more certain than that they oftener appear simultaneously
under the influence of a common cause, than that one pas
into the other, either by the extension of the inflammation
of the bronchi to the lung or by propagation from the
lungs to the bronchi.

The marked difference between them is, in fact, incom-
prehensible, and, in some sort, mysterious, when we consi-
der the whole respiratory tract as lined with a continuous
membrane from the larynx to the air vesicles or bronchial
extremities.

I860.] Bran hitii and P 7v-i

But it is important to know thai the anatomi well

as the practitioners, have allowed themselves to be misled

in this rase by the too evidenl continuity of the canal of the
bronchus with the cavity of the air-cell opening into it.
This is not less erroneous than it would be to assert that
the uriniferous tubules were continuations of the nretha,
bladder, or ureters, which, as they arrived al the kidney,
ramified into the tubules their mucous membrane, thin-
ned, alone persisting in these conduits. T<> admit Buch an
hypothesis in regard to the bronchi without direct and
careful observation of the tissue which limits them, is to
commit an error analogous to that which considered the
capillaries to have the same structure as the arteries and
veins, on account of the continuity of their canals.

To Bettle this point, I shall re-state the following; facts,
which I have already, at different times, given to the public.
kfter a certain amount of subdivision, the bronchi (one
ami sometimes two millimetres 3-100, 6-100 inches in
diameter) have no longer the partial cartilaginous rings ;
they also cease to have transverse muscular fibres, elastic
longitudinal fibres and a mucous membrane separable from
the proper bronchial wall. They also lose their ciliated
epithelial coat in a word, they lose the characters of
bronchi. These pulmonary canaliculi, which are continu-
ous with the real, unmodified bronchi, and are wrongly
termed ultimate bronchial ramifications, are further subdi-
vided and terminate in rounded culs de sac, slightly enlarged
at their base, and improperly called the bronchial or pul-
monary cells. (At birth these measure 05.05 mm., and in
the adult .1 mm. .2 mm. in diameter).

These canaliculi have nothing of the bronchial structure,
but one of their own, characteristic of the pulmonary paren-
chyma. Their walls are composed of closely interwoven
bundles of fibres of elastic tissue of a lnminated tissue of
fibro-plastic elements, and of vessels. These last form on
the internal face of the conduits (which present slight
salient folds) a network different from that of the capilla-
ries, ramifying upon the bronchi proper. This network is
composed of large capillary vessels, so closely interwoven
as to leave the free interspaces of less diameter than their
own.

It is distributed over the tissue of the walls of the pulmo-
nary conduits, although there is no mucous membrane
separable from the elastic coat, and there is nothing between

784

Bronchitis and Pneumonia.

[October,

it and the cavity of the tubes but a layer of pavement epi-
thelium with large nuclei, that commences at the points
where the cylindrical or ciliated epithelium of the bronchi
ceases.

Thus the pulmonary conduits, where ha?matosis is eftectec
have a different structure from the bronchial tubes whicj
bring the air to them. It is impossible to find in them
mucous membrane distinct and separable from the eL
parenchyma and laminated tissue in or upon which is dis-
tributed a capillary network such as is seen in the bron-
chial tubes provided with cartilages, where there is a
mucous membrane separable by dissection. This fact affords
an easy explanation of the facility of absorption in the lung
compared with that in other organs provided with a
mucous membrane, and also of the easy rupture of the
capillaries and escape of blood (or an injection] into the air-
passages.

Thus there is as much difference in anatomical structure
between the bronchus and lung as there is between the
tissue of a secreting gland and its excretory duct, and the
inference is unavoidable that diseases pertaining to one or
the other of such distinct tissues should themselves be
distinct.

But there is yet another important cause to account for
the infrequency of the extension of bronchitis into pneu-
monia. In bronchitis that portion of the capillary system
which is the seat of inflammation, belongs to the general or
tystemic circulation, and is supplied with red or arterial
blood.

In pneumonia, on the contrary, the capillaries of the
lesser circulation, in which the dark blood from the pul-
monary arteries is aerated and which nourish the paren-
chyma of the lobules, are the seat of inflammatory action.
It is at the expense of the dark blood that the morbid
products of pneumonia are formed as in hepatitis it is the
blood of the portal circulation that furnishes materials for
suppuration of the liver.

It is well known that the pulmonary arteries, although
accompanying the bronchi in all their ramifications, give
off no branches to them, nor to the interlobular spaces, and
that they do not anastomose with the bronchial arteries.
These last are not distributed beyond thte point where the
nuclei of the 2artilages disappear (where the canal has a
diameter of about a "millimetre), and it is precisely at this

I860.] Bronchitis and Pneumonia,

point that the branches of the pulmonary arteries break up
into capillaries between the contiguous walls of the pul-
monary canaliculi, thence to ramify upon their internal
surface beneath the layer of pavement epithelium, in a vas-
cular net work of peculiar character the type of which is
preserved in the lesser circulation of all the vertebrates,
far as the fishes.

The bronchial arteries, on the contra ry, beyond the
bronchi, give off no branches except the vasa vasorum and
those distributed to the interlobular laminated tissues, con-
tinuous with the pleura.

The preceding particulars of the organization of the lung,
as compared with other organs, are of the first importance
for the solution of the question to which this paper is
devoted; but they equally well explain the causes which
distinguish inflammation of the lung, in its nature and pro-
gress, from inflammation of other organs, and also the
modifications produced in pneumonia by the age of the
patient. modifications more marked than any which occur
in a single disease in other organs, and this, not only
because, according to the age, the respiratory canaliculi offer
marked differences of structure, but especially because
inflammation is controlled in its nature and course by mod-
ifications of the circulation, and these are nowhere so strik-
ing as in the lesser circulation, which anatomically and
physiologically unites the two hearts.

Besides differing in arrangement from the bronchial and
other systemic capillaries, those of the lung have also a
structural difference from them. They are in fact the
largest in the economy, and the nuclei in their walls are
smaller, more numerous and nearer together than in those
of the systemic circulation. It is important to observe that
the capillaries of the liver present the same peculiarities.

These facts are not without value, when it is remembered
that inflammation is a morbid state of capillary circulation.
Inflammation is, in fact, a complex phenomenon, but it
principally affects the function of circulation, being espe-
cially a modification of it in the capillaries of the part or
whole of one or more organs or rather, it is a succession
of phenomena occurring in the capillaries, and characteriz-
ed by, first, a contraction of the minute arteries and veins
of the part the proper capillaries as yet taking a scarcely
apparent, though real part in the phenomena ; and, second,

50

786 ' Bronchitis and Pneumonia. [October,

a repletion and dilatation of the true capillaries, with a
Blackening and oscillation of the circulation characteristic |
of simple congestion. In some cases, this state of things
may be followed by complete stasis, with great engorge-
ment and distension of the capillaries, gradually extending
to the minute arteries and veins. The capillaries in which
the veins originate, ceasing to furnish them with blood, the
current slackens and finally stops, and the veins are only
supplied from the collateral circulation, and with a con-
stantly decreasing force, so that the blood globules, not
carried on as in the normal state, gradually accumulate.
This is the cause of the sort of passive congestion and
swelling, which extends in the inflamed organs beyond the
portion of its capillary system, which is the seat of the
essential phenomena of inflammation, i. e., beyond the por-
tion of the organ that is really inflamed.

The study of inflammation demands a profound knowl-
edge of the capilliary system as much in regard to the
intimate structure of the vessels, as in regard to the dispo-
sition of their ramification. And as these ramifications or
meshes ("reseaux") differ in the different tissues, being
subordinate to the arrangement of the fundamental ele-
ments of the tissues, there result several important physio-
logical peculiarities among them the fact that inflamma-
tion, offering everywhere general or common phenomena,
presents different peculiarities according to the tissue in
which it occurs. To properly appreciate these differences
necessitates the study of the capillary structure of the
organs. The process is not only not always identical, but
the products as pus differ notably in the various tissues.
Moreover, the difference of these products is much affected
by the influence of the nutrition of the fundamental, ana-
tomical elements upon the blastema, exuded during inflam-
mation.

To the peculiarities offered by tissue, to which the sys-
temic circulation is distributed, these must be added, in the
case of the lung the presence of a capillary system, receiv-
ing dark or venous blood, and belonging to a distinct
circulation.

These remarks also apply in great part to the liver,
inflammation of which presents many points of resemblauce
to the same trouble in the lung. Boston Med. Sur. Jour-
nal.

I860.] The Laryngoscope* 7-7

The Laryngoscope. (From the Berlin correspondence Med-
ical Times and Gazetl
A.s far as I am acquainted with the periodical Literature
of our profession, no notice has as yet appeared in your
columns or in those of your cotemporaries, with regard to
the highly practical results obtained on the continent by
the use of the laryngoscope.

Having had occasion to convince myself of (he compara-
tive facility with which the larynx can be explored by
means of this simple contrivance, I feel confident that its*
importance for the diagnosis of laryngeal disease cannot be
overrated, and it will be a mere truism to state that we
shall be able to attack affections of the larynx with far
greater discrimination and success, if the uncertainties,
inseparable trom a symptomatic diagnosis, can thus be
replaced by the precise results which a distinct view of the
affected parts must afford.

A few weeks ago I was present at a post-mortem of a
phthisical individual, whose larynx had been carefully exam-
ined, a short time prior to decease, by Professor Traube.
The changes found in the larynx bore testimony to the
accuracy of the results obtained by larngoscopic investiga-
tion. The following remarks on the instrument and its
application, are mainly extracted from a monograph, pub-
lished in the early part of the year, by Professor Czermak,
who, together with Dr. Turck, of Vienna, has .the great
merit of having re-directed the attention of the profession
to this important means of diagnosis. Indeed these Vien-
nese physicians maybe said to have re-invented the larynx-
ailum. Apart from its decided practical usefulness, the
net of the laryngoscope being originally an English inven-
tion ouGfht to stimulate English surgeons to take an active
part in the reform of laryngo-pathology, to which the gen-
eral application of the instrument is likely to lead.

In Liston's Practical Surgery, page 417, we read, under
the head of Ulcerated Glottis, the following remarks: "A
view of the parts may be sometimes obtained by means of
a speculum such a glass as is used by dentists on a long
stalk, previously dipped in hot water, introduced with its
reflecting surface downward, and carried wTell into the
fauces."

This pregnant hint of Liston's remained unnoticed till
1855, when Garcia published a most valuable series of auto-
laryngoscopic investigations, instituted for the purpose of

788 'Ike Laryngoscope. [October,

elucidating the mechanism of the human voice. In these
experiments the image of the larynx was reflected from a
mirror placed against the soft palate, so as to be received
upon a second mirror placed in front of the observer (auto-
laryngoscopy). An elementary knowledge of cateptrics
will suffice to explain the principles upon which Liston-
Garcia's method of investigation is founded.

The examination itself is conducted in the following
manner : A metallic mirror, varying in size from six to
fourteen lines in diameter, in shape either square with
rounded edges, as recommended by Czermak, or oval,
according to Turck's proposal, or, as it has been found very
convenient by Dr. Levin, of Berlin, semi-circular, with a
concave inferior margin, soldered to a slightly flexible
metallic handle, is to be introduced into the well-opened
mouth, and fixed in such an angle against the uvula and
soft palate as to throw incident luminous rays upon the
larynx, and to reflect an image of the parts thus illuminat-
ed into the eye of the observer. To prevent the mirror
from becoming dim by condensation of vapor upon its sur-
face, it is necessary to warm it previous to introduction, by
dipping it into hot water, or holding the unpolished surface
over the flame of a small spirit lamp. Garcia made use of
the direct rays of the sun in his experiments ; as this source
of illumination, however, is not always available, and, even
if so, attended with obvious inconveniences in practice,
Czermak proposes the use of a perforated concave mirror of
7 12 sec. focal distance, by which the light of an ordinary
lamp can be concentrated upon the larynx-speculum, the
eye of the observer being applied to the perforation. As the
distinctness of the image will depend upon the brilliancy of
the illumination employed, it will be found advantageous
to concentrate the light of the lamp upon the concave mir-
ror, by means of a powerful bi-convex lens. Dr. Levin, of
this city, has devised a highly convenient apparatus for this
purpose, consisting of a tin tube carrying a convex lens of
two and a half inches focal distance, and about the same
diameter, which, by means of a simple contrivance, can be
fixed horizontally over an Argand lamp, after the shade has
been removed.

The perforated concave reflector can either be held be-
tween the teeth of the observer, fixed on a suitable ivory
handle, as recommended by Czermak, or attached to a large
spectacle frame, according to Stellwag's proposal, or it can

I860.] The Laryngoscope.

be suspended from a support screwed bo the corner of the
table on which the lamp is placed. The Latter contrivance
will be found the most convenient for practical purposes. I
think it was first introduced by Dr. Levin.*

It will be most convenient to place the 1 imp to the right
of the patient, who is to be examined in the sitting posture,
his hands resting upon his knees, his body slightly advanc-
ed, and his head slightly reclining backward. According
to Professor Traube's advice, the lamp, concave mirror, and
larynx-speculum ought to be on the same level, and the
angle formed by the rays incident upon, and reflected from,
the concave mirror as acute as possible. On this account
it will be wise to place the lamp a little behind the patient.
The observer supports the head and chin of the patientwith
his left, and introduces the larynx speculum with his right
hand, looking through the perforation of the concave mir-
ror, by means of which lie illuminates the pharynx.

By causing the patient to sound alternately the Roman
vowels, a. e., the velum and uvula will be raised so as to
admit of the mirror being introduced with greater facility.
In pressing the speculum against the soft palate and uvula,
great care must be taken to avoid touching the posterior
wall of the pharynx, the palatine arches, and the base of
the tongue, to prevent the supervention of vomiting and
deglutition. "In this manner," as Czermae says, "it is
possible to look into the very depths of the pharynx, to ob-
tain a distinct image of the individual parts of the larynx,
and, as I first demonstrated in my own person, to see the
bifurcation of the trachea reflected through the widely
opened glottis, with the tracheal rings shining through the
thin mucous membrane."

Of course, considerable practice and a certain amount of
dexterity are required for successful handling of the laryn-
goscope, notwithstanding the simplicity of the principle
upon which the method is founded.

The difficulties are mainly owing to the great irritability
of the palate, which, in some individuals, is so considerable
as not to tolerate the contact of a foreign body ; others are
unable to keep their mouths open for any length of time, or
to command the position of the tongue, which ought to be
well flattened and protruded. Some patients, as Professor

Mr. Yrarsley has r< quested us to state that he has used Mr. Avery's ear lamp
in this way for several years past.

790 The Laryngoscope. [October

Traube correctly remarks, suffer from a kind of " moral
nausea," threatening to vomit as soon as they are told tc
open their mouths. This extreme irritability can be over-
come by methodically accustoming the parts to the contact
of foreign bodies, as it is often requisite prior to surgical
operations on the palate. I remember reading that bromide
of potash has the power of lowering the sensibilty of the
pharyngeal mucous membrane; it might deserve a trial in
very refractory cases.

In general, however, the irritability of uvula and soft
palate will be found very inconsiderable, so that they can
be raised and pressed against the posterior wall of the
pharynx without any inconvenience to the individual expe-
rimented upon. In Professor Traube's clinic I have seen
an individual sitting for nearly ten minutes with the larynx-
speculum applied to the fauces, so that fit teen medical men
who wTere present could successively examine the reflected
image of the glottis without any reflex phenomena super-
vening to interrupt the observations.

In this case the mouth of the patient was held open by a
very convenient instrument, devised by Dr. Levin. The
handle of the larynx mirror is attached by a ball-hinge to
the upper bar of the mouth speculum, so as to admit of the
larynx mirror being easily adjusted for the purpose of de-
monstration.

In the fifth chapter, Czermak details his method for
obtaining a view of the posterior surface of the velum, the
nasopharyngeal cavity, etc., and he represents the image
obtainable by rhinoscopic investigation, the commencement
of the Eustachian tubes being also rendered visible. Wilde
has alreacty investigated the latter by a similar method.

To obtain an image of these parts, a speculum must be
introduced under the velum, with its reflecting surface
turned obliquely upwards, so as to illuminate the naso-
pharyngeal cavity. A speculum is proposed for this pur-
pose, to which a sliding wire-hook is attached for the
purpose of raising the velum.

Examinations of this kind are, of course, surrounded by
numerous difficulties, and can only be expected to succeed
if a combination of favorable circumstances obtains.

The auto-laryngoscopic observations instituted by Czer-
mak for physiological purposes, are mainly confirmative of
the results obtained by Garcia's celebrated investigations,
and his work will amply repay perusal to those who are

I860.] Raw Mod in Chronic Dysentery. 791

interested in the important questions involved in the study
of the mechanism of the human voice.

The pathological observations which conclude the work,
twenty in number, illustrating most varied and interesting
forms of laryngeal disease, as revealed by the larynx
culum, are calculated to convince the most sceptical of the
great advantages which must accrue to the practioner from
the adoption of this method of investigation.

The possibility of the eve serving as a guide tot- the hand
in the topical treatment of affections of the Larynx and deep
parts of the pharynx, is also proved by some of these obser-
vations. Von must permit me to reserve my detailed
statement for a future communication. Two of these ca
the first and third, during the course of which laryngotomy
had to be performed, on account of steonsis of the larynx,
are of particular interest, being the first in whieh, by a
novel adaptation of laryngoscopy, the glottis was investi-
gated from below. This was affected by introducing a
small mirror attached to a suitably bent handle, with its
reflecting surface turned upward, into a fenestrated trache-
otomy tube. By illuminating this speculum with aconeav--
reflector, the most brilliant and accurate images of the
lower aspect of the glottis, etc., were obtained, and the
nature of the pathological changes affecting the parts clearly
ascertained. This method promises to be of great impor-
tance for the diagnosis and treatment of deep-seated
affections of the larynx, particularly in cases of laryngeal
tumors, which cannot be attacked from above. By revers-
ing the refiectinor surface of the mirror introduced into the
tracheotomy tube, the deep parts of the trachea might also
be explored.

11" ir Meat in Chronic Dysentery. By J. I). Willis, Ji- D.3

Royalston, Mass.

The pati'ent wras a child eightee 1 1 months of age. lie was
one year old when first attacked with dysentery. He was
eleven months when weaned ; immediately after weaning.
he began to decline. I was first called to see him Septem-
ber 17th, 1850. I found him very much emaciated, and
unable to help himself much, with skin so shrivelled that
he appeared like a little old man. His abdomen was pro-
tuberant, and presented all the symptoms of tabes mesen-
terica, Avhich appeared to follow as the sequel to muco-en
teritis. His appetite was capricious: and what little he did

Glycerine in Surgery. [October,

eat, was either undigested in its passage or vomited. There
was diarrhoea, with frequent discharges of pus and blood,
attended with feverishness and atrophy. Hard and irregu-
lar lump were perceptible in the abdomen. Various reme-
dies, which are usually recommended in like cases, were
tried, but with very little benefit. As a last resort, I or-
dered him to have the palp of raw beef, as suggeited by
Dr. Weisse. He took one tea-spoonful of the pulp once in
four hours. It set well on the stomach ; the patient soon
began to improve in strength and flesh. The dejections
diminished in number, and became more healthy. This
was the only treatment, with the exception of Dover's pow-
ders and McMunn's elixir of opium. For some time the
stomach would not bear any other diet ; but the last time I
saw him, Jan. 24th. 1860, he was able to eat the same food
as did the family. He has become very fond of the raw-
beef, and weighs many pounds more than which I first
called to see him. He acts lively and appears quite heal-
thy. After the stomach became able to bear it, I gave cod-
liver oil, and the syrup of phosphates twice a day.

[Boston Med. $ Surg. Jour.

1. Advantages of the Use of Glycerine in Surgery. M.
Demarquay, a distinguished hospital surgeon of Paris, has
used, and recommend;;, glycerine in ulcers and fistulous
tracts along which latter it should be injected to fulfill the
the following indicates viz : to diminish excessive suppur-
ation, cleanse the secreting surfaces, modify the noxious
properties of the pus, prevent the stagnation of fluids, or
simply to excite the pyogenic membrane, and bring about
cicatrization.

Glycerine may be advantageously used in deep absceses
connected with diseased bone, and in such cases the author
combines glycerine with iodyne, because the former is. al-
chohol excepted, the solvent of the latter, and penetrates
very powerfully, reaching to a great depth. Glycerine may
also be employed in the dressing of scorbutic, scrofulous.
syphilitic, and atonic ulcers, either alone or as preparatory
to another kind of treatment viz: compression with straps
of adhesive plaster. When used for ulcerated chilblains,
glycerine should be extremely pure, because it is apt, when
' not quite free from foreign substances, to excite very pain-
ful inflamation Drug Circular.

\

1860. [ Editor 798

EDITORIAL AND MISCELLANEOUS.

An Air-Plug for the Speculum Uteri, By Henry F.
Campbell, M. D., of Augusta, Ga.

Any one who is at all familiar with the. use of the Speculum in the
diagnosis and treatment of uterine and vaginal diseases, cannot have
failed to feel the extreme inconvenience and embarrassment which often
attends the introduction of this instrument in almost any of its various
forms. Many Speculum s are of such material and construction as to
admit of a plug at rhe uterine extremity, which greatly facilitates their
entrance in; i the vagina. This plug is generally made of some dense
wood, fitted to the opening and attached to the end of a wire I have
always found, even these, inconvenient and liable to become deranged
from their adjustment, running the risk of pinching the folds on the walls
of the vagina. The glass Speculu?n, however, that which is now most in
use and preferred by a large majority of practitioners for ordinary pur-
poses, is. from the brittle nature of the material, without a plug or any
other efficient means of facilitating its introduction into the vagina, The
slight, prolongation or lip on the lower edge of the uterine end, is cer-
tainly a very poor substitute for a plug, provided one could be con-
structed which would be perfectly safe and at the same time efficient.
However carefully or skillfully the instrument may be applied, it will
Bometimes happen, even in the most practiced hands, that the upper edge
of the rim will press painfully on the clitoris, or become entangled,
causing grea pain and distress to the patient. A proper plug, fitting
well into the end of the speculum, and covering the hard rim, is cer-
tainly, then, a great desideratum. Such an addition to the Speculum I
have, at la-:, devised, and the following brief description shows its con-
struction and mode of application :

This very simple apparatus consists of an elongated India rubber bag,
with a tube >f the same material at its posterior end. This tube may
be eight or ten inches in length ; must have an air-tight stop-cock in the
end. The bag is put into the Speculum in a flaccid state, protruding a
little bey or 1 rhe uterine end just enough to produce a somewhat wedge-
shaped rotundity when fully blown up. At the point where the uterine

704 Editorial. [October,

ctid of the speculum would form a ridge, there is a slight elevation oi
crimp on the bag; so that when the plug is blown up, the edge of the
Speculum is buried in the India rubber, and completely protected from
coming in contact with the delicate soft parts of the vulva or vugim
The bag being properly adjusted in the Speculum, is now fully dh
tended with air from the mouth of the operator, and the stop-cock
closed. The whole instrument is now lubricated with oil and intro-
duced in the usual manner, when the stop-cock may be turned and the
air allowed to escape. The bag of course becomes flaccid again, and
can be easily removed by pulling on the tube, when the Speculum may
be adjusted so as to bring into view the os uteri and any other part > to
be examined.

The air-plug can be adjusted to metallic speculums by a little change
in the shape and plan of construction, and will be found to possess many
advantages over those now in use. It is more particularly, however, for
the glass tubular Speculum that we at present suggest it. Most of these
glass Speculums now in use are shaped oblique/// at the uterine end
air-plugs made for these Speculums will therefore require that rri/np
near the fundus of the bag to be made to pass obliquely over it, corres-
ponding with the direction of the edge. If the air-plug should come into
general use, however, all glass Speculums should hereafter be made
without that obliquity at the uterine end. The adjustment of the plugs
then, will be, of course, very much simplified, With the use of the air-]
plug, the lip is no longer necessary.

Messrs. George Tieman & Co., No. 63 Chatham street, New York-
the Charrieres of the American continent, will furnish these instruments,
neatly made, to all who may apply. These gentlemen have also, under
our direction, made a convenient Speculum case, containing all the im-
plements necessary for the local treatment of uterine affections, a
gorgement, inflammation, ulceration, &c.

The above little invention I take pleasure in presenting, feeling only
too happy in connecting my name, in any useful way, with an instru-
ment so constantly in the hands of my professional brethren.

Augusta, Sept. 26th, I860.

Twenty-Ninth Session of the Medical College of Georgia.
As will be seen by the Annual Announcement, published under cover
of a former issue, the Twenty-Ninth Session of the Medical College u(
Georgia will begin regularly, on the first Monday in November, The
Preliminary Course, commencing on the loth of the present month.

I860.] \torkd.

ober,) will be found highly interesting and instructive to thorn >tu-
ients who may I that time.

Tho prospects for a large class are very encouraging. The advauta-

\ .rsrv. as a place wb to the Southern student may acquire tho
thorough instruction, both theoretical and practical, adapted to hie
future wants in a Southern field of practice, arc too well known to re-
quire further p m by us. We know too well, that diligence in
teaching, and the 1 indefatigable labor of its Faculty for the
benefit of the Profession, are far higher claims to a continuance of |
Berity than anything which the most enthusiastic advocates of the Col-
in effect,
Students arriving in Angusta will find the Registrar, Dr. Charles
Palmedo, at the College Library, who will take pleasure in assisting
them in finding comfortable board for the winter.

New Needle for Sutures We have received the advance sheet
of the Nashville Journal of Medicine & Surgery, containing a descrip-
tion of this valuable invention of Dr. Paul F. Eve. It will be found
entire amonsr our selected articles of the November number.

Year Book of American Contributions to Medical Science and
Literature. Dr. 0. C, Gibbs, of Frewsburg, New York, has sent us
his Prospectus of the above valuable and patriotic work. The paper
comes to hand too late, however, to receive at this time a more extended
notice. We will do ourselves the pleasure of giving the work our best
attention in the next number.

Fifty Yi: ins Ago. The following letter, from our otd and highly
res] ectable practitioner, will be read with interest, both because it pre-
- a clear statement of an embarrassing case, often met with at the
present day, and also because it revives the past, ever pleasing to recall,
and not unprofitable, for from the light of the past, we may here and
there find a ray to illumine both the present and the future. It is true,
we would not give up the advanced progress of the present to retrograde
into the imperfections of the past, but lessons of practical wisdom, and many
valuable sug restions, may be sometimes gleaned from a consideration
of its ways and its expedients; all inferior as they professedly are, to
the ways and expedients of the present day. Now, we cure fever and
all its complications readily, almost certainly, with quinine. Calomel is,

796 Editorial. [October,

by many, regarded a poison, and the lancet an instrument of destruc-
tion. loiv, improved views of pathology enable us to recognize the
neuropathic element in fever, and treatment is addressed more directly
to locale of the disease. Fifty years ago, the humeral pathology still
held almost undisputed sway, fever was regarded as a humor, and the
" obstructed liver " as the sole offender in the "body corporate." Pel-
letier & Caventou did not give us quinine till 1820, and calomel and
the lancet were the most reliable means, throughout the whole Southern
country, for controlling the fearful paroxysms, now so amenable to anti-
periodic treatment. The lesson we may draw from this may not be
altogether valueless. If calomel and the lancet were once the sole reli-
ance of the practitioner, certainly they may sometimes even now, be
useful when the more ordinary means prove inefficient. Our venerable
correspondent tells us. be gave the child, seven years of acre, near twenty
grains of calomel in divided doses practitioners of the present day
would condemn the practice as hazardous, nay, destructive ; but that
was not of the present day, but a note of practice taken fjty-one years
ago. The patient did not die, but was cured.

" Men change with centuries, principles with times."
Mr. Editor : T do not know that it will be amiss to make you a
report, taken from my note book of the 9th November, 1809, of the first
case of sickness I attended in my youth on my own responsibility. I
will preface it with the introductory, that I am a Virginian, the son of a
true Buckskin a hater of secession, but a lover of my State and coun-
try. I studied at Charlotte Court House, Va., under those excellent
physicians Drs. Elliott and Jameson, and while at the North, was
taken with a teazing cough, and threatened with a pulmonary affection,
and, by the advice of my medical friends, was induced to come South
and spend one winter, but I fully intended to return to Charlotte C. H.
the next spring. On my arrival at Augusta, I was advised to go down
to the "Four Mile Branch " neighborhood, and stop with Capt. R. Han-
kerson, a clever man of that settlement, In a few days I left Augusta
for Capt. H.'s, in Barnwell District, S. C. My attention was soon called
to a severe case of sickness just in the neighborhood, which was said to
be despaired of by the two attending physicians. Now, Mr. Editor, for
the report, I presume I spoke something of what I knew so it wai
soon known there was a young doctor in the neighborhood, and on the
4th day after I arrived, I was called on by Mr. Buckley, the father o*
the child, who, after conversing with me some time, told me that he had
a very sick child, and that he wished me to see it, remarking that its

I860.] Editorial. 7 '.'7

physicians had loft it as a hopeless case, still it would the better satisfy
lii ii i iii its loss, if I would go and see it, I then asked him a few ques-
tions, and, after a little, consented to ride down in the morning and see
his child. My patient was as handsome and suffering a little child, from

five to seven years of ago, as ever excited a physicians sympathy or
claimed his efforts for its relief, The little girl was laboring under, as
I supposed, an aggravated case of Aphthous sore mouth, accompanied
with high bilious fever, aud from my examination, I discovered the fol-
lowing complication of symptoms, viz : Sore mouth, which spread to the
lips, and almost over the entire face. There were strong indications of
Hepatic derangement. The aphthous affection had doubtless affected the
intestinal canal throughout, aud had formed on the two nates and around
the anus.

What, Mr. Editor, could be expected from a young and inexperienc-
ed physician in such a case ? After looking at, and considering well
the case, it occurred to me, that if I could reduce the fever then present,
the cause of all the external appearances, the continuance of which, also
induced the bilious appearances, there might be some chance, conse-
quently my first prescription was 1^- grs. Calomel and 1-16 gr. Opium,
administered in soft sugar to allay the irritability of the stomach, and
finding that it answered my purpose, I left 6 powders, consisting of 1^
grs. Calomel and ^ gr. nitre, given every three hours until I returned,
unless they commenced to operate more than 3 or 4 times. Then I
directed one to be given every 4 or 5 hours and to drink tepid sage tea.
On my return, the next day, to my great astonishment, they had not
operated, and now, what I have told you, that I was a Virginian bred,
and in my locality 12 grs. Calomel and 3 of Nitre would operate on a
child of the size of my patient almost unto death : and what to do now,
I was entirely at a loss. Away from friends, in a strange land, deprived
of the advice of learned preceptors, for one minute's interview with either
of whom I would have given my horse. Well ! on a little reflection, it
occurred to me that there was less sensibility about the southern stom-
ache than the northern, owing to the papillae thereof being more ob-
tunded and less sensible. Having been brought to this conclusion, my
secoud prescription was 3 grs. Calomel and 1 of Nitre, to be given at
intervals of three hours, unless they appeared like operating more than
three or four times in twenty-four hours, then even four, five, or six
hours.

On my third visit, I found that the second prescription had had a
most happy effect only giving four powders, and operated four times,

798 Miscellaneous. [October,

discharging a quantity of very fetid and grumous looking bile. The
word was, my child is better "see, the fever is muh abate! I the
mouth, face and nates discovered a disposition to cicati':* ." My mind
was also so elucidated that I could see my way without the assistance of
iny preceptors. The last of the four operations from the second pre-
scription was not so fetid and grumous as the first, and consequently,
my third prescription was the same, but given at longer intervals, that
I might effectually deobstruize and dense the liver, which I was to know
by the fujees becoming less offensive, less grumous and more yellow.

On my fourth visit, I found the little patient much better being
clear of fever, and the ulcerations rapidly healing. I had only to di-
rect one of the powders left on my third visit to keep the bowels in a
soluble state. On my fifth visit, I directed for the sixth day, small
portions of sulphate of magnesia, and took my leave, and still, Mr.
Editor, fifty-one years thereafter, you find me in Barnwell, now an old
man, having completed to the full, my three score years and ten.
I am, dear sir, respectfully yours,

Samuel J. Bailey, Sen.

Four Mile Branch, Barnwell Dist., So. Ca.

Thirteenth Annuo! Meet big of the American Medical Association.

THIRD DAY. CONCLUDED FROM SEPTEMBER NUMBER.

A communication from the Clinton County Medical Society of Iowa,
to which was appended a catalogue of the College, was read.

This communication charged the Western Reserve College wi:h hav-
ing exceeded its rights and privileges, in conferring the degree of the
doctorate upon one Freeman Thompson, who had not con"e up to the
requirements of their curriculum, who had not b?en examined by the
professors in the presence of censors, and who had not been in attend-
ance on lectures since the session of 1848-9 a single day. It stated that
at one time the Western Reserve College acknowledged the truth of the
above charge, and at another time denied it.

They called the attention of the Association to this case, and desired
that the Western Reserve College be refused representation in the Asso-
ciation. Various papers were appended to the communication, substan-
tiating the truth of the facts mentioned.

A motion was made to refer the whole subject to a select committee
of three, to be appointed hereafter by the Chairman, who should report
on the same at the next annual meeting of the Association.

Mr. Davis, of Illinois, reminding the mover of the existence of a per-
manent Committee on Medical Ethics, created for just such purposes,
on motion was altered to refer the matter to the Committee on Medical

0.] Mi u&.

Ethics, with instructions to report at the next annua] meeting, and

i d.

A communication was read from the Legislature of Connecticut, stat-
ing that the Judiciary Committee had under consideration their memorial
on criminal abortion, and asking, in order to further the matter, th
oommittee be appointed by the Association, to frame a bill meeting the
ncies oi' the ease, to hi' presented for due consideration <>i' the Le-
gislature.

It was moved and carried, that the chair appoint a proper oommi
to draw up such a bill as would meet the views of the Association, and
present the same to the Legislature of the State.

A motion was made to alter the time of meeting from June to May,
so that it' the Association desire to meet in 1 8 62 in New Orleans, they
could do so before the time when yellow fever occurs. This being an
amendment to the constitution, was laid over for one year.

On motion of Dr. S. W. Butler, of Philadelphia, it was resolved that
this Association request the Convention of Medical Teachers to be per-
petuated in connection with the American Medical Association, and
meet in conference the day previous to the annual meetings of the As-
sociation, and report to the same.

On motion, the same committee appointed last year was continued,
any vacancies occurring to be filled by the President.

On motion of Dr. J. L. Atlee, of Philadelphia, the chairman of the
committee on the memorial to John Hunter, was empowered to fill any
vacancy which may occur in that committee.

A motion by Dr. Mason, of New York, that a committee of five be
appointed to prepare rules of order for the Association, and to report
them at the next annual meeting, was laid on the table.

A communication from Elmira, N. Y , was read, advising the offer of
a prize for the best essay on the application of mechanical contrivances
in the practice of surgery, having reference to the cure or alleviation of
hernia, stricture of the urethra,' stone in the bladder, fractures, disloca-
tions, &c, was referred to the Surgical Section of next year.

A vote of thanks was passed to the retiring ofiicers, for the efficient
manner in which they had performed their duties.

A resolution was passed to the effect that the thanks of the Associa-
tion are due to the Faculty of Yale College, the medical profession, and
citizens of New Haven, for the elegant hospitality tendered to the Asso-
ciation ; and to the proprietors of the different manufactories, for the
generous manner in which they welcomed the delegation to inspect
whatever of interest their factories embraced; to the railroad and steam-
boat companies, who have reduced their fare on the respective routes, in
favor of the delegates to the Association.

Various amendments to the constitution, laid over from last year,
were called up and indefinitely postponed.

Dr. Lewis A. Sayre, of New York, offered a resolution that the
Smithsonian Institute be asked to collect all the medical literature that
has appeared in this country, and is scattered in various journals and

800 Mi scellaneous.

periodicals, and collect it in a general library for the purposes of the
profession.

On motion of Dr. Davis, of 111., the Association went into a commit-
tee of the whole to consider the report of the Committee on Medical
Education, Dr. Askew, of Delaware, in the chair. An animated discus-
sion ensued as^to the extent of preparatory qualification, which ought to
be exacted from young men designing to commence the study of medi-
cine, but no conclusion being arrived at, the committee rose, and reported
that they had considered the above report, but had no suggestions to
make to the Association, and recommended the resolutions to the Com-
mittee on Publication.

Dr. Hamilton, of Brooklyn; N. Y., moved the adoption of a resolution
to devise a plan for the organization of a College, or Board of Examin-
ers, to be called the College of Physicians and Surgeons of the American
Medical Association, in order to arrest all legislation which has reference
to medical schools, and to determine what shall be the pre-requisites to
a degree of doctor in medicine. Said College to consist of one member
from each State, and to meet annually, immediately before the annual
meetings of the Association.

Dr. S. W. Butler, of Philadelphia, stated that the whole plan in
detail, only under a different name, had been brought before the Asso-
ciation at a previous meeting.

Dr. Cox, of Maryland, was exceedingly surprised at the idea of such
a suggestion, and spoke against it in bitter terms, though at the same
time he urged the necessity of a proper preliminary education for medi-
cal students.

Dr. Thompson, of Ohio, said that the asserted pre-requisites for a
degree in reference to preliminary education, established twenty years
ago, were always disregarded in his State.

After some general discussion on this subject, the Association, on
motion, adjourned sine die.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL

(new series.)

Y.l. XVI.

AUGUSTA, GEORGIA, NOVEMBER, 1S60.

NO. 11

ORIGINAL AND ECLECTIC.

articlj XXIV.

FIRST REPORT TO THE "COTTON PLANTERS'
CONVENTION" OF GEORGIA.

[continued.]

Chemical Analysis of Shell Marl, Hickman county, Ken-
tucky. *

Water, - - 1.35

The insoluble Silicates con-

Organic Matter, soluble in

sisted of

Water, - - 0.30

Silica, - - - 60.G

Insoluble Silicates, - 73.30

Alumina, - - 7.4

Carbonic Acid, - 10.00

Lime, - - - 1.1

Lime, - - 6.80

Loss, Alkalies and a trace of

Magnesia, - - 3.78

Oxide of Iron, not estima-

Alumina and Peroxide of

ted, - - - 3.8

Iron, - - 2.80
Chlorine, - - 0.12

73.3

Loss, -Alkalies and Phospho-

ric Acid not determin-

ed, - - - 1.55

100.00

By Dr, David Dale Owen. Loc. Cit. p. 27*

51

802

Tertiary Lime Formation [Xovember,

Table 11. Chemical Constitution of the Limestones and
.Marls of Alabama, according to Profs. Tourney and Mallet.*

LOCALITY AND NAMES,

O j o

ID S3

-1 -.

o o

a o

J8

X

C

-

W 1

-r

vr

3

3"

o

3

Ou

0

o

-

O

re

T3

o

re

3
S3

o

er
o

a:

o

P

3*
9

<

3

re

o

>

O*

Q

re

5'

re

t"1

5

QQ

MkT AM ORPHIC A.NU SI-
LURIAN LIMESTONE.

Talladega County Marble,..

Marble, Talladega County,. 35.67

Grey Compact Marble, Talla-
dega County,

Greyish Limestone, Big San-
dy Creek,

Dark Gr?y, Crystaline Lime-
stone. Talladega County,.

Dark Compact Limestone,
Shelby County,

White Crystaline Limestone,
Tulladega County,

White Marble, Macon Co.,..! 55.07

Crystaline Limestone, do doJ54.57

White Crystalline Limestone

Macon County 159.33 37.93 1

Compact Greyish Limestone!
Macon County, 159.33

Greyish Limestone, do do. .'56.07

99.47

96.22
96.37

90.43
90.52

0.38 J trace
2.51 61.15

0.66

1.72

4.2S
4.93

55.48! 44.04
43.95
42.94

5.39 1
41.84!
Blue-Grey Limestone, do doi55.16j44.321
Brownish White Limestone,!

Jone's Valley, 54.62 40.13

Yellowish Grey, Crystalline'

2.79

1.04

4.30

4.*

0.09
0.40
1.39

5.05

1.81

Limestone, Chockolocho,. 55.17

Dark Bluish Grev, Oxford, 151.48
CARBONIFEROUS LIME-
STONES.

Greyish Brown Limestone,
HuntsvUle, 64.03

Blneish Grey Granular Lime-
stone, Tennessee River,.. . 92.17

Cream Colored Limestone,!
Franklin Co., near Athens, 99.21

Limestone with Encrinites
Maple Creek, 54.25

Stone containing Bones of
Fossil Fish, Cowpens

Creek 16.41

CRETACEOUS LIME
STONES.

Shell Conglom'rate,Maconco 53.66

Fossileferous Limestone,)
Macon County, ;8S.S2

Fossiliifrons Limestone,!
Macon County, 46.96

Dark Grey Limestone, Ma-
con County 51.92

Rotten or Prairie Limestone,]
1 I smopolis 7.r>.07

Rotten Limestone, Cahawba, 64.37

Rotten Limestone, Green]
County, 180.48

43.39
34.32

1.76
0.61

0.39

0.39

trace

trace

trace

trace

trace
trace
trace

trace

trace;
1.64Jtrace
0.7'.' trace

4.64|trace

0.45 trace
10.55 0.47

31.91
5.57
0.39

0.34 43.44

trace

0.32

trace

0.20

0.25

0.74

0.49

0.31
0.19
0.26

2.24

0.33
1.04
0.44

0.80

0.89
3.05

2.03

0.7!

trace

trace
trace

0.24

trace 1 68.28 trace

0.97
2.18
1.19
0.61

44.60 0.27
7.20 '

50.61

45.71

0.72 21.16

0.79
0.53

30.44

13.09

trace

trace

0.79
0.75

0.9S

trace

1.21

trace

0.36

6.31

0.22

0.94

0.24

0.78

0.26

1.60

0.44

1.44
2.19

1.24

0.200.14
0.25J0.59

0.17|0.19

trace

0.094
5.041

0.11J

2.712
2.761

2.711

3.717

2.698

2.717

2.846

2.885
2.865

2.S60
2.845
2.844

2.617

2.S53
2.847

2.676
2.702
2.592
2.641

Ul9

2.649
2.611

0.40! 1.976
0.54 1.923

0.30

Second biennial Report on the Geology of Alabama, by M. Tourney, A. M. Edited by frof. Mallet

2.064

1800.]

Qf Georgia,

Table 11. Chemical Constitution
Marls of Alabama, continued.

808
of the Limestones and

LOCALITIES AND NAMES

a

Q

hd

n 1

'/.

-

1i

~

cr

T

r

cr
c

j

3

o
M

S

0
t 1

n
p

-

=

3

D*

51

a

3

-.

p

p

O

.

p

JO

o

o

o

o

o

>

>

>

1

re

p*

s

0

p

n

i

p

:-.M

0.91

LIS
1.04
0.71

TERTIARY LIMESTONE

AND MARLS.
Brownish Yellow Limestone,

Clarke County,

Cream Colored, Limestone

or Marl, Clarke County,..
Shell Conglomate, Clarke

County,

Alabama Green Sand, Coal

Bluff, Alabama River,

Alabama Green Sand, Coal

Bluff, Alabama River

Alabama Green Sand, Coal

Bluff, Alabama River,

Alabama Green Sand, Coal

Bluff, Alabama River,

Alabama Green Sand, Coal

Bluff, Alabama River

Alabama Green Sand Marl,

Coal Bluff,

New Jersey Green Sand, . . .
Concretionarv M as s o f ")

fossil Shells, Railroad I

Cut, near Col u m b u s, |

Ga., J

Bluish Green Marl, Troy,

Pike County,

Marl, Bluish Green, Chatta-
hoochee River,

Marl, Bluish Green, Below

Eufaula,

Yellowish Brown Marl, Cam-:

den, 23.18

0.92

29.33
0.43

21.42

j.-..-:

13.4;

0.96

LSI

1.57

0.31

0.27

tree

1.09

1.03

0.26

1.35

20.93

6.70

2.05

19.34

6.42

1.70

20.13

6.56

0.S7

19.24

5.4S

1.48

21.06

4.71

0.27

1.003

23.72

5.76

trace

0.103

0.04

1.94

0.16 trace

2.8S

0.15

0.31 trace

3.23

0.94

1.0110.176

3.21

,1.08

trace

0.057

3.35

0.32 1

tree

trace

3.2G
50.99110.07

0.21

2

57.56

5S.91
58.74

0.54
0.30

2.297

26.26

75.0S

70.14
72.00

804

Tertiary Lime Formation [Xovember,

Table 12. Composition of Green Sand from the United
States and of the Green Earth of Europe.

(D P

i"

D

to

n o

d5 '

Silica !56.700i48 45 46. 1 148. 1 6 57.83

6.30
24.31
12.01

trace

8.40

5.5j 16.85 6.70
19.6.19 00130.93

2 '
r* a

E. o
-j
a.

tt o
ST c-

5 3
3.8

6.5G 4.81

2.91 1.35

2.67 0.91

2.35' 8.17

57.28157.56:58.91

6.42| 6.56 5 48

19.34, 20.13il9.24

4.95
2.05
1.18
8.17

4.88
1.70
1.04
8.17

4.58
0.87
0.71
8.17

Alumina 13.320

Protoxide of Iron, J20.100

Potash "

Magnesia I 1-176

Lime, I 1.624

Water. 7.000

Quartz. I

The Green earth of Europe appears to have resulted from
the decomposition of Trap, as it is found occupying cavi-
ties in trap rocks ; and it is highly probable that the Green
Sands of America have resulted from the decomposition of
the Trap dykes found along the Atlantic slope, from Xew
Jersey to Alabama. This being the origin of the Green
Sand and Green Earth, we have every reason to believe
that it will be found in Georgia, If it should be found in
large quantities it will prove an invaluable fertilizer to the
Planters of Georgia, on account of the large proportion of
Potash which it contains. We shall show hereafter that
Potash enters largely mto the composition of Cotton, Corn,
and in fact, of all plants and animals.

The careful comparison of the results, of the chemical
examination of 394 specimens of Limestones and Marls
from various parts of Europe and America recorded in the
preceeding tables establishes the following conclusions.

1. The Shell Limestone of Georgia, is richer in Lime and
contains less impurities than the majority of the Limestones
and Marls of Europe and of the LTnited States and is fully
equal to the best Limestones and Marls found in Europe
and America.

I860.] Of Georgia. 805

2. The Shell Limestone of Georgia is capable of furnish-
ing lime for architectural purposes, equal in purity and in
quality to any in Europe or in America.

8. The Shell Limestone of Georgia is more suitable for
agricultural purposes than the Limestones of fhe older for-
mations in Europe and in America, in two most important
respects.

(a) It contains less Magnesia.

(h) It contains a much larger proportion of the phosphates.

In the Limestones of the older formations, Phosphoric
Acid, and its compounds are either absent or exist in Buch
minute portions, that when employed in agriculture the
effects produced by the phosphates must be unimportant.
In the Shell Limestone of Georgia on the other hand, the
Phosphates exist in from J to 2 per cent, and will exert de-
cided beneficial effects upon vegetation. If we calculate
the quantity of Phosphate of Lime, contained in the number
of bushels of Shell Limestone which should be applied to
each acre of land, we will find that it will amount to several
hundred pounds ; and in fact to a greater quanty than that
which we are accustomed to add to each acre of land, in the
form of most expensive, "super Phosphates" and Phospha-
tic Guanos, whose value depend almost entirely upon the
Phosphates which the}7 contain. '

The establishment of this result is of the highest value to
the State of Georgia; for we have thus demonstrated, that
Georgia possesses inexhaustible stores of the Phosphates
which are considered by agriculturists to be amongst the
most, valuable fertilizers.

4. The Marls of Georgia are as rich in Carbonate of Lime
as the Marls of Europe, and of other portions of the United
States.

5. The Marls of Georgia are richer in Phosphoric Aci d
and its compounds, than the majority of the Marls of Europe
and of other parts of the United States, and are fully equal
to the richest Marls of Maryland, South Carolina and
Alabama.

806 Tertiary Lime Formation [November,

One of the beds of Georgia Marl yielded near seven per
cent, of Phosphate of Lime, and would give to the 300
bushels more than one thousand pounds of Phosphate of
Lime. Several of the analyses of the Marls of Maryland
and South Carolina, show a higher per cent, of Phosphate
of Lime, than those of Georgia ; but I find upon reference
to the accompanying description, that the specimens were
selected from deposits rich in bones, and excrements of fish,
and fragments of Corals. I have in my possession bones
and Coprolites from the Shell-Limestone and Marl-beds of
Georgia which would yield a higher percentage of Phos-
phates, even than those of Maryland and South Carolina;
but they have been excluded from my present tables, that
the analyses now presented, might faithfully present the
average composition of the Eocene Lime fomation of Geor-
gia.

In the Marls, then, as well as in the Shell Limestone,
Georgia possesses, inexhaustible stores of Phosphate of
Lime.

We may, then with truth affirm that in this important
element of fertility Georgia is independent of the world.

6. The Marls from different localities vary in Chemical
constitution within wide limits, some deposits are rich in
Carbonate of Lime, others in Phosphate of Lime, and others
again in Organic matters.

This diversity is highly important in an agricultural and
commercial point of view.

It is a fact well established, that the application of Marls
to the soil, should be guided by the constitution of the
Marl and of the soil. This diversity in the Chemical con-
stitution of the Marls and Shell Limestone of Georgia
allowes of latitude in the choice of fertilizing agents for the
different varieties of land.

This diversity in Chemical constitution of the Marls and
Shell-Limestone of different localities, demonstrates the im-
portance of careful Chemical Analyses of all the varieties
of Marl and shell limestone in Georgia.

I860.] Of Georgia.

The great importance and value tojthe State, of
and extended chemical examination i)\' the Maria andShell
Limestone of Georgia will be still farther illustrated by the
valuable results obtained in Europe by similar exami-
nations.

In the lower Chalk beds of Sussex and sonic of the
Southern counties of England, extensive layers of a yellow-
ish brown earth have been discovered to be exceedingly rich
" in Phosphoric Acid.

According to the careful Analysis of Th. J. Herapath,* it
possessed in the 100 parts the following constituents:
Carbonate of Lime - - - - . 28.400

Carbonate of Magnesia - - - traces.

Sulphate of Lime --.... 0.736

Tribasic Phosphate of Lime, \ Phosphoric Acid - 10.098
21.880. j Lime - - 11.790

Phosphate of Magnesia tracer

Phosphate of Sesquioxide of Iron, \ Phosphoric Acid 11.728

24.760. / Iron - 13.032

Phosphate of Manganese - traces.

Phosphate of Alumina, 1 Ph sphoric Acid - 4.789

6.998. /Alumina - - . 2.209

. Fluoride of Calcium - - - traces.

Organic Matters - traces.

Silica, with some silicate of Alumina and Silicate

of Iron. 13.240

Chloride of Sodium - traces.

Sulphate of Soda, .... traces.

Water . . . . 3.400

Loss . . . . 0.586

In every hundred parts of this earth there are found
26,615 parts of Phosphoric Acid.

The Coprolites from various parts of England, have also
been proved by Chemical Analysis to be rich in Phosphoric
Acid, and, when obtained in sufficient quantities, have
proved most valuable fertilizers.

*Chem. Gaz. 1849.70 Liebig and Kopps Annual Report on Chemistry, Vol.
3. 1849, p. 581.

808

Tertiary Lime Formation [Xovember,

The following Analysis of Coprolites by Hera-path will
illustrate their geneial constitution.

TABLE 13. 100 PARTS CONTAINED.

03 C O

c o ~ o

cc6

35-T3 f^

C 2

c 2 ^ 2

2 5> 2-

K3^ 5

X* &

o

o

CT5 -

s>

w*

3 2

c

tc o

3 P B

been 3

: - * a

=- cr

P3'~
on;

o

c lias

ight

ecoa

. j o

- ^ cr

o ,

: gj S &

Carbonate of Lime

12.280

39.50

23.70

7.09

15.86

60.80

Phnsnhntp of Magnesia

traces

6.90

4.71

Plin^nhnto of Sp^nuioxidp of Iron .

160

9.20

4 10

Carbonate of Magnesia

traces.

0.50

Sulphate of Lime

traces.

1.8

FMimrMfl of Calcium

0.608
5.792
0.400

1.700
10.600
11.600

1.6

Water and Organic Matters

6.10

Alumina

6.200

v .

In England various Marls, petrifactions and bodies re-
sembling Coprolites, and Phosphoric Acid concretions have
been discovered in the chalk formation to be rich in Phos-
phoric acid, and are extensively employed as manure.

The results of the careful examinations of these strata by
J. M. Paine and J. T. Way, demonstrate that the Phos-
phates are differently distributed through the Strata com-
posing the same formation, and that the proportion of
Phosphoric Acid and of the combinations of Phosphoric
Acid do not correspond in any definite manner with the
proportions of Carbonate of Lime.

Thus, careful experiments upon these strata in the Chalk
formation, show that the soft white chalk with flint, form-
ing the upper division of the formation contains 96.06 per
cent, of carbonate of Lime, and only 0.26 per cent of phos-
phate of Lime ; the second division, the hard white Chalk
without flint, contains no Phosphoric Acid; the third divi-
sion the Chalky Marl, contains 66.69 percent, of Carbonate

I860.] Georgia. son

of Lime, and 1.82 per cent of Phosphoric Acid, being much
poorer in Carbonate of Lime, and much richer in Phos-
phoric Acid, than the upper division; while the upper
Green Sand is far richer than the other divisions in Phos-
phoric Acid, yielding in sonic parts especially in its upper
thin layer of Marl (in depth from a few inches to 10 to 15
which contains numberless fossils, as much as 38 per
cent, of Phosphoric Acid.

Tiie soil surrounding these formations rich in Phosphoric
Acid, does not contain an unusual amount of Phosphoric
Acid except when the fossils, and the formations have been
mixed with the soil, or when the soil has resulted from the
disintegration of the former.

The following results of the experiments of J. M. Paine
and J. T. Way* will illustrate these important facts :

*Liebig and Kopps Report on Chemistry &c. Vol. 3 p. 5S4-5S5.

810

T( rtiary Lime Formation

[Xovember,

bC

P

w

-^

c

/.

7

o

CG

r>

+a

<^M

-

s

~

-

n

cd

-

02 H^

Total

oo
c:

o

O C - i> C C SB

O Ci C. C ~ C O

d x>

Water Organic mat.
andHydioflucricAcid

Ci Ol *
-r D cc
oi W oi

4.12

3.04

11.80

1 2.80

-y cm

CO CM

Sulphuric Acid

Soluble Silicic Acid .

Insoluble Silica.

Soda.

Potassa

Aumina and Oxide^
of Iron

<*

X

cm

T1 O CM t-

HM?M

CM >o

i-< CM

to

co

o tc x ::

CM CM <

X CO

OS

CO

op

l-H CO

OOOftMrH

oo o r-4 aa

CO t- JO

^ CO o

SB

t-

JO

C I t o

U2 co 00

i- ~r

CO

H

o r. Ci

-* 00 CO pH b4

Magnesia

EC g 01

Carbonic Acid.

~h io oi x :o

CO CO iC C *

ci cm * id c-i

Lime

-

71

X

::
o

01

-

HO

CO

o

CO .-
X CO

CM

Ci

Ci

no

0B

CI

CO -*
Ol CO

+3 .2 Phosphoric Acid. .

B

5?

o o

-

CO X CD

d d d

CM OJ

+3

0

7.

G

m

O

~

Q

o

+->

sd

y

Ji

0

V

o

l>

O

J

00

t> -G cS "c

S'S

it

- - -

^. c .=

- ^ 3 2

ftOOOftl

3 r- Sf

o .S K Pk ,6

^ ~ O crfw- .

X r . ^ O g

>^=

9 .

. Bl

~

^ .

. SB

o .

' Lo

is .

o

'.

m

: S

O

. c

0) .

. r3

^

.

/-

'd .

e .

Bl .

n

"j^

~

BS .

. O

tJ *

o

c

r3

a .

2

11

,fi*

^ c EC

a 5 1 s. g

.E x S

c

S t, o rt

III

~ c c

c 53 c tp

tfe jo ?3

_ a :* g

_ *< w ri

:- -x -S

- - -= i

i q

Ea 5

is ^ *

o o

I860.] Off- 811

We have every reason to believe thai an extended and
careful examination of the Calcareous deposits of Q-eorgia,
will lead to similar results.

Whilst the Marls and Shell Limestone thus far discovered
during this agricultural survey of the State of Q-eorgia, are
amply sufficient for all the agricultural wants of Georgia,
and if properly developed and used will not only reclaim
her worn-out lands, but preserve them in their primitive
fertility for untold generations, still the discovery of beds
rich in the Phosphates would be of great value to the State,
for at the same rates of transportaion, a much more valuable
article would be obtained, and an active commerce in these
native fertilizers might be established.

IV. Comparison of the Shell Limestone and Marls of Geor
gia, with various Commercial Manures.
It is of. the greatest importance, that the relative value of
the native resources of Georgia should be carefully determin-
ed by an impartial comparison with the most reliable Fertili-
zers offered in the American market ; for the value of the na-
tive products should control the price of the manufactured
and imported manures. Whilst we would not intentionally
injure any honest manufacturer or vender of Fertilizers, we
would on the other hand, do all in pur power to develope the
resources of our native State, and use every fair means to
protect the Planters of Georgia in the purchase of Fertilizers,
and prevent the ruinous drain of money which flows out of
the State, without any other return that worthless compounds,
foisted into public notice by false and brazen advertisements.
"We will commence the comparison with those Fertilizers,
which I have examined since my appointment as Chemist to
the Cotton Planter's Convention, of Georgia.

1. Khodes Super-Phosphate of Lime. This article is
manufactured in Baltimore, Md. It is but just that I should
state to the Convention that both the manufacturers and ven-
ders of this Fertilizer, have thrown open everything to my
examination, and have manifested a determination to conduct
all their operations in an open and strictly honest manner.

812

rL rHary IAme Formation [November,

Samples of Rhodes Super-Phosphate, selected by myself
the 14th of April, from the entire stock of Messrs. J.
Ansley & Co., Commission Merchants, Augusta, Ga., vielde<

the following average results.

I Ton of 2,000 pounds!
contain pounds ;

8" *- I-

o c o c o

f. 5 00 QC ~

cd *i to o <i _ >.*;

C-. t- l r :) :i 00

n n

1,000 pounds contain
pounds

100 pounds contain
pounds

<

E-

P

P

S

<

-

to
O

w

i-

.-
w
-
p

EC

300 pounds contain
pounds

>00 pounds contain
pounds

'00 pounds contain
pounds

100 parts contain

ooooo
rf r X r1 C Ci - r ^ - r, iQ X

iQ I- h- (N m OS C - < ~> C x

x r. i- x en r: x ci r- ^ Tr

id ct kri o a d iri pa id kd cr. >~ <~ r-
c: en w r- n en 5 -<

?} OJ # iQ X <- M &Jj X c> in in N -r
M -^r M 55 F- ^ <^ a 0> vr. i- t- lO X

- - -^ x c 7) c x - c lt. r- c ~)
C4 04 (S 35 ^ o

QD(C'COO)(SC90QO)GCOOGO(

xoiooOxUMiau in in to o

N l^ t^ r? Li ^ r. t- t- *r ^) r. x
en s> en

*f ^< GO lO (9 Q *- 'X -r i ifl t x

t* in r- t- 55 in c-. to r* oo ci 04 oc ?>

- o x cc h x r. r. x J) - ': ~

^ . .

Tf S r t- C* Q to l~ X 04 ^ oc n)

-cx'ci^it'OodMXCi-C'?

tO ~J X

c% in o -r

c: ro -r

?j ec x

~.

i-

r.

^r

l^

3

X

-

~

s

Q

n

iQ

-

-

~>

^

X

pq

*> .

w>

_

01

"

X

i~

in

X c c t
os i- 35 :n

r= > 3

in cc

I860.]

Of Georgia,

813

Samples from the stock of Messrs. PatteirA Miller, Com-
mission Merchants, Savannah, Ga., by my brother
Charles Colcock Jones, Jr., Esq., of Savannah, yielded the fol-
lowing results :

I, m P n Ann ,, c:rr~---z o e

I I on of -.000 pounds to ^ 55 :>/'.< j - - - -.>

contain pounds

- - -r c M Q) r v-. \

1.000 pounds contain
pounds

w

100 pounds contain
pounds

- (-<-->-- ~ to - c /. - /
h oj t Si l- -. -> 55 **

-

1

1
1

o

-

}-

J'

4-

.iJO pounds coontain ,x to m - os S /. . ~' ~~

nnunds U^ N Si >r- " > "* W <~ - ~> - ~

pounus ^, __ -.) 7> -^ -:>

300 pounds contain
pnunds

CJ X iT. O X

3Q

z: M

54

X

5

O

M

r.

i^

r;

->

Ci

Z

00 pounds contain |~. i- i~ c* to ^j o oo o x> , to i - n

I- or. f cii-r. c-^^c;!- .~ ci to
55 -* 4-) - -^

pounds

100 parts contain . .

g

c-

i~

iC

l""

o

c

0*

X

X

~-

~

<M

l>

c~.

o

OJ

0?

c*

<fl(<

cr1 c* to to j
fcD

S -i

V-

2*<x>

_, ~.
"3 ^> -;

."5 PL.

o

to
O

wo

to e

g.2 .

lO

~2

^ ^

be

60 S

a

t- s s s .s

d au => 2

3 S 2

5 r c -p

^'3 a.s H 03 >,

lo . 1 L.' CJ_-r-

814

lertiary Lime Formation [Xovember,

1 Ton of 2,000 pounds

8

o o

o c

^2

O

cc 0^

a
5!

a

a
a

e

a

contain pounds, . . .

r

kT5

W / 0)

Ol

C. (^

r

_ HO)

X

o> ^ 0

1000 pounds contain
pounds,

c

O J-

1- 70 OS

"

co

OS CO

co 53 qd

TJ X -

ct

O!

-^ -' .0

co co o

<3

400 pounds contain
pounds

j.

TJ

X

j. '. > _; -r

j CO CO

*^

-r

*-<

GO >*

os co os eg i>

< -

0) ifl

ft

CO

co co x ifi

CO

O r-H

1

300 pounds contain

O

;

uO

30 1- CO
-r 4- 0)

CO
CO 0) X kO

1=3

pounds,

CO '

CO

ct

1- iri ' - so

0) -.>

-r I-

200 pounds contain

T
l>

"3

CT *< GO CT

< - < - X

-.1
0

O)
0} CC 0)

fc

pounds a

ct

cs H

-* OS ' X

X

<~J r- 0

<

11

TH

"~

CJ

<3

100 pounds contain

CO

lo i*-

- ro

CO CO X. .0

s

2SS

GO.

pounds,

PH O

os co

CI CO d -r
CJ

C"

CO co ci

S

O

O t- o

I - CO -

tf

Pk

1 00 parts contain

O CO

o t-

ci CO

co c--
c^l a

GC' O <

" t+

c

_

<^j

" co

ci

H

S

M

1-5

Cm

T3

o

"3

<1

w

o

H

'C

<3
i (

o

Cm

o< .

sj"

CO

o

w

'.
'o

< :

00 C;

EH

r

P-.

P4

-

o
a, S;

w P>

o rt

o
<u c

0

e
id

c
0

CO

!;

2 <^

CO -r; 0

0

J.

09

CO

H

ft
o

<5

p. E

6 fs'Si

s

o

cT

s : s

c
QQ

CD
tH

CO
H

co

N

i-5

0

a

O

^ CO

V

S3
T3

13

o

2

rt kfl

P-r-

o

V

3

J -C c

"o PQ >>

0

>

C3 "g

0
tf

1

0

5^_

H
o

E

T3 O

|*4

I.

-

'o
cx>

i w

a

e

DQ

CT

ifl

CO TO

^

CO kQ

0

CT oi
c

CO

0

(X T

~.i
kri o)

X
0) -

^* '

-

0 JU

(N

iO CO

c

r

C

-T 0<
(

CT '

0 -. 1
0
00"

CO X

i-

CO k

' ci

CJ c>

*

3

j-

:o 0

CT OJ

X '

O

o
to

5- O

c ^
P c

0 I

3 s

O PU

J*

-al

,- j J

. M
'_ O

c 0 o
2

c 3

*>

'-^

Cm _o -2

o 2

-=; 3 ra

3 o b

-3 2rS

W ^ PQ

18G0.]

Of Ghorgia.

:l Ton of 2,000 pounds

;ooo r c r - - - ~

< contain pounds

- N .-- ; / -. .- .-. - -. -.

1,000 poundl contain

5gooooooc

*

.-. _:: -.'/ . ;

1 pounds,

. 55 1 r. r r. ~

- -: n

-:i

w . n T C * " '

100 pounds contain

-. r. 2 ". - /

N / -* " < - " ! I - I - - ^ ' ''

pounds,

:: :-.:: / >C :~ -

0

o co o) x c. c co o ifi 2 i

300 pounds contain
pounds,

-r

_:/'.'--:-/'.'/-:./ -

t ; x i x n < - *

?} CJ CJ CO 1)

- . : !c -

--

300 pounds contain
I pounds,

r

C '/-'-/ Tl ~ ^ O - / "'

-.' :-.- / N 0 -. '.'..'*

-

' oj H kri id r go x f

'' ~ A

! r

< -

.-. tShtSO^ is '.' in M '

100 pounds contain

ooieo&iQDeio^cic

- -j

pounds,

-.)

i -

ift .wCCCO,O,*"*CM0Cf"

0 c. -

100 parts contain,

*?

23 -c t- -c c - - ^ 'i i-~- "] cn
os w ci 000105 cj W - ni ~

cj

T3~ i

O

<; :

0

c

0 .

-c .

a. - z
m v z!

S g a .

Cu 3 ;

X

'

| rf

V

t

*

*- O '-T C

m

^O

.5,

0 'C r

-
z

: 9 co <m' j

"0 ! !

c

.| &-^i ; :

0

V

z

-

0

' '-

<

k* G CO ^ ^

2 3 ^^

Id

CO

t

-,_ - j t^ 0

rf

O

0

2

c

GO

B 5 j

j i ~ -

JOB

O

-

2.02

phatc of
1.01

ic Phosp
irth) 17.'1
ulphate c
ypsum,
44.31

.2-3 :

rz\ 0

g 2 .2

-

gs rt-a3a

*- ,9

. Jg M a, -a ;

3 c <5

-

1 J

SSs

-

3 36-S

3 "O > -P

0 - u

-

- fl

a -3 *

0
CO

c

> 1

PQ

U

CO

OS

^

s --,

H

z

0

-

X

-
S

c

CO

r.

iS

-. -.

kfl CO

..

2'

22

n

-r*

-r- X
CO X

2.'

-r ro

c

a

ca

<

_

0

5

*

T* CO

be

^*

2

1 h

5

Q

3

0

1

,_

1-1

~

1;

ca

I <>

CO

: w :

b

-

0 s

bf

-

- : &

-

: 0

n

<,

: - "t

c

r?<~

'-

-t-.

C 2 0 5

liospho
of Lin
sphatc
e of Li

3

J

-

^2S2

~

^.^ PQ ~

33

i+ 5 ra 1

H---5

g "o "= >

2 -

^ P3

816

Tertiary Lime Forma: [November,

1 Ton of 2,000 pounds
contain pounds,

1,000 pounds contain
pounds,

=. Q O

3 CO

.". CO

C.

400 pounds contain
pounds,

300 pounds contain
pounds,

200 pounds contain
pounds,

100 pounds contain
pounds,

100 parts contain,

<- kg .-. to pg
>-. x x 35 of

Q o a
^> x 5 5

E; ~~ 2 ~

s -
x c> r:
o c? H

CO

25 x

~ d

hoooon;

-= x x on

eg > ' <si >~. x eo

C) T) -^ -r -:j

x id

KixCDh^

<- >-. 55 w co

k X C: QQ CO kC 75

kfl f.

O

o

^

~

O

c~.

>'.

>1

c:

i-

M

'>

u;

< -

5 )

C

O

O

SO

CO

J-

T

(N

X

__

-

c

l

CO

< -

kf*

~

o

< -

JO

50

-

*

TTi

iQ

S '

r/7

->

X

c

-

3

~.

__

"-.

p

Tt

GO

JC

C

,-

o

o

'".

'

Sfl

.-.

<-

-)

-

-

CO O CO

-r i_o co
' d.

c^^ca

Of Georgia.

817

The individual constituents were determined in several
mples oi' Rhodes' Superphosphate, from Augusta and

Savannah, with the following results :

52

/.
7

<

<

l Ton of 1000 pounds!
contain

$g$SS

^3&

300 pounds contain ..

200 poumls oontaln . .

sssaa

100 pounds contain ..22^:32

R

r.

7:

-
<

<

1 Ton of 2000 pounds! >*.}
contain $2S

300 pounds contain.. 15 i 3

5 5 '*
200 pounds contain ..222

100 pounds contain . .

"-' "7

t.
7.

<
<

1 Ton of 2000 pounds
contain

S8

wodo

.> o o>

300 pounds contain . .

3 3! 8

TT -=' 0>

200 pounds contain .. L>2w

1 1 - CO

100 pounds contain,..| ^ V\d

1 Ton of 2,000 pounds S 7 3 % |
contain }?-

-r T k- c< -:

a

7.

. . |oio-*dcc
300 pounds contain,.. Uiaa'ae

1 0 2 I - JC -3-

~

<o j_, -4. v. Ji

200 pounds contain .. S ; 5 r'

IfTfO ci ci

<

100 pounds contain . .

r.
7.

J

<5
25

<

1 Ton of 2000 pounds

*<
ST**

300 pounds contain . ,|^2w
lo t-s-

200 pounds contain ..2^:2

100 pounds contain ..L>3,

r"

/.

<
25

<

I Ton of 2000 pounds
contain,

oo <o <ri co oc
kj o oc cj -i

300 pounds contain . . |2 .- ~! 5 -'

1 oo cr o co -x
200 pouuds contain . . jjje* ^'

100 pounds contain ..52222

1 cn ci

. : e
: : :? :
:::! :

iS-c :-ia

as ! . z

9- Jv

Hill

I Tertiary Lime Formation [November.

2. American Guano. Samples of American Guano, froir
Jar vis St Baker's Islands, offered for sale in Augusta, yieldec
upon chemical analysis, the following results.

The Guano presented a reddish-brown color and consisted oft
loose pulverized portion, and large lumps, varying in size anc
weight from a few grains to several pounds.

The lumps were hard, being with difficulty broken. In tin
Btate in which I examined this Guano, it. was unfit for agri
cultural purposes. These hard lumps, although rich in Phos
phate of Lime, would exert but little effect upon plants, or
account of their insolubility. The lumps of American Guam,
should always be crushed before it is offered for sale.

analysis 25. American guano, (loose pulverized portion.

It

Phosphate of Lim 50.15O|50.15O: 100.300 150. 50 1 200.600 '.01.50

ateofLime 1.750| 1.760 305001 6.350 1 7.000 17.50

Lime 8.890 3.8;0| 7.7S0 11.770 15.560 88.90

Ammonia 0.238 0.23 I 0.470 0.7141 0.963

Organic .Matters, rich in i abon 7.312 7.212 14.424 21.63(1; 28.848 7*J5

Silicates Insoluble in Hydrochloric Acid 2.W01 2.890 5.7S01 8.670' 11. 560 1 23.%

'. 0.375. O.37o 0.750; 1.1261 1.500

W al -ra-i Moistun- 30. .i^l 30.300 60.600 90.900 121.300

Chloride* ASulph. of Potassa, Ammonia, Soda & loss.. I 1 2.2891 2.2891 4.5781 6.S67J 9.1561 32.89

analysis 26 American guano, (hard lump portion/

Phosphate of Li . e
of Lime
Sulphate of Lime

Ammonia

Or unic Matters, ri h In Carbon
Si'iciites Insoluble in Hydrochloric Acid
Sand

"Watt r a> Moist tin-

Chi rides :.nd Sul; JumlnaJ
Soda, Siiicates, Soluble in Add and loss

860.]

Of Georgia,

819

NALYSis 27. American GUANO (Mixture of the Loose and
Lump, representing the average composition of the
Fertilizer.)

hosphate of Lime

airbon&te of Lime

ulphate of Lime

.mnionia

rfwric Matters rieli in Carbon

isolublc iu Hydrochloric Acid,.

Moisture

hlorides and Sulphates of Potassa, Iron, Alumina,
Soda, Silicates, Soluble In Acid and loss,

-

~

*i

J

"8

jM
: e-

h

*: e*

: 8

n

n

jt

3

i

a

3

I

3

: 8

3

: B.

. a

109.160

168.796

318.800

646.78

(.660

6.676

9 .800

18.16

6.600

9.909

18111

88.08

".711

urn

1.418

3. ;.7

16.102

14.60!

32. Sot

81.01

3.680

6110

7160 w.4o

txn

0.661

0.748 1.87

50.900

79.350

105.3001264.50

4.028

6.032

6.156

20.14 1

?H

1001.60
46.60
66.00

7.1!
164.01

8.74

529.00

40.28

820

Tertiary Lime Formation [Xovcmber

The following table will present the composition of vari<
Commercial Manures, as determined by reliable Chemists.

rH

-3
<

Carbonate of Lime, J

Carbonic Acid and Ingredients 5
not estimated,

S8S8 8tSgc$$8 365$3g8 SSSSfSi*

tioNOKv: c: \c cr. c 1 1.- ci V crj ~ * id r. i / -
-iik^. 3 t p-i si .-. o35e ~

Water,

^223S=j SSSSSSS 352?=?5 = ?!??3S?2 H

-t--jo -f 1- +&.* & eocg><n'io'ef a,

)H-co ci t-r-. cic-. - 1 1 c: o <o

- o 1 -r ci

Sand,

CrH^-.ir;.- 0 0 0 = 00 OCOOCSl HI

Phosphate of Iron,

Sulphate of Lime,

Phosphate of Alumina,

)rganic Matter,

o> X 00 I- te ' r- c> C l

So53q <r.

-o ec . acuco c-. cc 1 - -^

SSfISS

38

r.!ir.TJ)

:t-55IO T" ft -r X> L- o o t- c>
ICC-* o ci-*xo CC I- f I- *J

Sulphuric Acid,

'hlorine,

'51

ia e o c .- o
C; .-_ l- 9 1; c;

CI -T t> 3r. ' -7

Magnesia,

r-$ H

*s

_ K si -^ -1 :: ci %c x c n x t-i-i.~ -

M X. ^ C O C

eiaaonvia

Phosphate of Lime,

Equivalent of Phosphoric Acid A
in Bone Phosphate of Lime,.

k i" 5 T- 5 so *-<

;?.8

Phosphoric Acid,

fe =r. ci D -r

o-5i'co\-:-''
-in-wicajii

0 -? "l s x ticto
Kci-ifi do <o 00 1-00

n - 2 x ^

;?

5 :
rt< :

=^> :
80 :

*, j
13:

:0

: :0
:b

g?g

: : : :3 :
::::=<:

- ' : : : % M J
BfS c,VS o ^-S

c?-c ^ c?^

lJ*illiJwliilii"ii

si

ill!

<

60.]

Of Gh orgia.

821

Carbonate of Lime 1

Carbonic Add and [nfredlenta,
Dot estimated

'~i.

.-: i - j o a 3>

-r c r. -

Water i

- V a"

Phosphate of Iron Z

x rr i - 1 - . r

r.' -*" ' B IS "

Sulphate of Lime,

i- v- rr'r.'n

Phosphate of Alumina,.

X <o t s i - c
~ S Vi ?: S

J38S

Organic Matter

Sulphuric Acid,.

I3BS8SS S8S8SS

- s >n

-ii^^.-

Chlorine

Magnesia,.

i*S8.388 : : : :
5.5r-;''o'a;' '-r'tr' : : ; :

Lime,

S'^sg

-C : i x -r = c OdCD-fQe
M3 -= ii i;i k; -x -: r -:>
ic" e ' t~ " =-' -' r .' QO i" "

Phosphate of Lime Ja |

.-.-.:-.:

-.-.."'. r ' t *". ~ ' : : : : : :
- S .-" s' ' oa -^ cv ' h-'
r? -* x -.i -.

Equivalent of Phosphoric Add* 8>SaS8<
in Bone Phospnate of Lime, .- ti"^ S 8

Phosphoric Add,

;;5J^

2 O

2g*'

=>QOOC

Z-Z "' ~ -J

-. * 5 - 6 C 5 -X DO - X
T I -: 1 i rtGOOTSO

: :p
: :3

: :s:

: :<:
: :

: :-:
: :'y-
afc
: C
:"gfc

jgafi*

n-3 j 5

= -c c = .- --=-= -r

mm mm mm inii

1

822

w

M
EH

o
o

I

Tertiary Lime Formation

[Xovembei 1

Organic Matter,

Carbonate of Lime, jS

"arbonic Acid and Ingredirnts J. !M**.
not Estimated, s i-T^oS'lE

Water,

J

H ?i c< r: t'-

:

T

:

83888 3 S3. 8

ci i - ' .-:' .' -=' ci'Vi-c.'-V

Sand,

-ti^-cc nfOQ c< rt -r K= o

1 1 s:utc:i e *ao-i'* r- ci r: - .: -

'! O**4*i-4e0* r~' si 00 -r' -' a? *""c?H

Phosphate of Iron,

c< <*<ecge

Sulphate of Lime,

e - ao

Phosphate of Alumina,.

zzii'?--

Sulphuric Acid,

Magnesla -, J

Lime,.

Phosphate of Lime.

T DC Z I ~ i

c^ E- a c* i

ci r: -r - o

cir-ca. cci

*r " ^ ? s

288328 SSS8S8

oc t-'tt

i-t-Xi;o

gsssssa

r *[

ilHSifi 9

---

i*

"-I CI -

5833

Equivalent of Phosphoric Acid*
in Bone Phosphate of Lime,. .

Phosphoric Acid,

-1 & ? >e .

S8SSS8

00 t i~ =. r-

S8S2SS gs
SS'3'3'83 fe'S'SS?^

S"53S3 33S

. no

set?- ^of'

J*

rt c c c c<

c o o c

11?

gg?gg=

50.]

Of Gkorgiu..

Oarbonata of Lime,..'

OarbonkAdd and In- . i
gradients Dot
mated ""I

: : : : :

Water i

S ml

Fhoaphata flfiwni..iBg888aa8 'r ; : : : : : : : : : : : ; : : : : :

"ly^WflOICO VO'TC". o

~"* ~~c.^ :::::: :::::: ::::::

-uiphute of lime... gj

Phosphate of Alviminajp J S[S38&8$ 28R8SS j

'..-. t' SB -r Sk -r o * CDC > 0 =' SJ

1*82 '

3 2 S5 -^

1 1 00 iO t iee 6* < CO CO OC ' -

Sulphuric Acid.

0.35

1.05
L.40
1.76

7.00

a e - t" ..::.:

-

U

[agnosia,.

5 S 828388

;3.8ss

Ci cc -r ct '

sJ 2 ,
"c. 5:

ggjrs

"S '..7 .-.

1 - .- -
-. . ::

1 - ti < - - -' - v c- 1 - -r. . : - -:->'-

y; J tc :: - so -. u; - ..-. - -; -r <: .: y - - apebes -^ 3a S v. 5

9) -:' 30 :-' SO ' m ' a i- a c ci ' ' o - ' ~' . ' -r' v' .-:' .-' -' o c

"J - cc w r- -: . - <t>(iSceo *0O c* to 2 c i o j- r. Si i~ g >

"hosphate of Lime,.. 5

28S

V^uivalert of Phos- .
nhone Acid In BoneJo
Phosphate of Lin e.

~ L ' - -

-. :: :: v: ^- z> -\ r: ..-

SJgggS ?8&g$ &SS

'/" --C i.-' rr t: i' ' - .'

CM

Miosphoric Acid.

Ri

-

u

~ n 30 SO DO

^ S t OB

> c c o Bjeo

3

: : i-^s:
: ;g

Og -r-cT3-:-c5

- a

>< re

3 5

i -^

< :

> a

= /-:

'- <

c ^

3 g

ii t

141

cocooc Scsces oooc=
S'c-c-c-c.s gt3o gU'8'co

S8= 8g|c

cj-c-o-S-oo

~ - - : c

888881

824

Tertian/ Lime Formation [Xovember,

Phosphate of Magnesia, \

IS83SS

-.mated,.

2S S8888S

Water as Moisture,

Sand and Silica |

^S^iSS 5B8SSP-S

E ~ 5 i ^ 5 ^ S3

Potassa and Soda,

SSSSSS S%SiSS

Magnesia,.

Excess of Lime,.

Earthy Phosphates,

Lime

'. i -.-. .- = t - c - -~ O I i -.- - -

Ti BC -r O -ri ie -= -:; t- c vr r: -z. \z :'. -r t~. i- ~ r. -71

Chlorine,.

I i

Carbonic Add.

Sulphuric Acid,

S & So 1- 1 - s 3 ffi 00 1~ i~ a
c-: -r" ' a a " - ' ~. ' 00'

ricAcid,

_.QC r-. v= o
<r. oc 1 - as ks 3 c j O DO rr 36

:'i.-'t-'^.'

. r r-. v=
ts> so ri <

it :: = ..- 3 ei 3 ? ..-T 05

C- S8o "SfSSJ dc S i 3S8 3 ?, g 3 g J

Combined Water. Organic Mat-rfl e. -.-.-. 38 88 8 8888 KSS8SS
ter and Ammoniacal Salts 5 ES2SS8 gSSSSf

i5

:<;
p

:

:-
~<
SO

0 c c c c<

'"8 =---":

; 1

33

%i

11

1 3

3 =

11

88!

go =_=.

a - '

Pi

us

Of a

825

.

-

'=1

i\

.

if Lime,

C--CKI-

Earthy Phospll

j

rr. ri--;.: r

825388

c\r! J 77. -7.

i'^'4/iSS

"= ~ _

-.1 -71

i

--. i -. i -

II

SS2

g! 5 5 ;: g 3

, r . -.

t :i -.

c -7 i '. i : : -r

C ' i -7 1

V

-71 :: o o

- r :: -:i

o

X CtTICi

0.2(
0.40

0.80
1.00
4.00

a. . -r c i s c

=.)

rl e

-

Sulphurl

rio Acid,

rr .- c - /: i --r .- -

i ." - 1 - -ri :: v anc<sioD

: d d x ^_i ce d >-! n'ttV d e

Combined Water, Organic .
Matter and ArumoniacaU,

' d nV d

:-
:-

- -

:

-12.

cf o

------ -^ :

82G

Tertiary Lime Formation [November,

Water and Organic Mat
ter

%

ciwieccoc
: : <c a. n -r

d 1 1 x 0 >' <c
:-. c-.-~ -- 11

--1ic-:c

9

3

Water

D

18.33
86.6.
64.99
78.82

91.65
366.60

L2.67
26.14
87.71

62.76
261.40

12.60

87.60

60.00

50.00

18.67
27.84

40.01
54.68

278.40

::::::

i

3

<M CO -* O <?>"}- cifcacco 001

Sand and Silica

~

ncootcj nKici-ooi!' iioa-cTiO nn-ci--/) rtr.sccxj

1
a

a

#oc 1 - - - r - n<enoe

Chloride of Sodium

.-:.

S

SB 11 K3
11:: :;

- .- -
~ --. 1 1

n

i cc

s is

:-

Soda,

"B,\ ff'^toooo'ci -fl<cfj-7i = -i c - :i ^ t r

c;'

a

l,s.

J.07
5.14
9.21
2.28
5.86
1.40

1.80
7.20

8.00
2.00

i.44

i . 66

1.10

i. 10

i . 12
2.84

. 26
5.68

7. in

....

Potassa

d

~-| ^* . <> T-< 1 I- "i CI

;

^j i <m o X 5 : ' -r c 1 -r - x. if n^neoiHfi i - - a . -.= co
1 OOo'tHHiO OoddrN* do'c'cH^' ci c' r: i-

Sesquioxide of Iron,

^

c - so hsiw^
r- i - * x o a -i t ii c o tc ii x -r cc -~ ~. i . *? 11

Magnesia,

.<g OHein*n^> eo^no o.-Kin'M '-< o

10 cr. / 1 - - '1 t- -r t. : co 1 1

1 - r. x ..i -r r. - -r /. r. 1. - : 1- c. i -..--.

11

Lime

..fi

66 1

49 2
32 8
16 !
60 19

00 1
00 3

00 ('

00 8

00 82

64 1
08 2
52 3
16 4
70

50 29

69 1

04 S
08 i

60 a

40 21

_:

n

s

*

<

Sulphuric Acid,

.jh

Mt CC -S-X11-- iter. MX 11 diet- li

r-^r-t- 1 ill CO 1- 1 - CI Oi O

a,

U>

Phosphate of Lime Equn

?^i-^

^

~~

atent to the total Pho

9- 3

1-^- 5_

<

phoric Acid

,""*

9

CO * K

z

^ | ifccs

49.6

62.0

248.7

20.2
40.1
60. f
80.8

101.1

404.9

14.4
98.7
48J
67.4
61.8
287.4

14. r

29.1
48.8
68.9
72.8
291.9

14.7
29.8
44.2
58.9

7."..:

94.80

Phosphoric Acid

3

s

S

Ammonia Potential

.SI ' '

^-. r - r- -. -rr

.'

"" ! : :

^/^tdS

-

3

-

~i ; ;

CC t-

-li.lrl-

^
^

i i

w

J

PQ

<

oS-2ao SSoSSo-9 - ii 2 -r -i ~. . . * cc -*

Organic Substance an
Ammonia Salts,

d t^ir coo r- <' it coco c^Ti-crrii cioco t=> '
7J 1 t^ 5 ,_ x ;i 5 t:cCK -.c _!r ir ca 00 co -j k;t :

-;

H

3

<

:o
:<

0 : :
2 : :

<J : :

0 : :
2 : :

< : :

B :
<

0

t

3
9
/-

p

t> : :

& : :

-

b

fj

;tS

0 :

0 : :

0 :

<

*

:fc

2 : :

fe : :

K :

rt

3

H

4 : :

< :

-<

>

=>

$

;1 ;

^>

I

jj

-

-^

i^g -: i

: :=d :

. . . . =

~

cj

5CJ : :

: : : :g

N

*s

uw : :

1h : :

: : r.y :

:

-

c 1

:-3a< : :

: :"|fc :

::: =

c

0, ct

a. a

5 <^ '.

: : : : c
.... a

-5

r c r cJ

S-o'S'3'Sg g-o-S-o-ag ^cog -^~--5 t--i-c

Dunds c

do

do

do

do
Ton of

rands c

do
do
do
do

Ton of

ounds c

do
do

do
do

Ton of

ounds c
do

do
do
do

Tou of

ounds c

do
do

do

do

Tor, of

is

p

|

1

i

|

* 0
0 s

s

1

|

3

5
O

ill

1

2 -

111

1

1

3

I860.]

Of Georgia-

827

Oxalate of Lime,

888888

888888

-h' c i co >o <c' Jg

Urea,.

Sulphate of<

Soda i

Carbonate of Lime,..,

888.8S.c5

Water

86.10
(50.80

L27.00

S8S8S8
*J8S90

4.31

21.55
86.20

i

<-

P2S3S

fnor-o^^

co * o at o

r-ciwciej^

I-I CO KS <o CO CO

Chloride Of Sodium, . . .

4

JMIM

::::::

5.00
10.00
15.00

25.00
100.00

| ::::::
1 :::!:!

9.00
18.00
27.00
36.00
45. Oil
180.00

22.00
44.00
66.00
88.00
110.00
440.00

S 6351 3 88

8

Sulphate of Potash,

tB

1 ::::::

7.90

23.70

39.50
15S.00

6.01
[2.0

13.00
24. (V
30.01
120.00

f/SSSSS

3 S 8 8

Phosphate of filagnesl

and Alumina

a*

| ::::::
1 i-jljj

i-i c i eg id <c o
ci

1 4.50

9.00

13.50

; 14.00

22.50
80.00

1 1 . 13
23.20
.". l . 89
46.52
5S.15
32.60

Phosphate of Ammonia, ._i

: : : ggg88

LO rH tO CM*

to cv S i to -tf cwi-teoo

Oxalate of Ammonia,

to t? 1 CO ^t 8

o" r4 ih <n' co ei

Urate of Ammonia S\

ESrSSSS

c: s ci '.I .r c

i-f ccco

>-l CO >C l~ CO o

"858888

i :--f ci- -to co -r

-. i . : i - 1 - <n cc v <c *

Phosphate of Lime Equlv- .
alent to the total Pbos-ja
phoric Acid ""

[^58 Sulphate ot\
>Se Ammonia, v

888888

to CO o o

Phosphoric Acid,

Ci
V

S8 Sesqui Car-
.-:_ bonate of
l-g5 Am'onla..

iwn^co

ci co t- -o

Chloride of Ammonium, .ja

888888

oc to ~ c i . c g

cV io i-S ci

ci -f to Oi Cl o

Ammonia

Ol - OS 31 o. t

; ci 5 ^. (M e5 co -c

3

ci ua to co .

ci 65 tji to o

Organic Substance a D d
Ammonia Salts &\

to c< en < ov co to -. c i 1 3 c

T o. :? i - EC ci l - -r -- o. t- to

lo i' io !.o c i "? co ci c co

*; -I-!- ^< cm ci co

oo to s co cn en

r-^ co >3 i- en o>

to ci co -r

CM I." I- CO Cl

CO to c? ' IO
flClCOTftO

: ct i

;23W :

E-c-c-c-ag --c-=-c-

C~ C-3T3,

c c o o o a

a a

o o c

O
"1 J?

to <

IIIII5 8f8|P5 8|8|= 88888=

HtMCOVlOW rtWW-^OV HC^W^Ov H C W Tf VJ O

828 Tertiary Lime Formation [Xovember,

A careful comparison of the Chemical constitution of these
commercial manures, demonstrates that each constituent
varies in amount, within wide limits, thus, in Phosphatic
Guanos, the most valuable ingredient, the Phosphate of
Lime, varies from 330 pounds to 1759 pounds in the Ton
of 2000 pounds ; in some varieties of the Phosphatic
Guanos, presenting very nearly the same general appearance
with the best varieties, Phosphoric Acid is combined with
Iron and Alumina, and not with lime : in the Ammonia
Phosphatic guanos, the Ammonia and Organic matters
capable of generating Ammonia and the Phosphate of
Lime, vary within wide limits, not only in guanos from
different localities, but even in Gnanos said to be from the
same locality ; and in the Peruvian Guano, not only do the
individual constituents, the Phosphates, the Alkaline Salts,
the organic matters and the Ammonia, vary within wide
limits, but what is of considerable importance in the action
of the guano upon the soil and plants, the state of combina-
tion of the various constituents, especially of the organic
matters, vary within wide limits.

The following questions, highly important to the planter
demand an answer.

Do the venders of these fertilizers inform the Planters of
these variations ?

Do the venders of fertilizers fix their prices in accordance
with these variations, and with the actual value of the fer-
tilizing principles ?

The actual value of these fertilizers may be ascertained
by determining the agricultural value of the individual con-
stituents.

The actual or agricultural value to the planter is deter-
mined by the increased yield which these manures are
capable of producing.

The experiments upon the increased yield which these
fertilizers are capable of producing in Georgia, are not yet
completed, for the present purpose therefore we will avail
ourselves of the labors of English and American Chemists

I860.] Of Georgia. 829

in countries where definite experiments have determined the
actual value of the individual constituents. According to
Professor Johnson, the principle constituents of fertilizers
possess the following values.

Soluble Phosphoric Acid . . L4 cents per pound.
Insoluble " " " 4', " "

Insol. Phosphate of Lime (Bone Earth) 2. " "
Ammonia . . . 14. " " "

If now we apply these numbers, which I am convinced
are too high rather than too low for the great body of our
Georgia lands, we will find that the actual values of com-
mercial fertilizers differ in many cases widely from the
values at which they are offered in the Georgia market ;
we will find that the commercial value is often above and
never below the actual value ; and wre will find that inferior
articles frequently command as high prices as the very best.
An examination of the manufactured compounds, leads to
similar conclusions.

With reference to manipulated compounds it would seem
that every panter who reflected for one moment, would see
that if the planter is compelled to purchase commercial fer-
tilizers be had better make his own manipulations and com-
pounds for these sufficient reasons.

There must be some profit upon eacb compound intro-
duced into the mixture. If there be not some profit over
and above the actual cost of the guanos and other ingre-
dients entering into the manipulated manure, how do the
manufacturers of these compounds manage to make such
profits? If there be no profits made upon each ingredient,
why are our papers loaded with brazer advertisements, each
claiming to be "the best compound in the world ? " If
the original guanos and other materials used in these
manipulated compounds are sold at too high a price by the
importers, and if a handsome profit is made on each ingre-
dient, is it not evident that the planter would do better to
make his own compounds ? and is it not evident that the
planter would do better still to use the resources for the

830 Tertiary Lime Formation [Xovember,

regeneration of his land, which Providence has placed upon
his own soil, and abandon these imported articles which are
liable to great variations, until at least some arrangement
is made by the State to compell the venders of these com-
pounds to submit them to the constant examination of
competent chemists ?

Well established facts, prove that not only manipulated
manures, but also Guanos are in some instances greatly
adulterated. To substantiate these propositions we have
selected the following facts which rest upon the testimony
of responsible and competent men. Professor Philip T.
Tyson, State Agricultural Chemist of Maryland, in his
recent able report to the House of Delegates of Maryland,
thus notices the adulterations of Guanos and manufactured
fertilizers.

" It appears that the adulteration of Guanos, especially
the Peruvian is very extensively practiced in Great Britain,
and I regret to be obliged to believe that frauds of this
kind, are also perpetrated in our own country.

In order to protect our farmers against such impositions,
the system of inspection of guano was instituted in our
State, and it has doubtless been a means of protection to a
considerable extent.

But yet, it appears from the testimony of many farmers
that they have had palmed upon them sometimes inferior
or adulterated Guano, with the inspectors mark upon the
bags. Gentlemen have informed me, that boatmen who
have brought them Peruvian Guano, have offered to fur-
nish them with ^ood new bags, for the Guano bas;s con-
taining the inspectors mark ! Suspecting however that they
were wanted for dishonest uses, they refused to part with
them.

There is a peculiar earth on the southern slope of Ham-
stead Hill near the eastern limit of Baltimore, of which I
have been informed large quantities have been, and may
still continue to be secretly carted into the city. There
being no conceiveable honest use, for which this material

I860.] Of Georgia. 831

can be brought into the city, and it being very similar in
color to Peruvian Guano, it was reported to be used to
adulterate that article, the mixture being put up and sold
in old guano hairs containing the Inspectors mark ! Some
months since the inspector called the attention of the police
to the affair, who arrested parties carting away this earth
in Guano bags during the night, The arrest was evidently
made at an injudicious time, because upon examination the
hags were found to contain only earth. If however, the
parties had been watched until they had taken it to their
mixing depot, and completed the crime, they might possibly
have been properly punished.

During the lute season of active field work, I endeavored
to collect for examination samples of Guano, ground bone3
and artificial fertilizers, which had been purchased and re-
ceived by my farming friends. Finding but few kinds in
their possession, I requested ' that samples might be for-
warded me whenever they shall again purchase. Among
others I got in person a sample of guano from Col. John S.
Sellman, of Anne Arundel county, which being sold for
Mexican A. A. should have contained Phosphsric Acid
equal to 55 per cent, or more, of Phosphate of Lime, and
yet the analysis showed but 36 per cent. In this case the
Colonel paid for 50 per cent, or more, Phosphate of Lime than
was implied in the purchase, and if the deficiency had not
been discovered, he would have sueffred a still greatei loss,
by not applying a proper dose of the phosphate to his soil.
How much of this Guano was sold and used by farmers,
I have no means of knowing."* * * * Professor John-
son determined the value of several fertilizers.

1st. Mapis Super-phosphate from Newark, X. J. In
1852 its calculated value was 44. In 1857 it had degen-
erated to $15, owing to the introduction of worthless matter
and the total absence of soluble Phosphoric Acid.

2d. Another article called Mapes Xitrogexized possessed
a value by calculation in 1856, of 21 ; and in 1857 one
sample proved to be worth 14.50, and a second 12.50, so
that it seems to be going down pretty fast.

832 Tertian/ Lime. Formation [November,

3d. The name of De Burg's Super Phosphate of Wil-
liamsburg, Long Island, so familiar to farmers from adver-
tisements proved to be worth, tn 1852, 32 ; in 1856, 36.25,
and in 1857 it had fallen to 21.50.

4th. Coe's Superphosphate, from Middletown, Conn.,
has proven more uniform in composition as shown by seven
analysis between 1854 and 1857, its value being as follows :
33.75; 33. 41. 33. 35. and 33.25.

5th. Professor Johnson calculated the value of Ppiodes
Super-phosphate of Lime, (a Baltimore article,) from three
analyses to be 32.25, and his results, he remarks, do not
seriously differ from those of Dr. Higgins and Bickell.

Jourdaxs Super-phosphate. Since this capterwas plac-
ed in the hands of the printer, Dr. Piggot has reported to
me the results of analysis of two samples of an article under
the above name. They were furnished by Maj. Edward
"Wilkens, of Kent, county.

The first was purchased in 1858, and was used with good
effect by many farmers in that county. The second was
purchased in 1859. Their composition is as follows :

1858. 1859.

Gypsum or Plaster of Paris . . 25.30 39.31

Soluble Phosphate of Lime . . . 2.53 2.95

Free Phosphoric Acid . . . 6.86 4.45

Lime otherwise combined . . . 2.07

Phosphoric Acid com'd with lime aud magnesia 2.23

Sand 11.04 14.30

Animal Charcoal and organic matter, \ r>9 on io oo

(Containing some ammonia,) . j
Magnesia, Iron, water &c, not determined 4.66 15.95

The useful matters may be summed up as follows, and I
have also calculated their money value in the manner
adopted by Professor Johnson.

THAT OF 1858.

Per ct. Price. Am't.

Gypsum . . . 25.30 Jet. 0.08J

Phosphoric Acid Insoluble . 11.65 ijet 0.52J

" Soluble . 8.40 12fct 1.05

Value of 100 lbs. of the fertilizer . 1.66

18G0.] Oj- and Cervix Uteri, Doi ai i

ARTICLE XXV.

Case of Inflammation of Os and Cervix Uteri Cured by the
Cautery. By P. Wade Douglas, M. D., Dublin, Ga.

So conflicting are the opinions of our standard medical
writers upon the diagnosis, and especially the treatment of
certain diseases, that deep thought and investigation are

demanded at the hands of- every henest physician, or else
rational medicine would give place to routinism, and num-
bers of suffering humanity would he hurried hence, the

victims of the generous dispenser of prescribed remedies.
"The time has passed away when the human mind is to
credit the mene verba magistri, or to place implicit evidence
in a scientific assertion, without examination, because it
proceeds from this or that individual." But I propose, in
this brief article, reporting a case of inflammation of the
Os and Cervix Uteri, with my treatment, as recommended
by Prof. Jos. A. Eve, in his report read before the Medical
Society of the State of Georgia, and in opposition to the
views of the distinguished and learned Dr. Charles West.
I will not quote from either writer, as it would consume
space and time, but leave it to those who feel interested to
-read for themselves.

About the middle of February of the present year, I was
called in to see Molsey, a mulatto negro woman, aged 33
or 34, and weighing 170 pounds. I found her with symp-
toms of suppressed menstruation, but learning that she had
been sick for two weeks and had passed her catantenial
period, I simply relieved the urgency of the symptoms,
and put her upon a plan of treatment best calculated, in my
opinion, to re-establish the flow. Somewhat to my surprise,
however, though no debilitating -medicines had been given
her, save those at her first attack, I found a transition
rapidly taking place from a condition of plethora to that of
anemia; notwithstanding this, as the time approached for a
menstrual discharge, I resorted alternately to blisters, elec-
tricity, hot hip baths, stimulating vaginal injections, and
the tincture of cantharides, etc., and it was not until then
53

834 05 and Cervix Uteri. Douglas. [November,

that I became apprehensive that the cause was local and not
constitutional, especially when I learned from her intelli-
gent master, Judge Roe, that her last labor was very tedi-
ous, and that she had not menstruated since the birth of
her last child, ten months ago. Believing too, that the wo-
man "was not sick because she did not menstruate, but that
she did not menstruate because she was sick," and looking,
but alas, to no purpose, for a cause in the constitution, re-
garding anything that the speculum might reveal as trivial
in importance, my mind being prejudiced against every
local curative means other than was already used, the cau-
tery especially, as taught in the excellent work of Dr. "West,
I became hopeless, consulted several physicians, but with-
out any additional light, my patient in the meantime in a
perfect state of imbecility, bordering on to insanity. "Al-
together passing away was impressed visibly upon every
feature of this case," and finally the pitying interrogations
came up, "Why can't she die," as everything that had been
done seemed unavailing to produce the least perceptible
good.

Happily, about this time, the report of Dr. Eve fell into
my hands, and at once I was convinced of the importance
of using something more than constitutional remedies and
injections, and resorted to cauterization of the mouth and
canal of the womb with the solid nitrate of silver. And,
sir, I attribute to iU"vim carminis" almost daily, yea, hour-
ly, could I perceive a gradual restoration to health of both
body and mind, three weekly applications being sufficient
to effect a permanent cure."

If there had been any apparent signs of recovery at the
time of first applying the cautery, or if I had continued the
use of any constitutional medicines during the three weeks
of its application, there might have been left room for
doubt in my mind of according all the cure to the caustic.
But nothing else was done for her and she is now at work.

18G0.]

Diphtheritis. By. 0. A. Eai . M. D., Cleveland, Ohio.

The disease aow generally designated by this name
been brought forward as a new affection, and largely dis-
enssed during the last two years, especially in France, i
land, and America. It appears to have been frequently
confounded with croup, gangrenous and scarlatinous an-
gina, and other affections of the throat; even Breton*]
who principally initiated, in 1821, the recent consideration
of the disease, did not distinguish it clearly, giving it the
names diphtherite, croup, angme maliane gang . promis-

cuously. According to him, it is the same with the Egyp-
tian '//sane o[' the ( ireeks. Dr. Laird had previously in this
country recorded the particulars of an epidemic that occur-
red in New York, in 1771. lie described it under the
name of suffocalm angina. Other older names applied to
it are cynanche maligna, scarlatina anginosa (in America often
used up to the present day), morbus strangulatorius (Dr. Starr,
174.",), Fothergill sore throat, throat distemper, malignant sore
throat, malignant angina, membranous angina, etc.

Hippocrates seems to have been acquainted with it, and
a very good description is given by AretaBUS. Since then
there is no record pointing to diphtheritis until the days of
Cullen, llnxham, Fothergill, Starr, and others, in the se-
cond half of the last century; and although they described
it as a "new and separate disorder," it fell again into neg-
lect, until more recently the notices of Baird and Breton-
neau were followed by a very extensive epidemic appear-
ance of the disease, it spreading, Detween the years 1818-
'57, over France, since 1857 over England, and since 1845
over this continent.

Besides the general name, diphtheritis, dipldherite, diphthe-
ria (meaning an exudation in patches), a large number of
designations are found in the works of recent writers. It
is the angina diphtheritica maligna of Trousseau, angina couen-
neuse of Duche, Bouchut, and other French authors ; com-
monly called diphtheric, in French; the plastic pharyngitis of
Pory ; the membranous disease, commonly called membranous
croup, of Cotting; the hog -skin 'angina of Palmer ; diphtheric,
membranous, pseudo-membranous, putrid, malignant, and epi-
demic sore-throat, scarlatina, or epidemic angina, malig't
cynanche, of other American physicians. Some call it sim-
ply sore throat.

Diphtheritis proper is an eminently fatal, mostly epidemic,
but not unfrequently sporadic disease, of a very peculiar

836 Diphtheritis. [Xovember,

character, appearing with a great variety of symptoms, but
presenting, as general features, a marked prostration of the
nervous system, and the formation of a pseudo-membran-
ous exudation, which always commences with patches upon
a congested surface, and manifests a particular propensity
to attack the mucous membrane of the fauces, spreading
downwards and upwards ; it is, however, occasionally seen
upon other mucous membranes, and even upon the skin.
Children suffer particularly, but young persons and adults
are not exempted from attacks of the disease.

The symptoms, not only at different times and in differ-
ent locations, but during the same epidemic and in the
same place, are so variable that it is difficult to give a de-
scription of them of any general applicability. "In not
two cases," says one author, "there is a perfect resemblance,
either in the grouping of the symptoms, in their order of
succession, or in the degree of their individual symptoms."
Some cases commence with fever ; in others there is none,
or it only appears after some time ; there may be a dimin-'
ished secretion of urine, or not; aluminuria is often present,
bnt frequently wanting ; so it is with headache, difficult
respiration, diarrhoea. Some of the more constant symp-
toms are generally malaise, impaired deglutition, and a
weak, accelerated pulse. One fact seems to be pretty well
established : the statements of Trosseau and others show
that the disease since 1846 assumed a more violent and
malignant character, entirely different from what it was in
the time of Bretonneau.

The last named physician gave the following description :
The disease usually commences in one tonsil, seldom in
both ; slight fever ; white spots on the affected tonsil ; en-
larging of the cervical glands. Redness surrounds the con-
cretion, and it spreads rapidly to the velum palati, uvula,
the other tonsil, and the pharynx. The swelling of the
lymphatics either subsides or remains stationary. After
some hours or days a ringing cough, dry, or accompanied
by a frothy expectoration, announces the extension of the
disease to the respiratory organs. There are now irregular-
ly-shaped patches of redness, without swelling, coated with
a concrete exudation. One or more long, narrow, red
streaks extend to the pharynx or trachea; a stripe of con-
crete matter is seen on the centre of each of these streaks,
and small, semi-transparent vesicles often appear in the
substance of these incipient concretions. The edges of the

I860.] DipMhci

pellicle are gradually Lost in the surrounding mucus, which
is no longer viscid, bul coagulated near the concretion.
The latter can be easily detached; if is, however, in Buch
speedily reproduced, being now firmly adherent, often
Beveral Lines thick, and changing its color from a yellowish-
white to yellow, gray, and finally to black. The Bubjacent
surface is usually of a slightly red tint, more vivid at the
periphery of the patches, and sown all over with points of
a deeper red color, through which points the blood readily
transudes. Now the alteration of the organic surfaces be-
comes more manifest ; often concrete matter is deposited
into the very substance of the mucous membrane; there is a
slight erosion, and sometimes eehymoses, in points exposed
to friction, or from which the avulsions of the concretions
has been attempted. The corrupted exudations exhale an
infectious odor. If circumscribed, they appear depressed,
from the (edematous swelling of the surrounding cellular
tissue ; if they are, on the contrary, extended over consid-
erable surface, they become partially detached, and hang
down- in shreds more or less putrefied, simulating the last
stage of sphacelus.

Dr. David Wooster, of San Francisco, remarks on this
( Pacific Med. and Surg. Jonrv., May, 1859), that "no vesicles
have ever been observed in the forming concretion on this
continent; that here at the incipient state the false .mem-
brane adheres most tenaciously, and is not easily detached;
that the edges of it shade off so insensibly into the natural
aspect of the neighborhood as to render a rigorous defini-
tion of its limits impossible; that the centre of the patch is
whitish or grayish, and opaque, while its periphery becomes
more and more translucent; further, that the affected parts
never bleed, except when violence is used to tear or scrape
off the false membrane, and then the bleeding stops with
remarkable promptitude, and does not occur again, except
on the repetition of the violence." Wooster states, also,
that "our false membrane never becomes black; indeed, it
is paler after than before death/'

According to Dr. W. G\ Dyas {Chic. Med. Journ., Oct.,
1859, to March, 1860), there are at least four distinct forms
under which the disase may appear :

1. "It may destroy life in a few hours, by a violent and
deep impression on the nervous centres, attended by con-
gestion of the internal organs ; in this form we may not be
able to witness the pseudo- membranous exudation, suppos-

838 Dij [November,

ed to be pathognomic of it." There may be, corresponding

to occasional violent cases of scarlet fever, ua deadly pallor
of the surface, a dusky hue of the countenance, and |
tic'ularlv of the lips, a soft, irregular pulse, tongue m<
and livid, pupils dilated, drowsiness, urine limpid, often
suppressed; no complaint of local pain, and an air of indif-
ference when roused from stupor. In such cases death
will take place within four hours. This form of diphtheria
is rare."

2. Anotber form, scarcely less malignant, is more fre-
quently met with. "The subject of it, generally a child,
perhaps retires to rest apparently in its usual health. In
the middle of the night, or rather towards morning, it
awakes with a sense of du ; nausea, followed by

vomiting of a thin, whitish, glairy fluid. Then there is a
purging of something similar, but particularly offensive.
The child most probably does not complain of uneasii
in the throat ; he is drowsy, and seems disinclined to an-
swer questions. The face is palid, and the expression al-
tered. On examination, we are struck with a shining crim-
son appearance of the mucous membrane of the fan
From the velum a tenacious, thin sheet of translucent
mucus hangs like a curtain over the base of the tongue,
the papillae of which are tumified, its surfa.ee dry, clean
and red. The pulse is rapid, irregular and compressible.
The skin may be warm, though more generally it will be .
found cool. After a lapse of some hours reaction takes
place; and now there is a difficulty of deglutition. Drow-
iceeded by delirium; respiration is more ; -
quent. The neck is swollen, hard and tender, chiefly in
the parotid and submaxillary regions. The anterior half of
the tongue may be clean, but posteriorly it is coated with a
thick fur, which sometimes is continued to its tip. The
whole of the fauces is covered with a deposit like w
leather. One or both tonsils swelled : breath offensive; a
thin sani Lg from the nares. There may be epistaxia

and bleeding fro . ims. At first, the urine is limpid ;

but should the attack not terminate in death within twen-
ty-four hours, it becomes more colored, and there will I
deposit of lithates; at a later it is albuminous, and

contains the coloring matter of the blood; petechial spots
form on the surface, diarrhoea sets in, or if it has be< n per-
sistent from the beginning, the disci become altered
in appearance, being like what we occasionally see towards

18(50.] Dvphth

the close of dysenteric cases; serous, !ik<i the washing
flesh, ami accompanied by intolerable fa-tor. The Burface
grows cold, and either coma or a tetanic convulsion termin-
ates life, generally within tour days. Few cases of this
kind escape; and fortunately it is not the usual type of
diphtheria, even when malignant.,"

3. "The malignant form most familiar with practitioners
commences with a sense of Lassitude preceding a variable
amount of fever and slight soreness of the throat. The
pulse becomes rapid, small and compressible; thetongu
covered with a thick, yellowish, dirty-brown coat; the uvu-
la, velum, and the pharynx are at first of a dusky red ; de-
glutition is painful and difficult; the neck, about the parotid
and submaxillary regions, swells; from the nose distil-
acrid humor; the voice changes ; the breath grows fetid;
the breathing, from mechanical obstruction, is stertorous;
there is much thirts, and there may he vomiting. In some
hours the erysipelatous hue of the fauces is replaced by a
deposition as if, as Dr. Blount expressed it, a thin layer of
pie-pasre was spread over the parts, the edges being thick
and abrupt. The urine is scanty and albuminous; debility
increases, and the patient sinks exhausted, often retaining
to the last the intellect in its integrity. This is the most
frequent mode of accession, progress, and termination of
malignant diphtheria, and its duration is generally from
eight to ten weeks."

4. uThe next variety of the disease is what has been
termed coupal. In some epidemics, this has been the pre-
vailing type. It does not appear to be attended with the
same oppression of the system of those already described.
A sense of constriction in the larynx is an early symptom;
the accompanying fever is generally sthenic in character,
though some such cases have not presented, from beginning
to end, pyrexia. The false membrane rapidly extends to
the respiratory organs ; there is a hoarse, barking cough,
with occasional paroxysms of suffocation, and death takes
place by asphyxia."

5. "The 'form most frecpiently appearing in this country
is of a more gradual invasion, and commences with symp-
toms of catarrh; coryza, slight fever, with headache, and a
pain in one or both ears, usually usher in the attack. There
is some soreness of the throat without swelling either of
the fauces or the glands externally. The appetite is scarce-
ly lessoned. There may be diminished energy, but not so

840 Diphlheritis. [November,

much as to prevent the patient from attending to his usual
pursuits. The fauces, on examination, will present one or
more insulated patches of a grayish-white pseudo-mem-
brane, not so defined at the edges, nor bordered with the

same distinct redness as in the malignant variety, but more
shaded off. In this form, which lasts from five to ten d<A'<,
there may be some albuminuria ; and even after the n
prominent signs of the disease shall have passed away, al-
buminuria may for a variable length of time be persistent,
and accompanied by an anaemic state of the system."

Dr. John II. Ilollister, of Chicago, attributes [Chic
Med. Exam., March, I860,) the various modifications of the
disease to the different physical conditions of those suffer-
ing from it. The sthenic form, for instance, present sinflam-
tion of the most decided sthenic character, with remarka-
bly plastic effusion, resulting in the formation of firm and
thick false membrane. In one case, this pseudo-plasma
was found so perfectly developed as to give, after expulsion,
a perfect cast of the trachea and bronchial tubes to a great
extent. An asthenic case, on the contrary, may be marked
by nothing but a croupy cough, continuing, without any
other disturbance, for a number of days. The fauces will
he found affected by congestion of a passive character, the
tonsils much enlarged, and the whole of the mucous mem-
brane in the posterior part of the mouth of a dark livid
color. Slight secretion of mucus; labored respiration.
Soon the affected parts change in appearance, become cov-
ered with an abundant sanious discharge, asphyxia develops
itself, and- the patient sinks in a few days.

Prof. Alonzo Clark, in his lecture on diphtherite, before
the College of Physicians and Surgeon, of Xew York,
(lied, and Surg. Reporter,) divided "all the modes of i:
sion peculiar to this affection" under two heads : those in
which the constitutional symjrtoms are active from the b
ning, and those in which the disease makes its inva
very insidiously, and only becomes man;. the appear-

ance of a patch of exudation upon one or other of the ton-
sils or in the fauces. "In this latter class of cases, the
children do not complain of much ill-health; yet it is ap-
parent that they do not feel exactly well, and have, as a
rule, not much disposition to play;" they may, however, be
found in bed amusing themselves with their playthings.
Voice full, perhaps a little hoarse; some coughing; slight
glandular swelling on the outside of the teroat. A little

I860.] Diphtheritis. 841

patch of membranous exudation on the fo metimes

surrounded by a venous injection. Pulse qo1 very rapid,
perhaps LOO; countenance only a little paler than usual ;
rue not particularly covered with any coating, nor dry.
In such cases a few cold chills may form the firsl indication
of the disease ; the constitutional form commences almost
invariably with cold chills; there is high fever, and some-
times vomitting, on onsets

"The symptomsof membranous disease," says Dr. B. E.
Cotting, of Roxbury, (Boston Med. and Surg. Jour., Sept.
L859,) "are both constitutional and local. The consti-
tutional mav be so severe and SO rapidly developed as to
destroy life before the localhave become a source of danger,
or they may be so Blight as to be overlooked. The local,
also, may have the violence, though not the other character-
is of rapid inflammations, or their existence may even
be a matter of doubt, until made evident by obstruction,
caused by the membrane fully formed. It is a self-limited
disease, having its beginning, middle and ending, as marked
and uniform in p i, and as uncontrolled by any means

now known, as variola, measles, or any other disease that
can be cited. The formation of the membrane (as constant
a condition as the eruption in variola) does not always cor-
pond in amount to the severity of the other symptoms,
eral or local, in this also resembling the diseases allud-
ed to. The membrane may be only a thin film, or it may
have the thickness and toughness of moisted parchment ; it
may cover only a very limited space, or it may occupy the
Whole mucous surface of the organs attacked. It usually
forms gradually, being at first a very thin layer (not unlike
the first coat of white paint on a pine board) ; then this
layer becomes thicker and tougher, day by day, until it
readies its limit. Its progress, so far as it has any, is from
above downward ; and any deviation from this rule is rather
apparent than real. From the onset, however, it generally
covers all the surface that it ever will during the attack, in-
creasing only in intensity. Its thinness may prevent its
being early noticed on parts within sight, though clearly
visible at a later period of the disease. During its forma-
tive stage it remains firmly adherent to the mucous tissue
beneath it, so that it is impossible to remove it, even by the
: careful dissection. As soon as this stage is complet-
ed, usually in four or five days, the membrane begins to
loosen from its foundation, and soon becomes entirely

842 Diphtherifo. [November,

separated ; it then creates sufficient irritation and cough to
cause its expulsion. Sometimes it is cast off without ob-
servation, while at others its ejection is attended with con-
vulsive efforts of the greatest severity. If a portion is arti-
ficially removed, previous to this natural separation, anoth-
er forms in its place."

The false membrane exists in all cases of diptheria,
affirms Dr. Dyas (1. c), except in those extremely rare ones
within the system is at once overwhelmingly oppressed
the attack, and life is extinguished ere time is given for the
usual characteristic phenomena to be fully developed. It
appears very early, within eight-and-thirty hours from the
beginning of the disease, generally on one tonsil, or rather
in the sulcus between the anterior pillar and tonsil, like a
stain left by nitrite of silver on a mucous surface a pearl-
colored spot on a red ground. Sometimes it appears first
on the uvula or velum. It extends more or less rapidly
as often to cover the tonsils, uvula, velum, pharynx, pillars
of the fauces, and base of the tongue, with a continuous
layer, in from twenty-four to forty-eight hours. It may |
along the respiratory passages to the bronchial tubes, and
even down to the oesophagus according to some, as far as
the cardiac orifice ; it has been found following the nasal
ducts to the conjunctiva. The mucous membrane of the
cheeks and gums, the cutaneous surface, the vulva, and the
anus may be its seat. Hence the terms faucial, pharyng
pharyngo-laryngeal, or croupal, laryngo-tracheal, bu>
vulval, cutaneous, pharyngo-cutaneous, laryngo-cutaneous
diphtheritis. Several of these forms have happened in the
same family nearly at the same time, showing that the
tinction is immaterial.

Generally the thickness of the membrane increases with
its area ; this, however, varies from the thinest imaginable
pellicle to two or three lines. It may be firm, or a mere
diffluent pulp. Sometimes it is in distinct, dull Avhite
patches ; at others it is confluent. Occasionally it assumes
a light buff, yellowish, ash-colored, or even black apj
ance.

Diphtheritis may run its course, from beginning to end,
to recovery or death, without a single pyrectic symptom ;
when fever accompanies it, the type of it is not always
same, although the tendency is usually to the typhoid. In
this country "the attendant fever has been frequently of an
intermittent character, probably in consequence of prevail-

10.] Dtphtheritb. 848

mg malarious influences ; if so, the intermittent oughl to
tnsidered as a* complication, rather than a mortification
of tlio original di

Among other complications observed are
fever, small-pox, whooping-cough, gastric fever, gastro-
enteritis, menigitis, and the varl \ of the throat.

Dr. Daviot did not think pharyngeal diphtheritis eonl
gious; and Dr. Cotting also asserts to have seen no 4
donee that the disease in general is contagious. The evi-
dence so far collected, however, Leaves no room to doubt
the truth of the remark made in the London Lancet (April,
1859), that "contagion plays the principal part in the propa-
gation of diphtheria." Diphtheritic matter, ejected from
the mouth of a patient and Lodging in the nostrils of I
attending physician, has subjected the latter to severe diph-
.. spreading to the pharynx, and induc-
ing extreme prostration of the wl item. Quite a
number of similar cases are on record. A boy using a bath
in which a diphtheritic patient had been previously, con-
tracted the cutanious form of the disease. If the morbid
matter happens to come in contact with an abraded or a
wounded spot of the skin, the characteristic membrane,/
will arise from that spot, inducing also the usual constitu-
tional symptoms, and frequently the affection of the fauces,
ere are still some other phases of this singular disease
to be considered, liven it the patient has recovered from
the immedia -of the attack, and appears completely
convalescent, he may, in several weeks, sink and die with-
out any further well developed symptoms. Latent pn
monia is frequently discovered in the dead body. Amau-
mius, and presbyopia have been observed as
consequences of diphtheritis; hut one of its most common
Bequelse is paralysis, either partial or general. Two, th
we< ks, ^v a month after all traces of the original complaint
have disappeared, symptoms of anaemia manifest them-
selves, and slowly paralytic affections are developed. The
first is usually confined to the soft palate, ^>v tongue, char-
acterised by a difficulty of deglutition, and a nac eh :

but this may he wanting. If present, it gives way to i v

general nerv< to dilirium

and convulsi Inch must not b with the

same symptoms attending the more malignant forms of the

Lse). But these constitute rather an exception : inn
of the cases tending to paralysi ', a sense of numbness fol-

844 Diphtheritis. [November,

Lows, in one or both arms, the neck, or lower extremities.
There may be also vague pains in the back and elsewhere]
Now the strength fails gradually ; walking becomes more
more painful, until the uprig ion is impossible. The

upper extremities partake m this weakness, the head sink
the chest, etc. According to Trousseau, the same alt<
may be present as in purely nervous affections; the numl
changing from one hand to the other, or the paralysis attack-
ing the legs alternately. In all cases there is an evident an
fection of the spinal Bvstem. Numbness of the cheeks and
nose, or distortions of the face, defective articulation, strabis-
mus, paralysis of the bladder and rectum sometimes super-
vene. There is no fever, a small pulse, but often a tumultous
action of the heart, with ansemic murmurs. The intellect
remains intact, although the mental powers are depressed;
Dr. Faure, of Paris, adds that during this paralytic affection
sensation is diminished, and sometimes entirely lost, or re-
placed by formication. In some, sundry parts of the body
become oedematous, in others grangrenous ; others again are
subjected to repeated faintings. If this condition terminated
favorably, recovery is very slow, occupying from two to eight
months.

Dr. Cooper, of the San I'rancisco Med. Press, (Jan., I860,)
saw many of his patients die suddenly from pyaemia, after re-
covering sufficiently from attacks of diphtheritis to walk about.
In these cases the pulse never arose to its normal standard,
and the skin remained colder than natural.

The diagnosis of diphtheritis must be based principally
upon the patch-like aplastic exudation, accompanied by mark
ed prostration, and spreading, particularly downwards. Some
authors also mention a peculiar "muffled sound of respira-
tion;" with Dr. Cotting this is the principal diagnostic sign.
In his words, "It is very difficult to describe the sound. It
can only be learnet by attentive and frequent observations;
yet it is more reliable, and therefore more valuable than all
other diagnostic signs. Once in a while it can be detected
before any other indication of the disease is manifested say
in the first two or three hours." The absence of membrane
within sight is not always sufficient evidence that the disi
is not present. In such cases, the general condition of the
patient, the frequent and feeble pulse, and the gen
cvs must be our guides. It is then that the sound so much
relied on by Cot also prove a valuable symptom.

It cannot be difficult to distinguish diphtheritis and scarlet
fever, or putrid sore-throat, as there is no eruption , nor ulcer-

I860.]

(fcion and sloughing in our disease ; or at least the latter l>ut
arelv. More important is the diagnosis between diphtheritis
rod croup ; Bretonneau, Dnche, Guernsant, Baird, Barthez,
Etillet, Johnstone, and others defending their identity, and
imply designating croup as laryngeal or trachea) diphtneri
i>r declaring both to be the same di >nly affecting differ-

ent portions of the same mucous membrane. But diphtheritis ^
sentially an asthenic disease, affecting the whole system, /
thus producing a series of constitutional Bymptoms; it is epi- *
demic and contagious, while croup lacks all those attribui .
being only an inflammatory local affection. In croup there is
never the swelling of the lymphatics of the neck, which is a
constant attendant upon the diphtheritis, and the pseudo-
membrane itself sufficiently separates the two diseases : the
origin from patches, the aplastic nature and its spreading far
beyond the air-passages, which become affected merely by
luence, are found only in diphtheritis. Croup is, further,
almost exclusively confined to children, whereas diphtheritis
attacks indiscriminately children, adolescents, and adults.
Croup is never followed by paralysis, and kills only in one
way by suffocation ; diphtheritis may end in the same man- y^
ner, but it also induces death by asthenia, and months after
the disappearance of all exudation, by its effects on the ner-
vous system.

In regard to the prognosis, Dr. D. "Wooster thinks the mild
variety, or simple form of the disease (confined to the fauces),
is easily controlled; but the severe form (confined with constitu-
tional spmptoms and extensive exudation,) only with difficul-
ty, giving an extremely unfavorable prognosis even at the
beginning. The gravity of the prognosis in general may be
said to be in proportion to the suddenness of invasion, and the
signs of congestion. Good symptoms are : the false mem-
branes ceasing to extend, and detaching themselves in shreds;
; febrile symptoms; absence of stupor; an unaffected
pulse ; a soft and moderately warm surface ; expression not
altered ; unchanged color of face and lips; neck and papillae
of the tongue not swoolen ; no oedema of the fauces. In no
disease, however, amendment is more fallacious ; we can not,
either from a particular sign or assemblage of symptoms, cal-
culate with some approximation at certainty what the termin-
ation may be. The disease may have commenced without
i\ny indication of particular danger, may develope itself in an
apparently mild form ; and there may even be a manifest im-
provement in any symptom, the little sufferer perhaps sitting
up, smiling, eating, drinking, amusing himself; suddenly

846

croupy symptoms supervene, or re-appear to end only wit)
lite. The disease has extended from tne pharynx to the res
piratory passages, and death is the result of asphyxia. Thi
may also be produced without affection of the larynx, eithe
by the swollen condition of the lances, tonsils, and cervica
glands, in combination with abstraction of the nares and alter
ed innervation, or by a congested state of the lungs frequent
ly accompanying the malignant forms.
* Nausea and vomiting, or convulsions in the beginning o:
the disease, a rapid extension of the exudation to the poste
rior nares, a sense of constriction in the larynx, disagreea-
ble odor of the breath, a croupy sound of the respi ratio
great enlargement of the cervical glands, are among the
symptoms of fatal significance.

Life may be destroyed even after the whole membrane
has been thrown off. The excessive and unremitting ex-
ertions in breathing, caused by the obstruction offer
free respiration, as well as the intense constitutional distur-
bance, are apt to exhaust the vital power, without suffoca-
tion. Complications generally tend to produce an equally
fatal result. The superceding paralysis is frequently but'
not always removed by a proper treatment.

On the whole, the disease is, as Dr. TTooster says, one of
the most decidedly fatal ones. The chance for a favorable
recovery among children is about one in three, according to
Dr. Cotting; Dr. A. S. Clark thinks nine out of ten c
will recover, even with the malignant, from underan ap-
propriate treatment. Admitting the influence of the c
tive means employed, there is still a formidable mortality
unavoidably connected with the disease, though the num-
ber of deaths varies during different epidemics.

The post mortem examinations usually reveal a deep red
or livid appearance of the mucous membrane of the palate,
pharynx and adjacent part, more or less extensive. In n
cases the palate, tonsils, upper part of pharynx, epiglottis,
bronchial tubes, sometimes the internal surface of the oeso-
phagus, the pituary membrane, or some of these parts, per-
haps the trachea alone, are found invested with false mem-
branes. Seldom gangrene or ulceration is manifest. The
lungs may exhibit patches of hepatization or purulent infil-
tration ; and there may be more or less congestion else-
where. Occasionally, blood is seen extravasated inthemus-
cular tissue of the heart, and the kidneys often bear the
marks of disease. The viscera are frequently dotted over
with petechial spots.

I860.] 847

Dr. A. Jacobi, of NTew Fork, declares the diphtheril

membrane homogenous in structure to the pseuao-plasma
of croup; but tin to be a mistake. Tnegreal differ-

ance between them is, thai the diphtheritic exudation ap-
pears to be incapable of organization, and never tends to or-

c union with the subjacent tissues. Dr. Cotting de-
scribes it as of a peculiar structure : "a tissue of elastic fibres
[longitudinally arranged, the fibres smooth, and in no way
transversely striated. Great elasticity is one of its charac-
terise

Dr. Laycock found a parasitic fungus (oidium albicans)
in-tliis membrane, and supposed, therefore, that thedise

inated from the parasite; but its presence it thought to
be merely accidental.

The nature of diphtheritis is not entirely clear. It is now
y generally admitted to be a constitutional affection, of
an asthenic character, with prominent local manifestations,
principally in the throat, resulting in the exudation of an y^
inorganic pseudo-membrane. The disease is the result of a
distinct influence (diphtheritic miasm,) contaminating the
blood, infecting the whole system with morbid poison. The
conjecture of Dr. Dyas, who considers a morbid impression
on the par vagum as one of the principal features of diph-
theritis. needs confirmation.

In accordance with this view, the therapeutical indica-
tions are the elimination or neutralization ot the offensive
matter, whatever it may be, the correction and mitigation
of the local symptoms, and the support of the system,
where necessary. Consequently, a general or constitutional
and a local treatment is required, with strict dietetic meas-
ures.

Daviot, Meigs and others have practiced general and local
bleeding, not without success ; the general character of the
disease, however, during the last few years, and especially on
this continent, has been such as to forbid blood-letting in
any form; and it is at present looked upon as inadmissible.
The croupal form predominating at the time of Bretonneau,
seemed to offer an indication not now appearing. The same
may be said of mercury, in spite of the many advocates cal-
omel has found up to this day. Whenever the complaint
extended to the larynx and trachea, Bretonneau placed his
chief reliance on calomel, in three grain doses every hour,
combined with mercurial frictions over the neck, arms and
chest, repeated every three hours. The most extensive use

848 Diphthcr itia. [Xovember,

of it is made by Dr. I. Maranda, of New Carlilse, Ohio,
[Cine, Lane, and Obs., March, 1860.) To the strong, the ro-
bust, the plethoric patient, and in cases distinguished by
high arterial excitement, he prescribes it with jalap in full
purgative doses, follow inn; with the usual remedies against
high febrile action. To those of a feeble constitution, or
where marks of prostration are apparent, he gives calomel
in alterative doses, conjoined with opium and ipecacuanha,
or with camphorated Dover's powder, until there is an
evacuation ot green stools. When croupal symptoms
pervene, calomel in small but often repeated dose-- is Dr.
Meranda's remedy ; and in some chronic cases he maintains
to have observed the happiest effects follow a moderate sali-
vation. In a case detailed by Prof. Hollister, [Chi. Med,
Exam., Feb., I860,) powders of calomel and ipecacuanha
play also a prominent part. Daviot, however, who wrote
one of the best monographs on diphtheritis, looks on calo-
mel as useless in pharnxgeal, but particularly serviceable in
the cutaneous variety. Dr. Briggs, of Virginia, and Dr.
Anderson, of Xew York, admit it in small doses, two or
three grains, the last named in combination with prepared
chalk, in slight cases ; while Dr. G-. "W. Claiborne ( Vir
Med. Journ., Oct., 1859,) declares it to be a good remedy to
commence the treatment with and prepare the organism tor
a tonic course, where " a foul tongue and offensive breath
indicate disordered secretions of the primae vise." In the
opinion of Prof. Alonzo Clark, " the application of dry cal-
omel to the ulcerations of the throat is of decided benefit ;
but the administration of mercury, with a view of obtaining
its constitutional effects, is a doubtful expedient." A simi-
lar practice of Dr. Bigelow will be mentioned hereafter.
By far the most practitioners think rather unfavorable of
mercurials in diphtheritis ; and its inefficacy in many cases
has been clearly proven. Even as an evaeuant, the pro-
priety of administering it in diphtheritis is at best ques-
tionable.

The recommendation of cathartics is very limited, Dr. A.
S. Clark (Ohio Med. and Surg, Jovrn., May, I860,) being al-
most the only one who insists in their use. In mild cases he
orders a close of sulphate of magnesia, or some other saline
cathartic; but in cases of high fever, where 'an active ca-
thartic" is wanted, "that will stimulate the secretions, and
at the same time not depress the vital powers," calomel is
given, together with ipecacuanha, carbonate of ammonia,

18G0.] Diphtheritis. 849

and soda, followed, if necessary, with Rocheile salts, or any
pther saline cathartics. The drastic cathartics are univer-
sally objected to. Dr. S. M. Bigelow, of Paris, inhis excel-
lent letter on diphtheritis addressed to Prof. Warren Stone,
of Louisiana, (New Orleans Med. and Surg. Journ.y Jan.,

J.860,) mentions the citrate of magnesia, six or eight drahms,
to be given every two hours until it operates. Equal if not
better, is the advise of Dr. 1>. Wooster, of California, [Pa-
Med. and Surg. Journ., 1859,) and Wm. I,. Wells, of
Wisconsin, (Chic. Med. Exam., April, I860;) to select either
the mildest laxatives, or employ injections, so us to move
the bowels once a day.

"I protest," writes Dr. Bigelow, "in the most serious
manner, against the use of emetics in angine couenneuse,"
and they are certainly never plainly indicated. Neverthe-
less, they have been pronounced by some occasionally ser-
viceable at the period of invasion of the disease, especially in
young children, and when the false membrane extends to the
trachea; others, on a more rational basis, will not admit them,
except when their mechanical action might assist in detach-
ing the membrane. In either case, neither antimony nor ipe-
cacuanha should be used, on account of their depressing ef-
fects. (Wooster' s plan, to commence with ipecacuanaha in
full doses and repeat them for two or three days, seems not to
have been followed anywhere.) Drs. Meigs and Pollard used
alum as an emetic, a teaspoonful mixed with molasses, repeat-
ing that dose in the course of ten or twenty minutes, if requir-
ed. But the turpeth mineral (sulphate of mercury,) first rec-
ommended by Dr. Hubbard, of Maine, is now acknowledged
as the best emetic in diphtheritis. It never induces catharsis,
and is not followed by prostration, while it operates promptly
and certainly. Two or three grains may be given to a child
of two years every ten or fifteen minutes, until vomiting takes
place. Both alum and turpeth mineral are well suited to pa-
tients above one year; for smaller children perhaps some pre-
paration of squill would be preferable (Dr. Dyas.)

The most prominent amongst the remedies employed as di-
rectly counteracting the morbid influence is the hlorate of
potash, alone or combined with hydrochloric acid, iron and
ether. Dr. Bigelow administers every three hours ten grains
of the chlorate and ten grains of the bichlorate, in some conven-
ient vehicle, giving at the same time one-tenth of a grain of
calomel with sugar, to be put dry upon the tongue, once in
one or two hours or less frequent, sometimes omitting the cal-
omel altogether for a while, according to circumstances.
54

850 DvphiherUis. [November,

Chlorate of potash with hydrochloric acid has been recom-
mended by Dr. Kingsford (Zancet, Jan., 1859;) Dr. I. Merao*

da prescribes two drachms of the chlorate with one fluid
drachm of hydrochloric acid in eight fluid ounces of water,
half an ounce to be taken every three hours. This formula
was originally given by Dr. Lambden (Zancet, Nov. 1S58 ;) it
contains free chlorine in solution. The chlorate and quinine
in full doses constitute the treatment of Dr. Barker, New York.
Dr. Jacobi gives from a half to one drachm per day to a child
from six months to four years old, three drachms to those above
that age, continuing for weeks and even months. He usually
adds iron, the muriatic tincture in preference. Finding in se-
vere cases the chlorate to operate too slowly alone, he also
combines it or precedes it with a few large doses of quinine.
The best form, in his judgement, is the solution in water with
the addition of some acid, generally the muriatic. Dr. A. S.
Clark approves of the free nse of chlorate of potash and ses-
quichloride of iron in tincture, diluted with nitrous etlier, but
he prefers the following formula; chlorate of potash, one
ounce ; syrup of lemons, water, of each, four ounces ; sulphate
of morphine, two grains. Take a tablespoonful every four or
live hours.

In Wisconsin, the tincture of the sesquichloride of iron, the
hydrochloric acid and the chlorate of potash were given to-
gether in a convenient vehicle, or alternately in full doses.
Sometimes the tincture of iron cannot be borne for many days ;
then the sulphate of quinine with citrate of iron ought to be
substituted (Dr. Wm. L. Wells.) The "Lancet Commission"
placed the most reliance in a mixture of sesquichloride of iron
with chlorate of potash, chloric ether and hydrochloric acid,
sweetened with syrup. The chlrorate may also be given after
the method of Dr. Gardner, of New York, in a syrup saturated
with it, a teaspoonful in four hours, alternately with three
drops of perchloride of iron in syrup. Nothing else is required
in cases without local affection.

But notwithstanding this general adoption of the chlorate of
potash, some doubts in regard to its efficacy have been express-
ed, especially by American practitioners. Prof. Alonzo Clark
says it is not, as claimed, a specific in this disease, but still of
some benefit, and should therefore form a part of our treat-
ment. In the able article of Dr. Dyas occurs the following
passage : " It is very much a matter of conjecture how chlo-
rate of potash acts on the human organism, and in the whole it
is doubtful if it possesses a great deal of therapeutic value in
diphtheria. It may be prescribed in combination with some

18G0.] Diphtherias,

bitter infusion (cascarilla, gentian, or bark,) in doses from ten
to thirty grains, according to age." Most Bummarily I)--.
Wooster disposes of it; he believes the chlorate of potash
harmless, but unproved efficacy, simply mitigating the ftetor
of expiration.

The declining reputation of this remedy is apparently to be
transferred to the muriate and sesquichloride of iron, hereto-
fore only employed as adjuvants and tonics. In the latter
quality, Dyas speaks of Thompson's bitter wine of iron, con-
taining one grain of Wetherell's precipitated extract of bark
and two grains of citrate of iron in a teaspoonful of cherry
wine; but some prefer the tincture of the sesquichloride of
iron, "ten or fifteen drops every third or fourth hour." Dr.
F. [snard warmly recommends (Gas. des Hop., Amer. Ned.
Monthly ', March, I860,) the perchloride of iron as specific
against croup and diphtheritis. It should be administered as
soon as possible, in large doses, and continued at all stages of
the disease. Dr. Th. lleckstall Smith, (Braithw elite's Jxetro-
tpect, Jan., I860,) while relying chiefly on gallic acid, found
the sesquichloride of iron tincture far superior to anything ;
and Dr. W. II. Ranking (Banking's Abstract, No. 29,) con-
firms the value of this tincture as an internal remedy in diph-
theritis. If so, the treatment of this disease would be materi-
ally simplified ; in most of the present methods too many rem-
edies are administered promiscuously.

In a monograph on scarlatina and diphtheria, (London,
1S59,) which he considers as one and the same thing, Dr.
George Hull praises the sesqui-carbonate of ammonia as a spe-
cific, in doses from two to ten grains, every two, three or four
hours. Baron treated before him (Gaz. de Paris, 5, 1856)
diphtheritis with Vichy water and bicarbonate of soda.

A composition called "ferruginated cod-liver oil," has been
proposed by Dr. D. Wooster, two fluid drachms with one of
brandy, to be taken four or five times a day, or oftener, if the
stomach will bear it.

To meet the second indication a large number of topical ap-
plications have been employed, without due consideration of
the question how far, if ever, it was practicable or necessary
to remove the false membrane. Dr. Biglow always removes,
with a long forceps, or by scraping, or by any other means,
violent or gentle, all accessible portions of it. Dr. (Dotting, on
the other hand, found that harsh attempts by emetics, pro-
bangs and the like, to dislodge the membrane before its natu-
ral separation, are often accompanied by fearful risks ; and
could it be effected, it would involve a re-formation, more to

852 Diphtlieritis. [Xovember,

l)c dreaded in the exhausted state of the patient than its first
appearing. Dr. Wells also removes the membrane with the
forceps, where it can be done, which is rarely the case.

Nitrate of silver in the solid stick, where practicable, or
more commonly in strong solution, has been applied most ex-
tensively to the throat. Many are of the opinion that it could
not be superceded by any other local application : such an as-
sertion, however, will not hold good everywhere. The appli-
cation in substance is stated to have had occasionally the most
serious consequences. Twenty, thirty, forty, sixty grains to an
ounce of water have been employed, in the beginning as well
as in the most advanced stages of the disease. Prof. Alonzo
Clark and Dr. Jacobi, considering the application of the caus-
tic to the membrane itself of no special service, only applied it
to the parts immediately around the exudation, so as to prevent
the inflammation from spreading, and limit thus the further
extention of the membrane.

Bretonneau principally depended on the energetic applica-
tion of concentrated muriatic acid. It has been employed by
others, diluted or not, in very young children mixed with an.
equal quantity of honey. Equal parts of hydrochloric acid
and tincture of myrrh, says Dr. Beardsley, detached the pseu-
do-membrane most readily, and diminished the liability of its
being renewed.

A strong solution of sulphate of copper (one drachm to one
ounce of water) may also be applied topically. Used in the
same manner, some preparations of iron have been found
equally useful. The concentrated solution of the perchloride,
or Monsell's salt in powder, or the tincture of the sesquichlo-
ride, are declared by Wooster, Wells, Beardsley, Dyas, A. S.
Clark and others, to be the most efficacious and valuable of all
topical applications.

Dr. J. J. Morgan expresses a great predilection for a satur-
ated solution of acetate of lead (adding one grain of morphine
to the ounce,) as a gargle to be applied with a sponge, two or
three times in twenty -four hours. At least he commences with
it in every instance, and if the disease advances in spite of it,
he substitutes the lunar caustic in solution.

Tannin has not been tried sufficiently. Dr. Ileighway, of
Cincinnati, dissolved two drachms of it in one pint of glycer-
ine, and applied that solution by means of a probang, with
good effect. Tannin may also be used alone.

Particularly destructive to the exudation is sulphurous acid
(Dr. Ileighway, Prof. Comegys ;) it is best used in the form of
a salt, as the liypophosphide of soda.

1800.] DiphtheriUs.

Dulmonl found(#e, dee //<>/>., 17, 1856,) nitrate of silver
and muriatic acid insufficient, but Lemon juice, painted over,
a good application ; Bomotte added a little alum. Tincture
of iodine has been tried about the same time, without giving
satisfaction. Upon experiments made by nim, Ozanam based
in the same year, the conclusion that all pseudo-membranous
productions are best destroyed by the alkalies and muriatic
acid, and soonest removed by bromine and bromide of potash.
Thereupon ho recommended that bromide or a bromine-water
against diphtheritis, croup and similar affections; but his pro-
position seems to have met with no favor.

An idea of Dr. A. S. Clark deserves a trial; lie thinks gly-
cerine may be employed, in advanced states, between the
cauhtic applications, for its lubricating as well as for its solvent
powers.

Stong nitric acid, applied by means of a brush, is the rem-
edy of Prof. Comegys, when there are deep and extensive ul-
cerations.

Baudelocque used a decoction of bark with chloride of soda
as a gargle : Wooster also mentions the solution of chloride of
sodium, and Dr. Wells asserts that gargles with chloride of so-
da and chlorate of potash act undoubtedly as a solvent of the
membrane.

Dr. Roche ( Union Medicate, No. 88 ; N. Amer. Med-Ghir.
Ji< v. Nov. 1859,) was very successful with injections contain-
ing chloride of sodium, lie practices an almost continuous ir-
rigation of the throat, by means of Equisiers irrigator, consid-
ering the irrigation the principal curative agent, and therefore
employing indifferently solutions containing salt, alum or the
chlorates.

In mild cases alum gargles as the only local applica-
tion have proved sufficient. Gargles with alum and red-oak
bark are proposed for severe cases ; but tannin and alum seem
to be useless, at least in Dr. Well's experience. Bauldelocque
applied powdered alum to the nostrils by means of a souffloir;
Davoit thought it useful only in the early stage of the affec-
tion.

A method mentioned by Dr. Perron (Z' Union, 53, 1856,)
has been revived and modified by Dr. Bigelow. Perron blew
alum and sulphate of zinc into the mouth" several times a day,
using afterwards gargles with alum. Bigelow commences his
treatment with an insufflation of one drachm of powdered
burnt alum, and repeats that operation as long as a tendency
to a formation of the false membrane continues, alternating
in the latter time with tannin.

854 Diphlheritis. [Xovember,

"When, after a few days, the fauces become so exceedingly
sensitive as to give great pain, Dr. G. W. Claiborne ( Virginia
Med. Jour., Oct., 1859,) used with good success a wash of bo-
rax, honey and myrrh.

Dr. L. S. Bristom prefers locally in all cases the employ-
ment of mild detergent gargles (B raithwaiU? 8 Retrospect, Jan.,
1800.)

A gentle stimulant, in the form of a mild lotion, say eight
grains of iodide of zinc to an ounce of water, is, in the opin-
ion of Dr. W. Judkins, of Cincinnati, all the tropical treat-
ment required.

Dr. S. A. Cartwright employs a local application of his own
invention, and expresses himself well satisfied with it (TV. 0.
Med. and Sur. Jour., Nov. 1859.) He infuses for several
days in one pint of dilluted alcohol , finely powdered hydras-
tic root and the powdered bark of the rcot of the myrica ceri-
fera, of each one ounce; three ounces of gum myrrh, and
two drachms of copscicum. "A piece of wool or cotton (this
better), fastened to a probang, saturated in the above tincture,
is the best thing I have ever found to swab the throat with."

Where the running from the nose is very excessive and of-
fensive, a solution of chlorate of potash or better of chlorate
of soda (Dr. Jacobi,) or Labarraque's solution (Dr. Thomas, of
New York,) may be injected through the nostrils.

Fumigating the throat with boiling water and vinegar pour-
ed on catnip, and Labarraque's solution of chloride of soda
added, is a method practiced by Dr. Gordon Buck, of New
York. In two cases treated by Dr. Bibbins, of the same loca-
tion, inhaling the vapor of warm water seemed to benefit the
patient the most. Prof. Comegys testifies to the beneficial
effect of inhalations of one ounce of sulphuric ether with two
drachms of tannic acid, a cloth being wetted with the solution
and placed into the mouth.

The opinions of the profession, decided on nearly everything
connected with diphtheritis, are most decidedly opposed to
each other in reference to external applications. Davoit, for
instance, admits rubifacients ; Wooster exhorts us never to use
liniments or mustard, because they increase the anguish of the
patient and do not mitigate the affection. Baudelocque ap-
plied blisters to the thigh; Daviot objects to blisters in gene-
ral as having the serious inconvenience of adding cutaneous
to pharyngeal diphtheritis, and Meranka, who has but little
confidence in external applications to the throat, informs us
that blisters are especially hurtful. Dr. Beardsley experiene
ed no satisfactory results from external revulsives, and Dr.

I860.] Diphthei 855

White, of Cincinnati, declares all external applications in the
form of liniments, tincture of iodine, poultices, etc., of no
benefit. According to Wooster's directions, in the first stage,
While the engorgement is red and hot, cold wel compri

ould bo applied to the neck; farther along, when the en-
gorgement of the throat l>< comes oedomatous, warm fomenta-
tions. Dr. (J. Hull orders the outside of the neck and throat
to l>e well rubbed with a Btrong embrocatian <>f ammonia,
camphor and opium. A more extensive course is followed by
Dr. A. S. Clark, who carries the thing almost too tar: he ad-
vocates sinapism to the Legs, feet, hands and arms, external
stimulants to the neck, and as the disease advances, fomenta-
tions of hops, poultices, etc.

Instead of all these annoying and troublesome appliances,
pr. S. M. Bigelow puts his patients from the beginning into a
tepid bath of one <>r two hours' duration, and has that repeat-
ed every two or three days.

There is another feature in the rational treatment of diph-
theritis which claims particular attention. The system is to
be supported by a free, energetic and persistent tonic or sus-
taining constitutional treatment, besides the exbibition of gen-
eral and local remedies as already specified. All authors
agree, that a vigorous course, with tonics and stimulants, is an
imperative requirement. Therefore the most generous diet : ^
strong beef-tea, mutton-broth, chicken soup, eggs, wine, bran- V
By, and " whatever other form of nutriment the ingenuity of
the surgeon, or the fancy of the patient may suggest" (Lancet
Commission.) " We urged," relates Dr. Wells, "and in some
cise} forced patents to take nourishment, notwithstanding the
loss of appetite, amounting in some instances to a disgust for
food." Where a sufficient amount of nourishment can not be
applied by injections.

Among the remedies proper, turpentine, camphor, carbo-
nate of ammonia, Peruvian bark, but especially the tinctures
of iron and quinine, in doses adapted to the age and condition
of the patient, are usually selected. Quinine, with a mineral
acid and a little lemon syrup, (Dr. Claiborne,) is a very desi-
rable preparation. Sometimes, however, there seems to be
some contraindication to the exhibition of quinine. w% When
the tongue is foul and the stomach irritable, it is better to
withhold or suspend it. Loss of appetite, soft compressible
pulse, tremulous tongue, languor and subdued expression are
indications for its exhibition" (Dr. Dyas.) A most compre-
hensive and impressive description of this part of the treat-
ment is furnished by Dr. Bigelow. He says :

856 Diphtheritis. [Xovember,

" I commence immediately with the use of tonics, stimu-
lants, and the most nourishing possible fluid, animal food.
Quinine every three hours in as large doses as can be borne:
bitters composed of chinchona, columbo, chamomile, quassia,
bitter orange peel, etc., formed into a strong infusion, to which
I add brandy and a little syrup :

"]$ Cortex cinchonas flavse cont.,

Radix gentianae cont., aa 5 ij.

Radix columbse cpnt., ss.

Cortex aurantii,

Flores anthemidis,

Quassia amara, aa 5 ij.

Aqua bulliens, O. ij. M., flat infusum ;
Adde: Spiritus vini Galliei, 5 vj.

Syrupus aurantii corticis, 5 iv.

"D. S. To an adult, one-half to two-thirds of an ounce
five or six times in twenty-four hours.

" Strong bouillon of beef, mutton and chicken cooked to-
gether, with tapioca or vermicelli as a change, a teacupful
every three or four hours, occasionally with a boiled egg. Ale,
porter, sherry, brandy and water in such quantities as may be
borne. During recovery I add to our already nourishing fluid
diet solids, such as beef-steaks, roast-beef, mutton chops, poul-
try, game, vegetables, etc. Throughout the whole course of
the disease I give an abundance of such fruits as peaches,
grapes, apricots, cherries, currants, raspberries, strawberries.
Lemonade and morsels of ice as beverage, or soda-water and
syrup of raspberries, currants, and gooseberries."

A constant supply of fresh air must not be overlooked, nor
that all-important care, with the whole train of minor services,
usually included in the phrase " good nursing."

A few peculiar methods of treatment remain to be noticed.

During the epidemic in Augusta, in 18-8, Dr. Campbell,
observing that the accompanying fever was paroxysmal in
character, adopted an anti-periodic medication, which proved
more successful than the method previously employed.

Dr. C. Swaby Smith, of Burbage, {Braithw. Metros. , Jan.,
I860,) commences with the application of a strong solution of
chlorinated soda to the fauces, and a sinapism to the throat .
A gargle, containing two ounces of a solution of chlorinated
soda, two drachms of the tincture of myrrh, and six ounces
of water, is to be used every half hour. Where the children
are too young to gargle, the throat may be frequently washe-
ed with the same mixture,by means of a piece of sponge. Inter-

J8G0.] Diphtheriti3. 857

nail v : chlorate of potash, two drachms ; dilate nitric acid, two
drachms ; Battery's solution of cinchona, one drachm ; water,
six ounces. About the sixth pari (varying according to the

patient's aire') to be taken every two hours. It* there is much
pain in the limbs, a few minions of the tincture of colchicum
are added, which addition has proved highly advantageous.
The diet to consist of strong beei-tea, port-wine, and all the
nourishment the patient can take.

Dr. G. Bottomtey, of Croydon, describes {Braithw. Iletros.,
Jan.,) his plan for children as follows :

I{' Solutionis chlorini,

Syrupi simplicis, aa 5 ss.
Aqine distillate, q. s. ad. 5 vj.
M., fiat gargarisma saepe utendum.
]$ Solutionis chlorinii, gtt. iv.
Syrupi aurantis, Sj-
Aquae distillatse, q. s. ad. g ss.
M., fiat haustns, secunda quaque hora sumendus.
The dose is increased according to age. Calomel in one
grain doses and more. Diet: concentrated jellies, strong
beef-tea, wine, etc.

Dr. J. C. S. Jennings, of Malinesburg, (Braithw., Jan.,) has
adopted a rather rough treatment, and institutes it invariably
in all cases, regardless of sex, age, or incubation of disease.
First, an active emetic of antimonial wine, from half an ounce
to an ounce, according to age ; then free cauterization of the
throat with solid nitrate of silver ; mustard-poultice from ear
to ear ; the feet and legs plunged into a hot bath, and the pa-
tient confined to bed. After the operation of the emetic, a
cathartic of calomel and compound extract of colocynth ; four
hours afterwards this mixture :

1$ Quinise disulph., 5 ss.
Potassoe chloratis, 5 j.
Acidi hydrochlorici diluti, 5 ss. .
Aquas, 5 viij.
M., fiat mistura, cujus sumatur pars sexta quartaquaque
hora.

At the same time a gargle of chlorine solution is directed
to be prepared frequently, by saturating water with the proto-
oxide of chlorine, generated from two parts ot chlorate of
potass, one of hydrochloric acid, and one of water. The fauces
are to he sponged out with this quite frequently.

Greatly at variance with all others is the method detailed by
Dr. B. E. Cotting {Boston Med, and Surg. Jour.) While

858 Diphthcritis. [November,

disapproving bleeding, leeches, capping, blisters, sinapisms,
mercurial and drastic purgatives, emetics, cauterizations, he
restricts the therapeutical applications to almost nothing.
" Mild and nutritious diet, including, if possible, such articles
as the patient willingly accepts, is to be preferred to absti-
nence, certainly to a stimulating course. The inhalation of
watery vapor, by an inhaler or other practicable expedient, is
often, not al ways, very agreeable ; and if it is not very effec-
tive, it is at least without objection. A warm fomentation, or-
better still, a warm emollient poultice, covering the whole an-
terior half of the neck, is probably of service. But above all,
anodynes, sufficient to subdue restlessness and ensure quietude
are the most important agents. The particular form is of lit-
tle consequence. Dover's powder, or an equivalent contain-
ing the strength of a grain of opium and a grain of ipecac to
the ounce, is a very convenient form, The ipecac, however,
is not important. Mucilaginous drinks are generally accepta-
ble." From his own statements, it appears that Dr. Cotting
was not very happy with this lenient treatment, as old as the
history of medicine thought it to be.

Stronger still, but far more successful, appears a plan which
Pj-of. E. S. Cooper adopted (Boston Med. and Surg. Jour., Jan.
4, 18G0 : Pacific Med. Jour., Jan.,) after despairing almost of
achieving anything against the fatal disease. With his treat-
ment he lost only one patient out of thirty-one ; and this enti-
tles his proposition to a consideration it could otherwise hardly
claim, with all its originality. No applications to the throat
are used by him An embrocation of chloroform [three oun-
ces,] cod-liver oil [twelve ounces,] and spirits of turpentine
[two ounces,] is applied freely all over the neck, breast and
abdomen, upon flannels covered with oil-silk. For internal
use he gives this mixture : Ext. glycyrrh., three ounces; aca-
cia gum, one ounce ; antim. tart., one grain ; sacch. alb. two
ounces ; aqua, eighteen ounces, Give a wineglassful every
two hours to a young child, say two years old, and increase in
proportion to age. During this treatment, not a particle of
anything else is allowed, not a drop of water, nor the least
nourishment, save what is in the medicine.

Whatever method may be followed, if seems to be essential
to continue both general and local treatment for some days
after the disappearance of all morbid symptoms.

Experiments with tracheotomy in diphtlieritis have not been
wanting. On this continent it has been strongly objected to,
and is stated to have never been successful. With Breton-
neau it was the last resource; he operated three times, saving

I860.] Whooping-Cough, 859

one patient. In France the operation has been defended and
performed up to the present time. Dr. Bigelow follows Trous-
seau in recommending it, adding thai it must be done earlier
than in croup, before the vital powers are too low. A method
beculiar to Dr. Biglow is the insufflation of alum into the
pharynx, and a- tar as managable Into the larynx, through the
tracheal tubes, immediately after the operation, and repeated
according to circumstances.

In conclusion, the sequalffl of diphtheritis ought to come in ^
for their share of the treatment; hut the reports are in this v^^
regard almost too meagre. Dr. Bigelow merely alludes to
iron tonies, a generous diet, cold affusions, warm clothing, and
exercise in open air, for the cure of the subsequent paralysis.
In slight cases, sulphate of zinc and quinia have provedsuffi-
cient. According to Dyas, the blood must be supplied with
ormal proportion of hsematosin ; and this is to be effected
through the agency of preparations of iron, witli a generous
and supporting diet. Sulphur baths, electricity, preparations
of zinc and valerian, are occasionally valuable auxiliaries.
The same treatment will be required for starbismns, presoyo-
pia, and other ailments sometimes following piphtheritis. Dr.
Meranda's cure of the first named, by spigelia and caloniQl
(given in consequence of an imagined connexion with worms,)
was evidently an accidental occurrence. Jackson's compound
syrup of phosphates has been recommended, and Churchill's
preparations of the hypophosphites may be still better ; but
the remedy principally to be relied on, as well for the general
and local treatment of diphtheritis itself as for all affections
following it, is undoubtedly iron.

Whooping Couqh. We notice in the Semi-Monthly
News, that Dr. Harvey A. Hall states he has seen marked
and speedy benefit in whooping-cough from the application
of one or more blisters, from the size of a crown-piece and
upwards, according to the age of the child, to tne back of
the neck, as high up as possible, and even encroaching a
little upon the scalp. In four or five hours the blister
ought to be replaced by a warm linseed-meal poultice.
Under this treatment the convulsive character of the cough
is broken within twenty-four hours. In bad cases a second
blister must be applied, when the second one is healed up.
Mr. Hall says he has treated a considerable number of cases
on this plan, and in only one instance has the blister failed

860 Whooping- Cough. * [November,

to produce a decided benefit; but in this case, after a sec-
ond blister Lad been applied, the mother reported at her
next visit that the child had been better ever since. His
constitutional treatment is simple.

Penins. and Indep. Med. Jour.

When whooping-cough has resisted the agents most ordi-
narily used, the following syrup, which is the formula given
by Delahaoe, slightly modified, will be used with full suc-
cess :

Take eight ounces of Mocea or Martinique coffee, slighly
browned, in powder ; treat by displacement with boiling
water, so as to obtain sixteen ounces of infuson. Dissolve
in this liquid alchoholic extract of belladonna, alchoholic
extract of ipecac, of each one and one-fourth of a drachm ;
alcoholic extract of cinchona, thirty-six grains ; sugar six-
teen ounces. Digest on a water-bath and filter.

Dose ; For children of three or four years a table-spoon-
ful three times a day ; under the age, the dose should be
reduced one-half.

" We have experimented very often with this syrup,"
says Dr. Courbassier, ' in localities where hooping-cough
appears each year with an epidemic character, and it has
rarely foiled us." Revue $ Therap.

Dr. C. M. Mueller, of Berlin, in 1857, advised (Journal
d, Kinderkrankh, Nov., Dec.) small doses of morphia in
the treatment of whooping-cough, explaining that affection
as " pre-eminently a peculiar nervous affection connected
with bronchitis." He considered, consequently, the work
done as sood as the spasmodic cough was changed into a
common catarrhal cough. 1 o corroborate these views, Dr.
Edward Smith, of London, wras quoted, and he had indeed
obtained very favorable results with the same remedy.
Mueller commenced, in very young children, w7iththe sixti-
eth part of a grain, increasing to one-fortieth, or even one
thirty-sixth of a grain, until a slight degree of narcotism
or drowsiness appeared. The same dose wras then given
until the whoop had quite ceased.

Dr. Whitehead (Banking's Abstract, July, 1869,) also
opposed the notion that whooping-cough was uncontrolla-
ble by remedies ; but he found belladonna the most effec-
tual agent against it, although opium was not entirely neg-
lected. In simple cases, or when the complicated ones had
been reduced to this condition, Dover's powder alone, or
with camphor, camphor inhalation, emetics, belladonna and

I860.] Whoo^ing-Cough. 861

local irritanta were employed ; sometimes tincture of opium
in place of Don-it's powder; always either opium or bella-
donna was relied od as the principal remedy. 68 cases
treated by the opium method, yielded in the average in 28
davs, while 67 others were subdued by belladonna in about
2- davs each, giving a decided preference to the latter.

The treatment by small doses o\' morphia, seems to be a
still better and tin4 most effectual plan.

In a report to the Buflstlo Medical Assocsation last Au-
gust, (\ew York Monthly Review, and Buffalo Medical
Journal, Oct., 1859,) Dr. Oronyn speaks highly of a formula
containing cantha ri des.

Take : Tinct. cinchonse, four ounces.
Tinct. canthar., three drachms.
Tinct. camph. comp., half an once.

Mix. Three times a day a tea-spoonful to be given in a
table-spoonful of flax-seed infusion.

In about sixty cases thus treated, the " seven paroxysms
t)f cough disappeared in ten days." Dr. Haynes had be-
fore maintained, in the London Lancet, that whooping-
cough was as certainly cured with cantharides as chlorosis
with iron. From this resulted the so-called " abortive
treatment of Dr. Haynes." The strangury is supposed to
be necessary to the cure.

Dr. 0. C. Gibbs, in noticing the method of Dr. Cronyn,
(Amer. Med. Monthly, Dec. 1859,) is inclined to ascribe
the curative influence to the cinchona, having himself suc-
cessfully treated " the worst ease we ever saw occurring in
an anaemic patient, and complicated with pneumonia and
a congenital heart affection," with full doses of quinine and
belladonna. He also had, for six years, the best satisfac-
tion from belladonna, in cases of whooping-cough, as recom-
mended by Dr. Jackson, (Amer. Jour, of Med. Sciences,
August, 1834,) and Dr. H. Corson, (ibid, Oct., 1852.)

The powdered root of belladonna, one-sixth of a grain
twice a day, with sugar, and with intercurrent emeti3s, has
been relied on by Trosseau (Jour, des Connais. Med-Chir.,
January, 1850.) Xo cure, however, could be effected in
less than three months. Others have employed compouud
powders containing the extract of belladonna, tannin, ben-
zoic acid and rhubarb.

Dr. Stegmann, in Wernigerode (Horn's Archiv, July,
Aug., 1835,) and Froriep (Tagesberichte, Macrz, 1850,) pro-

862 Incontinence of Uri [Xovember,

posed the carbonate of iron in the same doses as exhibited
against chlorosis. Watson in Glasgow, and Jobert in Chi-
non, expressed, about 1850, their preferences for the local
a j (plication of nitrate of silver, in the same way as used in
other affections of the larynx. Hydrocyanic acid has also
been recommended and will be found sometimes very ser-
viceable.

Dr. Loewenthal, of Berlin, named a rather singular reme-
dy, (Medical Counsellor, January, 1846,) which, however,
deserves attention on account of the real good following its
use : this is sweet whey in doses of half a table-spoonful
and more, several times a day. Previous to exhibiting any
of the last named agents, the affected parts ought to be
freed from mucus and other impurities by appropriate emet-
ics. Cleveland Medical Gazette.

incontinence of Urine. Against the nocturnal inconti-
nence, Debout (Bull, tie Tlier.) confidently recommends, 32
grammes of mastich in tears, made with a sufficient quan-
tity of simple syrup into 64 or, if the child swallows with
difficulty, into 123 pills of boluses ; or an electuary may be
prepaed by substituting honey for the syrup, and this can-
be given wrapped in a wafer. Children over ten years old
should take at least four grammes of the mastich morning1
and evening, so as to consume the whole quantity in four
days ; younger patients may be allowed six or eight days
for the same amount of medicine. If there is no improve-
ment after this, the whole course ought to be immediately
repeated; but it is useless to pursue the medication bevond
that

With this treatment, the successful trials are said to form
the exception, generally a cure being effected even with pa-
tients eighteen and twenty-four years old, and who had been
afflicted with this disguisting infirmity from their infancy
The following powder is extensively emploped by the phy-
sicians of Lyons, against nocturnal incontinence in chil-
dren :

Take : Carbonate of iron, fifteen centigr.

Extract of belladons, three "

Xux vomica, powdered, three "

This dose to be taken every day. Dr. Faure says a com-
plete cure generally follows at the end of eight or ten days.

Before the Medical Society of Toulouse, X. Mittet, of
Eours, indicated as a remedy more efficacious than any

18G0.] Sun Stroke.

pther, for the incontinence of urine in young people, an
electuary compounded by M. I l-oimand, a dispensing chem-
ist at G-oitiers, for the treatment of chlorosis, chlor-ansemia
ami leucorrhoea:

R. Pul. cinnam., eleven oun<
Ferri. limat., thirty-two oun
Becal. corn., four and a half ounc
Mellis. thirty-two 6un<

Mix; sixteen grains to be taken each morning and eve-
ning

This preparation is, of course, applicable incases of perma-
nent incontinence only, connected with general debility,
and not to nocturnal incontinence, which so speedily yields
to belladonna, and is referrableto the contractibility of the
muscular coat of the bladder being awakened by the heat
of the bed. The Druggist, from Championniere's Journal.

Sun Stroke.

On this subject Dr. L. Ch. Boisliniere, Coroner of St.
Louis county. Mo., publishes in the St. Louis Medical and
Surgical Journal, for July, a report of seventy-two cases
observed by him.

The necropsies in these cases revealed the following con-
ditions :

External appearances : marked lividity of the skin ; neck
and anterior part of chest became soon of a purple or blue
color ; in a few hours the abdomen was quite tympanitic,
an abundant froth came out of the mouth and nostrils, re-
sembling thick lather, mixed sometimes with a little blood.
By pressing upon the chest, blood could be made to flow
freely from the mouth and nostrils.

The lungs and heart were in every case seen to be more or
less congested ; the right side of the heart and the pulmon-
ary artery generally contained black and liquid blood; left
side empty ; on section, the lungs were found to contain an
abundant quantity of frothy uncus, mixed with more or
less arterialized blood. By moderate pressure on the chest,
as above observed, this bloody froth could be made to run
freely from the mouth and nostrils. So characteristic was
this appearance, that from its presence alone many post
mortem examinations towards the end of the summer were

864 Glycerine in Skin Diseases. [Xovember,

dispensed with, tlie jury, before tlie writer, after a short
explanation; being able to make a satisfactory verdict of
death by sun stroke.

The brain was generally found normal ; in a few cases
only there was moderate congestion of the superior cere-
bral veins and of the sinuses. This the author accounts for
by the difficulty the blood found in returning from the head
to the thoracic organs, already full of venous blood. Oc-
casionally the ventricles of the brain contained a little
more serum than usual. This, Dr. B. attributes to the
obstacle about the heart and lungs, damming up the blood
in the veins of the brain and its sinuses, and causing some
of the serum to ooze out. This effusion of serum was
often quite remarkable on the surface of the bpain under
the membranes, where it frequently assumed an opalescent
appearance.

liver and spleen were, as a rule, enlarged; the spleen par-
ticularly softened.

The author remarks that these appearances coincide with
what has been observed by several distinguished writers,
among whom Andral, Russell, Gerhard, and Levick.

Cause. The cause of sunstroke, according to our author,
sustained by the best authorities, without doubt, is a hot
and rarified atmosphere the want of oxygen ; for the dis-
ease occurs very frequently in houses where, from some
cause, the air has become rarified. Several of the deaths
reported above by the writer having taken place in low attic
rooms, in kitchens or laundries, and in sugar refineries, as
observed by Dr. H. II. Swift, (X. Y. Journal of Mediciue,
vol. xiii, p. 45, 1854.) From these and other observations
Dr. B. concludes that rarified, or poorly oxyginated air, is
the "conditio sine qua nci" of sun stroke.

Idolized Glycerine in Skin Diseases. This solution i?
prepared after the following formula : R. Potassii iodidi,
et iodini, each dr. i,; glycerine, f. dr. ij. Add the iodide oi
posassium to the glycerine, and when solution is effected,
add the iodine. A few minutes' agitation will cause a per
feet solution.

This solution has the great advantage over alcoholic so-
lutions of not drying ; in consequence the surfaces remain
supple, and the absorption and the action of the iodine is
much prolonged. It should be applied to the affected part

I860.] Rheumatic Affections. 8G5

ami covered with gutta percha paper, to prevent evapora-
tion unci increase the perspiration of the part It is left
untouched for twenty-four hours, and the degree of action*
regulates its further application of water will readily re-
move all traces of the solution. This solution occasions
bain, which varies in intensity and duration according to
the state of the diseased part and the sensitiveness of the
patient. There has, however, never been any general in-
convenience. On removing the application, the healthy
skin has become brown, and the diseased parts paler than
before. On ulcerated surfaces, no trace of iodine will be
found two hours after its application. Sometimes its action
has been so powerful as to produce phlyctene.

The result of Dr. Richter's experiment are, that this so-
lution acts as a caustic ; that it has really a heroic action in
cases of lupus ; that its efficacy is remarkable in non-vascu-
lar goitre, scrofulous ulcers, constitutional syphilitic ulcers
doubtful in primitive chancres and eczema, and useless
in psoriasis. Wener Wed. Wochens Schrift.

On the treatment of Rheumatic Affections By James Abnott,

M. D.

In the whole catalogue of diseases there is none which,
from the failure of his efforts at cure, gives the Practitioner
more annoyance than chronic rheumatism. Though not
a dangerous malady, like rheumatic fever, it is so
frequent, so painful, so apt to produce a permanent in-
capacity of using the limits, and has been so little under the
influence of Medical treatment, as to make it a question
whether of the two affections it has not constituted the grea-
ter evil to humanity. A large proportion of our military
pensioners, and of the inmates of our workhouses, consist
of those who have thus been rendered capable of earning
their livelihood ; and as respects the former class, even when
the usual remedies for this disease prove unsuccessful, so
much time is required for the accomplishment of a cure by
them, as often seriously to injure the public service. Acute
rheumatism, like most other fevers, runs a determinate
course, and this may, doubtless, be frequently shortened by
judicious treatment; but no one can foretell the end of
chronic rheumatism. When the disease disappears it gen-
erally remains a question whether the cure is to be attributed

5o

866 Rheumatic Affections, [Xovember,

to the remedy employed or solely to the efforts of Xature.
And it is often the most judicious plan to leave the cure to
these efforts exclusively, or to attempt nothing more than,
by strenghening the system and removing all disturbing in-
iluences, to render the tis medicatrix adequate to its task.

Among the various purposes served by the new remedial
agent, congelation, the most striking, if the most important,
is its use in the various form of chronic rheumatism. I do
not bring it forward as a remedy which may only occasion-
ally be of service, for this may be affirmed of numerous
other plans of treatment, but as one which extensive expe-
rience of its use has shown to be capable, in the great ma-
jority of instances, of immediately and permanently reliev-
ing the pain and subduing the inflammatory condition of
the part to which it is applied. Indeed so few have been
the cases in which considerable advantage has not been ob-
tained from its use, that 1 have attributed the apparent fail-
ure more to error in the diagnosis or to a complication of
rheumatism with other affections, than to the inefficacy of
the remedy. It is almost unnecessary to add that this agent
can have no influence on any constitutional affection co-ex-
isting with that which is local ; but the existence of such a
general affection is only known by the local symptoms, and
when these are permanently removed the disease may be
said to be cured.

If this (or indeed any disease) can be cured by the ap-
plication of local measures, instead of those whose agency
pervades the system, the local measures should be preferred.
Few internal medicines of an efficient character can be long
persisted in without incurring some degree of danger ; and,
after all, though the whole constitution is pervaded by them,
their beneficial action may be limited to the seat of disease.
A coroner's inquest was lately held at Chatham to investi-
gate the circumstance of a death caused by an overdose of
opium, administered for the cure of rheumatism ; and two
kays ago, I was requested to visit a gentleman dying from
an\attack of bronchitis, which owed its fatal severity to the
extreme debility caused by a protracted course of active
medicine for sciatica. A vulgar and pernicious prejudice
against local or external remedies is that' they " drive the
disease inwards ;" but when internal remedies succeed in
" driving it out," they too often cause, or (as in the instance
just mentioned) predispose to, a worse disease in its stead.

Of the modus operandi of congelation in chronic rheuma-

18G0.] Rheumatic Affections, 867

tism it may be difficult to afford a satisfactory explanation.
Sonic may deny that there is any new or peculiar action ex-
erted by it, contending that it is only the thorough develop-
ment of the antiphlogistic and narcotic virtues of cold ap-
plications; while others may regard it as only an appropri-
ate mode of producing countei -irritation, or as a combina-
tion or succession of these two remedial agencies. A
rational explanation of the mode in which a remedy ope-
rates is always very desirable, but experience is the only
real test of its utility. The following case illustrates the
niode of using the remedy, and its usual effects.

A woman, between fifty and sixty years of age, employed
as a cook in a gentleman's family, was, after an exposure to
cold and dampness, affected with pain, swelling, heat, and
slight redness of both ankles. She walked with great diffi-
culty, and her sleep was much disturbed by an increase of
bain during the night. There was no fever, nor other symp-
toms of constitutional disturbance. I saw her nine weeks
after the commencement of the disease, and learned that the
colchicum, iodine, quinine, and other remedies, which she
had taken, had proved of no avail. On the contrary, her
sufferings had increased, and it was proposed to send her
into the country for change of air. On the 26th of Febru-
ary last, recourse was had to congelation. About three-
quarters of a pound of ice, enclosed in a small canvas bag,
were, by means of a flat iron, broken into a fine powder,
and rapidly mixed with about half their weight of common
salt. The mixture was then poured into a piece of gauze,
and applied to both sides, successively, of each ankle, while
the foot rested on the edge of a basin. The gauze bag
covered a circular space of skin of between three and four
inches diameter, and was kept in contact with it for about
six minutes. During the last half of this period, the skin
was white, hard and insensible. When this congelation
had ceased, a small quantity of pounded ice was placed
across the ankles in order to prevent the smarting which
would have otherwise accompanied the returning sensation,
and the patient was desired to keep the ice applied for a
quart er-of-an-hour, or longer than this, if the smarting
should return on its removal.

Circumstances prevented my seeing the patient until the
third day afterwards, when she expressed in very energetic
terms, her thankfulness for the relief which had been affor-
ded. There had been no return of pain after the

868 Rheumatic Affections, [Xovernber,

congelation, and consequently no interruption of her
at night. All that she now felt was a sense of
stiffness of the joints. There had been heat and ting-
ling of the skin, particularly on the second day after the
frigorific had been used, but this she had quickly removed
by sponging the part with iced water. As the congelation
had not been kept up so long as it sometimes is, there had
been no vesication produced, and, consequently, none of
that tenderness of the skin which follows vesications. The
stiffness and weakness of the joints continued for some time,
but not in such a degree as to prevent her walking ; and
had the disease been of shorter duration, these effects of it
probably would not have existed. On the other hand, when
the disease has continued for a very long period, aud pro-
duced organic change in the joint, though all suffering may
be removed, the stiffness will probably be permanent.

The congelation did not last four minutes; for being de-
sirous to avoid vesication of the skin, I should have pre-
ferred repeating the milder application to causing this an-
noyance from one of greater duration. In determining the
proper period during which the part should be kept con-
gealed, it is necessary to take into the account the strength
of the frigorific mixture employed. A large quantity of
well-pounded ice and salt, applied when the materials are
acting strongly on each other, will produce a more deeply
penetrating and a more lasting cold than a smaller quantity
not so well prepared. The only instance which I have
known of healing by the first intention being impeded after
an operation performed under congelation, proceeded from
its having been too long continued when produced by a
very powerful frigorific ; but even under these circumstan-
ces there would probably have been no impediment, had an
appropriate mode of dressing the wound been adopted.

To the prevalence of two errors must the imperfection in
the treatment of rheumatism be chiefly attributed. One of
these is the undue influence which certain theories of the
nature of the disease have been permitted to exercise ; the
other is the false view that has been taken of the disposition
which rheumatic inflammation has to extend from one part
of the fibrous system to another, or of what has been term-
ed metastasis.

The theory of the nature of acute rheumatism at present
in vogue is a plausible one, but it ought not to be relied
upon to the degree that would render those lessons of expe-

I860.] Rheumatic Affections,

rience which are apparently contradictory to it Less impera-
tive. That an arid exists abnormally in the blood, there
can, reasoning from chemical analysis alone, be little doubt;
but whether this acid be the cause o( the disease, <>r only
one of its numerous effects, or what the importance of each
of these ejfects may be, arc points to be yet ascertained.
What has been termed bythe late'Dr. Todd the eliminating
mode of treatment, and which mainly consists in the ad-
ministration of large doses of some alkaline substance, ac-
cords with this theory; but the well-attested advantages
proceeding from what are known as the bark, opium, and
lemon-juice modes of treatment are adverse to it. So, also,
though the supposed common causes of rheumatism, cold
and moisture, are in favor of the idea that the emunetories
f the skin are closed by their influence, the immediate^c-
;urrence of this disease, and of the analogous disease, gout,
after sprains, wounds, and urethral irritations, would lead to
a different conclusion. One of the most severe attacks
which I have met with of rheumatic fever, immediately fol-
lowed the bite of a horse ; and one of the severest attacks
of gout was the consequence of sudden dilatation or rup-
ture of stricture of the urethra.

The common opinion respecting the metastasis of these
diseases is founded partly on imperfect theory. Inflamma-
tion of the heart sometimes precedes inflammation of the
joints in rheumatism; and is so common an event during
the continuance of the disease, that Dr. Watson has only
known two cases of rheumatic fever occurring previously
to puberty in which the heart was not effected. That rheu-
matic inflammation of the heart often takes place ahout the
same time that inflammation ceases in a joint, is indisputa-
ble ; hut this coincidence no more shows the connexion of
cause and effect, than the occasional coincidence of dreams
and events shows that dreams are prophetic. Rheumatic
inflammation extends to various parts of the fibrous system,
just as common inflammation attacks successively various
parts of the respiratory mucous system ; and, doubtless,
the part last affected may act in some degree as a counter-
irritant in removing the inflammation previously existing in
other parts. If it be true (and the idea is, to a certain de-
gree, supported by the pathological researches of Di\ Gar-
rod) that the articular inflammation is produced by the de-
position of a materies morbi, it must follow that, as inflam-
mation so produced would impede this secretion or deposi-

870 Rheumatic Affections. [November

tion, whatever is calculated to moderate or remove it, will,
instead of reoelling the poison into the blood, not only pro-
mote its deposition in the joints, but, by preventing a feb-
rile disturbance of the system from the violence of the local
affection, facilitates its excretion by the skin and kidneys.
If we take it for granted that rheumatism is a blood disease,
we must admit, with Dr. Graves, that the poison, in certain
favorable conditions of the system, may pass off by the
emunctories without exciting local disturbance just as elec-
tricity may pass from the clouds to the earth without injury
to buildings on its surface.

Before concluding, I may mention another circumstance
calculated to oppose the general introduction of congelation
in chronic rheumatism ; I allude to the imperfect manner
in which it has been too often used for antiphlogistic and
other purposes. To this cause principally I would attribute
the failures in its use mentioned in a work on rheumatism
recently published by Dr. Fuller. He states that, out of
-five cases of lumbago in which he employed congelation,
there were two failures. As this differs widely from my
own experience, I can only explain the difference by the
supposition that the remedy was applied by him in a differ-
ent manner; and this opinion is continued by finding it
stated in his book, that congelation is objectionable from the
pain produced by it both during and after the application.
When properly used, the smarting or tingling caused by it
is too little to be complained of, and will certainly never be
deemed by the patient a counterbalance to the immediate
and permanent relief of the suffering from the disease. Dr.
Fuller thinks that these failures of two out of five cases sup-
ported his theory, that rheumatism of every description!
arises from lactic acid in the blood, which must be neutral-
ised or expelled b}^ internal medicine. But surely, instead
of the two failures, it would have been more reasonable to
have adduced the three successful cases as a corroboration
of this theory. What appears a metastasis or shifting of
inflammation, probably arises from the poison (assuming the
truth of the theory) being carried by the vis mediatrix to a
new outlet or excreting texture, when the previously excre-
ting texture or former outlet has been obstructed or disturbed
by inflammation set up by the excreted matter ; and, conse-
qently, what would continue or restore the excretion in a
joint already affected by removing this disturbing cause, or,
in other words, by arresting the inflammation, would ap-

I860.] The Laryngoscope. B71

pear well fitted to prevenl its extension to other parts* The
truth is, however, that there is boo great a dissimilarity be-
tween the various forms of acute and elironie rhewmati>in
to authorise reliance on reasoning of this description, for
less the substitution of such reasoning for the results of ex-
perience.

1 he Laryngoscope of Prof.Czermak, By Hugo Stangen-
- WALD, M. P. (Read before the New Fork Mcdieo-Chirur-
gieal College, June 14, 1868.

The principal parts of this simple and useful instrument
consists of a small metallic mirror attached to a long flexi-
ble handle, which is introduced into the cavity of the fauces
to aid in physiological and pathological investigations.

The flexibility of the handle allows of the adjustment of
the mirror undes different angles, and in order to prevent
the condensation of watery vapor upon the reflecting sur-
face, it is gently heated over a lamp, or dipped into warm
water, before it is introduced into the cavity for observa-
tion.

The earliest mention of such an instrument for diagnos-
tic purposes, Ave find as for back as 1840, in a work on
"Practical Surgery,*' by Robt. Liston, Esq. Under the head
of " Ulcerated Glottis," Mr. Liston says :

" A view of the parts may be sometimes obtained by
means of a speculum such a glass as is used by dentists on
on a long stalk previously dipped into hot water, intro-
duced with its reflecting surface downward, and carried well
into the fauces." In Xovember, 1855, M. Garcia published
in the Physiological Magazine and Journal of Science his "Ob-
servations on the Human Voice," in which he published a
number of very interesting and accurate experiments, dem-
onstrating the formation of the voice and the position of the
vocal organs. After him, in the winter of 1857, Dr. John
X. Czermak, Professor, of Physiology, at the University of
Pest, in Hungary, commenced his laryngoscopic investiga-
tions, respecting the formation of the Arabian guttural
sounds, at the same time repeating the experiments of Gar-
cia; and while thus engaged, became aware of the truly
practical importance of the instrument for diagnostic pur-
poses. By an article in the Vienna Medical Weekly, of
March, 1853, he gave the first impulse, by calling the atten-

872 The Laryngoscope. Xovember,

tion of medical men to the importance of its use, and recom-
mended its adoption as a valuable means of diagonis. In
June of the same year, Dr. Turk, of Vienna, also published
his observations on the laryngoscope and its manipulations.

Without entering any further into its history, I shall pro-
ceed to describe the second part of the instrument. This
consists of a large concave mirror of about 8 to 12 inches fo-
cal distance, and three or four inches diameter, arranged on
the well known principle of the ophthalmoscope, which
serves to reflect the light of an Argand burner, or gas flame,
upon the surface of the small metallic mirror, while the lat-
ter is held skillfully and carefully in the cavity of the
pharynx under a proper angle. The image is observed
through the circular aperture in its centre, thus making the
centre of reflection at the same time the central point of ob-
servation, and consequently losing a very small amount of
light. When it is desirable to have both hands free for use,
the mirror, freely movable by screws in all directions, is at-
tached to a support of soft wood or orris-root, by means of
which it may be firmly held between the teeth, thus ena-
bling the operator to use a spatula, probang, or other surgi-
cal instrument, with perfect ease. The use of the spatula,
however, will but rarely be necessary ; for if the patient
puts his tongue far enough forward, so as to form a long
central cavity on its surface, continuing all the while to
breathe naturally, no great difficulty will be experienced in
introducing the mirror iuto the pharynx ; while at the same
time, by stretching the tongue forward, the epiglottis will be
lifted oft' from the aperture of the glottis, and by pronounc-
ing forcibly certain sounds, the corclse vocales will be
brought into full view.

On pronouncing the long sound a, (as in fate,) these will
be seen to open, allowing the inspection of the parts be-
neath. After becoming a little accustomed and skilled in
the use of the hand holding the small steel mirror, so as not
to produce any undue pressure on the parts concerned,
which might distress the patient, we find no difficulty in
bringing into view7 such parts as the back of the tongue,
the epiglottis, the arythenoid cartilages, the true and false
vocal cords, the ventriculi Morgagni, and the anterior walls
of the larynx and trachea. This would certainly he suffi-
cient inducement to adopt the use of the instrument for di-
agnostic ting pathological changes in those parts : but even
more may be done by persevering and skillful efforts.

I860.] The Laryrq B78

During my recenl European tour, I visited Prof. Czer-
inak at Pest, and was invited by him to examine aeveral
patients at a private clinique, suffering from polypi, and
other diseases of the vocal organs, which could be seen with
surprising clearness and distinctness by means of his laryn-
goscope. Yet the fall capability of the instrument appeared
in its true bearing, when he proceeded to exhibit to me on
himself, not alone the above mentioned parts, but also
whole anterior wall of the trachea, and twice during the
course of the evening Ma bifurcation of the trachea itself. The
latter could, probably, only be -attained by great persever-
ance and careful training, yet goes to show what might be
accomplished by the use of this instrument in skillful hands.
I had heard of his ability to show the bifurcation of the tra-
chea before I came to Eungary, but had smiled incredu-
lously at the idea o( its being possible to see the same in a
living individual, yet 1 went away convinced and perfectly
Satisfied on the subject.

While repeating the above experiment, it is necessary to
remember the anatomical curve of the trachea, and obviate
it^ eonvexitv forward by resting the back firmly asrainst til.'
corner of a sofa or easy-chair, and bending the head and
neck slightly forward. For inspecting the epiglottis and
vocal cords merely, the patient is rested in front of the ope-
rator, his hands supported upon his knees, the upper part
of the body and neck inclining somewhat forward, and the
mouth open as wide as possible. The only difficulty in the
operation is the amount of skill requisite to manipulate the
small mirror, so as to bring the required parts into view,
and to get the eye accustomed to the appearance and rela-
tive position of the parts when thus shown reversed, accord-
ing to the laws of reflection of light. This, however, is
easily acquired after a few experiments. The temperature
of the mirror must of course be such as not to cause pain to
the patient, and is most conveniently tested by the feeling
of the operator before its introduction. When there is great
irritability of the parts, several trials may be necessary be-
fore we can accomplish our object; yetthat sensibility grad-
ually subsides by continued use, and when it is excessive it
may be modified by applying previously a solution of nitrate
of silver of moderate strength.

I ought also to mention that this instrument, in somewhat
modified forms, has been used by Pro Czermak for exam-
ining the posterior wall of the soft palate, the upper wall of

874 On Iritis [Xovember,

the pharynx, (cavaom pharnyngo-nasale,) and the nasal eavi
as well as the orifices of the Eustachian tubes, all of
which Iliad the pleasure to witness during my visit. The
upper part of the larynx and the lower part of the epiglottic

have likewise been examined by means of a very small mir-
ror introduced through the canula of a straight trachea
tube, in cases where there existed perfect closure of the gloti
lis from disease. The mirror used for this purpose being
necessarily very small, great difficulty was experienced to
prevent its cooling too rapidly, till it was foundthat by cov-
ering the reflecting surface bv a thin and even laver of a sat
urated solution of gum- Arabic, this trouble might be avoid-
ed for a considerable length of time.

On my return to Paris, M. Charriere requested the use of
the present instrument as a pattern, and a number of physi-
cians expressed themselves well satisfied with its perform*
ance on my exhibiting the same at the Hospital des Fai-
fants, and several other hospitals at Paris. And since my
return the instrument has been frequently used at the office
of Dr. Horace Green, No. 12 Clinton- Place, where, in a
number of instances, it has verified by the sense of sight,
and in a most interesting manner, the rational diagnosis pre-
viously made.

Perhaps I should add that Mr. Ford, a skillful instrument
maker of this city, has also perfectly imitated this instru-
ment after the present pattern, and is now manufacturing
the same at his establishment, Xo. 85 Fulton Street, for the
use of the profession.

On Iritis as it Occurs in Syphilitic Infants.

This form of Iritis which is occasionally met with in
syphilitic infants, is of great interest to all engaged in the
extensive practice of our Profession. Several circumstan-
ces combine to make this affection of much greater impor-
tance than its admitted rarity might seem to indicate.
Among these may be mentioned, its insidious nature and
the ease with which it may be, and usually is, overlooked ;
its very serious consequences; and, lastly, the facility and
certaint}T with which its destructive effects upon the func-
tion of sight may be prevented if a correct diagnosis he
early formed. The circumstance that these cases rarely
come, in the first instance, under the care of specialists,
but are met with by those who, whether in Union practice
or otherwise, come in contact with large numbers of the

I860.] In Si/phditic Infants.

boor, also tends to make a correct knowledge of the fea-
tures o[' this disease, by the Profession at large, of increas-
ed importance.

In the pages of this Journal, during the la.-t Pew years,
repeated examples have been adduced. These it is now
proposed to collect into a tabular statement, with also the

addition oi' such other cases as are to be found on record
elsewhere. The number oi' the fatter is not Large. Mr.

Lawrence, in the first edition of his work on "Syphilitic
Diseases of the Eye," was the first to publish an example
of infantile iritis, and since that date by Mr. Dixon, Dr.
Jacob, Messrs. Maunsell and Kvanson, and Nfr. Walker
about half a dozen others have been placed on record. Is
it possible that the discovery o[' a few others might reward
a more detailed search through the journals than the writer
lias been able to make. It is a fact of some value, howev-
er, as denoting the infrequency of the disease, that the best
writers on hereditary Byphilis omit altogether to mention it.
Conclusions Deducible prom the Series of Cases. 1.
That the subjects* of Infantile Iritis are much more fre-
quently of the female than the male sex. In Cases 2 and 3
In the tabukr statement we have no information as to the
sex ; of the nineteen others, in fourteen the infants were
girls, and in live only were they boys. There is no doubt
a reason fortius.

2. That syphilitic infants are most liable to suffer from
Iritis at about the age of live months. The youngest pa-
tient in the series before us was seven weeks old at the date
of the first attack (Case 21), the oldest sixteen months
(Case 14).

3. That Syphilitic Iritis in infants is often symmetrical,
but quite as frequently not so. Our cases give nine in-
stances in which both eyes suffered, and eleven in which
the disease was limited to one only ; probably, however, in
not a few of the latter a transitory and unobserved inflam-
mation had occurred in the other eye. In some also it is
very likely that the other eye suffered subsequently to the
period at which the patient was under observation, since
the interval between the attacks in the two eyes was in
several instances considerable, and a mercurial cure of the
iritis in one by no means preserves against an attack in the
other.

4. That Iritis, as it occurs in infants, is seldom complica-
ted, and is attended but by fewT of the more severe symp-

876 On Iritis. [N ovember,

toms which characterise the disease in the adult. In but
very few of the cases was there any haziness of the cornea,
a complication very common in the iritis of adults, nor was
there usually any marked degree of intolerance of light
denoting inflammation of the ciliary muscle and adjacent
structures. The absence of sclerotic congestion was also
very noticeable in more than half the cases, while in scarce-
ly any did the patients appear to suffer much pain. In a
few of the cases the pink zone of sclerotic congestion was
well marked, the eye intolerant of light, and the cornea
hazy. As a rule, however, the disease may be considered
a very insidious one.

5. Xot withstanding the ill-characterised phenomena of
acute inflammation, the effusion of lymph is usually very
free, and the danger of occlusion of the pupil great.

6. Mercurial treatment is most signally efficacious in
curing the disease, and, if recent, in procuring the com-
plete absorption of the effused lymp. In all the cases in
which the remedy had a fair chance, the disease promptly
yielded to it, and in several in which the effusion was of
considerable duration, and apparently organized, it was
absorbed under the mercurial influence (see cases 7 and 13).

7. Mercurial treatment previously adopted does not pre-
sent the occurrence of this form of Iritis. In many of the
cases the patients had previously been treated with mercury
for other symptoms of hereditary syphilis. In one instance
the eye was attacked while the patient was taking mercury
for the cure of iritis in that first affected. This I have
known occur more than once in adults. In the latter, in
two instances, I have seen acute syphilitic iritis set in dur-
ing actual ptyalism.

8. The subjects of Infantile Iritis, though often puny and
cachectic, are also often apparently in good health. The
more ill-nourished of the subjects of hereditary syphilis are
certainly not those most prone to iritis. In several of the
cases given, the patients, despite the presence of individual
indications of hereditary taint, were in remarkably good
condition. The puny class of syphilitic infants are those
in whom the disease falls with its chief stress on the organs
of assimilation, on the mucous surfaces or very certainly on
the skin.

9. That infants suffering from Iritis almost always show
one or other of the well-recognized symptoms of hereditary
taint. In the cases before us, the following symptoms were
present at the time of the outbreak of iritis :

in

9

cases.

2

u

1

a

>

a

I860.] Editorial. 877

Psoriasis of the general Burface

A papular rash

Psoriasis palmaris
Erythema marginatum
"Peeling of the skin" 1 "

Falling of the eyelashes and tinea tarsi 2 "
Snuffles 10 "

Sore mouth and aphthse 4 "

Condylomata at the anus 5 "

In two instances (Cases 5 and 15) no other specific symp-
toms existed at the time of the outbreak of the iritis. In
these, however, as in almost all the others, there was a his-
tory of symptoms of a suspicious character, which had pre-
viously occurred and had disappeared.

10. Most of those who suffer from Syphilitic Iritis are
infants horn within a Aiovt period of the date of the pri-
mary disease in their parents. In one instance the mother
had contracted primary syphilis (from her husband) only
three months before the birth of the infant. In another the
interval was four, and in a third six months. In five about
a year had probably elapsed ; and in another five at least
two years. In two, judging by the fact that the mother had
previously borne a number of children, some of whom had
died with suspicious symptoms, the date of the original
disease in the filth er could not be placed nearer than six or
seven years. This calculation quite accords with what is
observed in the iritis of adults, which, in a great majority
of instances, is a secondary and not a tertiary symptom.

EDITORIAL AND MISCELLANEOUS.

The Year Book of American Medicine.
It affords us a very great pleasure, to give place to the circular of Dr,
0 C. Gibbs, of Frewsburg, New York. Fearing that some of our read-
ers may have forgotten, what is to be the character of his work, we pro-
propose to mend his presentation of the subject, by adding what his
modesty, and reluctance to occupy space, causes him to withhold. Many
of our readers will remember, that in the February number of the pres-
ent year of this journal, we gave place to a letter addressed "To the Pres-
ident and members of the American Medical Association," by Professor

JBdtiav [Xovember,

L. A. Dugas, of Augusta, Ga., during the session of 1858. This letter
earnestly advocates the establishment of " An American Abstract of
Medical Science," which should be both comprehensive and com-
pendioits, accessible to all readers every where, which should pre-
sent a resume of all American contributions and rescue American med-
icine from oblivion, which the ignoring disposition of European cotem-
poraries would, in time, accomplish for it.

We advocated the measure at that time, in the strongest terms. The
idea seemed to take well, both among the readers of journals as well
as us, among the journalists themselves : both Dr. Dagas and ourselves
received letters on the subject, from several of our ablest confreres who
proposed to address themselves to the useful undertaking.

The immense labor of the work, the expense attending its prepara-
tion, and the difficulty of finding a publisher, we suppose deterred our
correspondents from their enterprise ; for we have looked in vain, for the
first number of this, which we consider the most important of all under-
takings in behalf of American medical science and literature.

The proposition of Dr. Dugas had in view the benefit of no one indi-
vidual, no one college, no one section, but its benevolent design was to
extend its advantages to the entire profession of the United States,
to let every contributor to every medical journal in this new world speak
in its pages, to let every American idea in medicine become condensed
and crystallized and effectually preserved in the vast show-case of this
comprehensive yet compendious arcana. The idea is benevolent na-
tional patriotic, and when we come to reflect upon it, at a time like the
present, the proposition comes like the welcome truce-flag in the din and
carnage of the battle field. Let medicine still be national, though blind
political palinurusses may run the ship of state into breakers and finally
split her spended hull in pieces, en the rocks of secession, disunion, and
anarchy !

We have said that the labor and expense of preparing such a resume
of American medicine would be great this cannot be denied. Any one
who is familiar with those English works, "Braithwaite's Retrospect" and
"Banking's Abstract," cannot fail to gain some idea of the labor but
these are no fair data of the estimate for every English medical jour-
nal published, we have nearly ten American; with ten times the number
of communications and ten times the amount of condensation to make.
Why do foreign ideas and doctrines in medicine gaiu such ready cur-
rency among us and throughout Europe, while American ideas and
doctrines are ignored, often sneered at, and sometimes discredited ?

18GC] EditoriaL

There are several good reasons for these results; it \s not that Ameii-
can Physicians are not intelligent or scientific, it is not thai their vast
country with its variety of climate, soil ami morbifio influences does
not furnish material for medical reports ; it i- not that American Phy-
sicians arc too indolent to report kheir experience ; it is aot that their
reports are inelegantly expressed or that they do not reach the eye of the
Profession in printed form. None of these influences materially hinder
the progress and extension of American medicine. There is as much
material afforded ; as much intelligent and accurate observation ; as
much energy in collecting facts ; as much elegance in expressing ideas,
and as many medical journals printed in the United States as in the
whole European continent and British isles put together.

We have indeed too many journals ; American periodical literature
is diffused, American ideas are too much divided up, not sufficiently con-
centrated it is too great a labor to search for them and authors and
journalists of other countries give it up in despair while but few of
our writers have at hand, any reliable source from which they may elicit
the American opinion on any single point in medicine. We have no
work like that of Braithwaite or Hanking, and hence the evil and injus.
tice to American medicine.

We want a work which will contain a resume of every new idea pub-
lished during each current year, in any medical journal, any where in
the limits of the United States, that will be sufficiently condensed to be
transmitted to any part of the world, and yet clear enough and full
enough to convey a correct idea of each writer's views. This is the dis-
ideratum. This is the work which Dr. Gibbs proposes to publish and for
which he claims the assistance of the Profession in every part of the
country.

It will be appareut to every one, that, besides labor and the expendi-
ture of money, a thorough acquaintance with the past and current medi-
cal literature of our country, and also a peculiar talent, well practiced
in the difficult art of condensing fairly and justly, will be required to
carry out and perfect this important enterprise. Dr. 0. C. Gibbs is
eminently fitted in all these respects to carry on the work. For years
he has been connected with several of our best Medical Journals, as a
reviewer and contributor, and for the past year has been most successful-
ly engaged in the very kind of labor, aud employing the very kind of
talent necessary for the work he has undertaken. His "Monthly Sum-
mary of Cotemporary Medical Journalism," published in the Amer-
ica?! Medical Monthly, well attests his ability and industry, as well as
the utility of this kind of work. The work will not be published unless

880 Editorial

a sufficient number of names are sent in before the first of January,
1861, to authorize the undertaking. Subscribers will, therefore, send
on their Dames and addresses to the Editor, that he may know what to
depend on. We would think that at least every American Physician
would gladly secure a copy of the work. We have said enough. We
now let Dr. Gibbs speak for himself:
The Undersigned proposes to issue a yearly volume with the

following title: "Year Book of American Contributions to

Medical Science and Literature.'"

It is designed that Part First of each volume shall comprise an ar-
ranged and classified Summary of, and index to, all the important
original papers found in the various Medical Journals of this country,
for the year immediately preceding. Part Second will comprise a Sum-
mary of, and index to, all papers found in the published transactions of
the National and the various State Medical Societies. Part Third will
embrace Reviews of all medical books of American authorship, pub-
lished during the year, with a Summary of all the novelties in opinion
or practice therein. A copious index will complete the work. To the
above plan and arrangement, such other additions shall be made as time
and circumstances may suggest. The first volume will be issued early
in the year 1861.

For the preparation of our Monthly Summary of American Medi-
cal Journalism for the American Medical Monthly, we have ar-
ranged for all the American Medical Journals [over thirty in number]
and at least four of the best European. To facilitate our design, we re-
quest a continuajice of the exchange.

American authors of medical works, and publishers of the same, are
requested to send to our address a copy of their respective works and
publications. Medical Societies that publish their transactions, will, we
trust, be kind enough to send a copy of the same to our address. For
this kindness of an exchange from Journal publishers, authors, book
publishers, and Presidents of Societies, we shall be happy to reciprocate
by an exchange of publication.

The importance of a work of such kind as above, which shall com-
prise all there is of interest in the more thorough journals, medical
books issued for the year, and the various society transactions, will be
readily conceded by all. We cannot prepare the work and publish it at
a pecuniary loss, aud hence the object of this circular is to request that
all physicians who would encourage the work, and become subscribers
to the same, would send us their names at once payment to be
made only on the publication of the work. The work shall contain from
500 to 800 pages, to be substantially bound, and furnished at the very
low price of Three Dollars. That we may know whether the work is
to receive sufficient encouragement to justify its completion and publica-
tion, we request that subscribers' names may be sent in immediately.
As a special favor we request that our friends will not allow a day to
pass before responding to this Circular.

All Books, Journals, Published Transactions, and Names of Subscri-
bers, should be directed to O. C. GIBBS, M. D.,

Frewsburg, Chautauqua County, N. Y.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(new series.)
Vol. XII. AUGUSTA, GEORGIA, DECEMBER, 1860. NO. 12

ORIGINAL AND ECLECTIC.

ARTICLE XXIV.

FIRST REPORT TO THE "COTTON PLANTERS'
CONVENTION " OF GEORGIA.

On the Tertiary Lime Formation of Georgia, by Joseph
Jones, M. D., Professor of Chemistry in the Medical Col-
lege of Georgia, and Chemist of the Cotton Planters'
Association.

(continued.)

THAT OF 1859.

Jvpsum .... 39.31 Jet. $0.13

Phosphoric Acid insoluble . . 7.06 4}ct. 0.31}

" Soluble . . 6.27 met. 0.78J

The value of 100 lbs. being multiplied by 20, gives the
ralue of a ton of each.

thus, that of 1858 is worth .... $33.20

1859 " " . . 24.60

Difference against the latter . . . $9.60

The proportion of Ammonia was two small in either to

)e worthy of notice.
Comment is unnecessary. I have given the chemical

constitution and its money value, so that the farmer may

eally know what he is buying.
The result of all this shows a great falling off in the value

}f three manures, which have been much used in Maryland,

whilst in two others (Coe's & Rhode's) the quality has been

generally maintained.

5Q

vsJ Tertiary Iamu Formation [December,

What quantities of these inferior articles have been sold
to our farmers because of their original reputation cannot
be ascertained, but it would seem that means should be
taken to arrest such frauds.

It is felony to obtain money or goods under false preten-
ces, and people are punished criminally for such acts. Is it
not equally criminal in morals, if not in law, to publish
certificates of the existence of certain proportions of
valuable matter in a manure, and yet sell a material con-
taining perhaps one-third or one-half the amounts stated in
such certificates ?

After consultation with many farmers and planters, and
seriously reflecting upon this subject, I am fully satisfied
that if a proper sum be allowed me for such assistance as
will permit a comprehensive system of analysis to be exe-
cuted, the evil will be very soon corrected.

The conscientious maker or dealer will of course furnish
fair samples ; but as there might be some who would act
otherwise, I would propose to take such means as would
insure samples of the articles actually received by the
farmer.

such a number of each kind used in this state should be
analyzed from time to time as will keep the public inform-
ed -their composition and value.

The law might require them to be reported monthly or
quarterly to the Governor or other officer, and published in
one or more papers in each county, as in the case of the.
laws.

3 effect of these measures would not fail to afford ample
protection to the farmer against both fraud and ignorance,
and whilst benefiting the honest dealers would very soon
drive all others out of the trade."

First Report of Philip T. Tyson, State Agricultural*
mist to the House of Delegates of Maryland, January
1860 pp. 101-102, pp. 130-13^

I have selected the testimony of Professor Tyson
because he is the appointed chemist of a State from which

I860.] Qf Georgia.

we receive a large portion of our Guanos and manufactured

manure-.

It should be remembered by the Planters of ( Georgia, that
in most instances, the manufacturers of these compounds
are residents of distant States, and that the venders, in our

midst are also in many instances natives of distant States
birds of passage, who come merely to make a fortune and
then to migrate to colder regions. It results from this, that
whatever losses of money occur in the purchase of fertiliz-
they are in almost every case total losses to the State of
Georgia, for the money does not simply change hands
amongst her own citizens, hut is carried out of the State.

The only method of protecting the planters, is that re-
commended to the House of Delegates of Maryland by Mr.
Tyson.

A law should be passed compelling the venders of fer-
tilizers to throw open their entire stock to the inspection
and examination of competent chemists. Xo honest man
will object to this test. Dishonest men will always endeavor
to defeat the execution of the law. Every attempt to elude
a fair examination, should of itself be sufficient warning to
the Planters df Georgia that there is fraud.

"We will now institute a careful and impartial comparison
between the commercial fertilizers, and Marls and Shell
Limestone of Georgia.

In this comparison, it would be manifestly unjust to com-
pare pound with pound in the commercial and native fer-
tilizers ; to render the comparison just and equal, we must
I compare the amounts necessary for each acre of land.

The following table presents the composition of the Shell
Limestone and Marls of Georgia in tons and bushels, and
in comparing it with the preceding tables of the chemical
constitution of the commercial fertilizers, we should com-
pare bushels with pounds-

884

Tertiary Lime Formation [December,

c5

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Organic Matter.

Water as Moist.

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r-iCNrHTOifiCt~-<f rH

i !>* n CO C r- M M H Tl ^ C O H ^ H iO CON

IMC rH N Jl CO t- W OT ?1 C rl nl((lOH

>Q i-i i I i-< CM CM O rH rH CO rH

Silicious Sand ..wm^S&w^S

CO Ol nf CM

i-h O rH CM CM <C (M H CO * n Jl O a, O -i n 71
C G-J CO to ^OOJIOOO

i-i cm cm o * i-t i-< ci ~&

Insol. Silicates

rH CM CO O CM

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31 31 CO CO J.- t.-- -rf 1 1 i-< CO 'C N * if O OS C n (S (N t- O
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to CM tO CO tC 31 to CM CO -* O

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A1UU""'1 <* UAlueH H M iC t- C5 a !M C (N C W O CO (N to CO 31 < CO to
nf Tr/, . CO t- "* CO iC rH rii-iCM C C N O TO (N
Ol lrOIl ^ ^ ,-, CM CM CO t- O rH rH

Chlorides

^f O * X M O rHCNOOOOOOiOrHiftOUtOueO
rH CO Tf

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CO CM CO t> O Hji CO CO to CM to CM 31 C CM t O rl rl CM CO ^i S5

Lime

xo^jihx3j xxtt>-eOJwNeN

CM CM ict CO r- 1 Hfi CM 3131313131311 1 X rl CO "O l> Cft CS

C^HCCCMt^rHrfirt*31'*31-<}i31-*31 CV 3> X t- *-C C H

Hf CO CM -<f t- 31 CM CM CM 31 CM Tf 1- 31 CM Hf 31 Hf 31 "P 31 Tf 31

CM Tf rH -tfl rH CM if rH i-l CM -<f

Carb. of Lime

if CO CM CO CM

^b.-*XCNNiHCOO OOOOriMN'CNifJia^'*

TO to TO t- -* CO to 31 CM i.~ X- t~ O TO CO *>

TO X * X CO t- t^ TO CO d ^i X Ji N O TO N rH X N >C O CO N

4, t, r-i^r-.^^oO rl r( CM if X n N CO rf X

co

31- : : : :aS

a 3 m . . . c o -
** "3 *a"Co^3 2

O.CM13 wcjV0^0CMU

ou ?; ~^!m a
^^^S^-o

-^gui

ow. P-

f 3ri OOrHCMCO

c .-
o a

SI-

s*2

- J5 5 S

- O O ^ TO

rMTJ

0} a, a,

a a
^wiH^OCojco
la

^1 O rH

I860.]

Of Georgia.

885

o
O

Organic Matter.

00 O CO * N O -CM-*

Ci to X n .-I r> N C3 <* })

Ms>aasjia s oo i- o o f-H

M t. i-< ut 7< M OO CM O 00 r-H -<j< cj
rHt^rHCM-<J<^CtOrH3<^^,: rH r-H CM

CN

CM CO
*t< -r* CO CM

Water as Moist. . > g g

co o t

WOOfl ^1 'O 00 ri * 00 M< <-" iM tJi a: f ^
M J4 X -O O O X '~ H ?1 -t 3! N ^ r-i M5 rH

co f to co to co c. to cc to -o 3: -<* as **< ex co t

f-l tO r-H r-H rH CN CO tO rH C VI 35 -C CM -<H

< < -m - :> to

Silicious Sand,

-*< r-H -* f CO
r-H lC O "0>

MOHnN"tH co to

r-H t>. Tfl Ci JC-- -fl rH CO '0 r-H

CM CM O f~- tj* C5 00 ;o N

* THHfl^

Insol. Silicates

OrHONOO-^OOSMOJOONWNO
C X O n H /I a - H <J n i.O t-- r- d
CO 35 CO t- tO 'O N to CM -* to GO O r-H
Ci n CO C N 3) H Ul C0O3J J)0 'N

CO rH CM CO . 35

CCtO^CXCMtO

cm ..o x to '.o co cm #

CM C X H * X

Alumina &^0x
ide of Iron . . .

CO Ci CO

."* -^srseoco'^o-* .
cNM<CM'<tir^CiCM-yirHCN

0-J r-H CM CO if to CM -CM

r-H r-H rH

. . CM

-* co -to

r-H 30 -tH IC t~ TJ*
rH CM CO ^ O r-H

eja co
0-J >.o
co

to

rH CM

CM 1.0 CO rH

CO tO 31 iO
rH CM CO "O

-* 35
tO 31

to :o

0.005
0.10
0.5
1.0
1.5
2.0
2.5

1240.

0.120
2.4

Chlorides

CN h* co 00

i-h CM CO * to CM

Sulphuric Acid.

Sulphate Lime.

Carb. Magnesia

COtOCOto-^CMtO
CM O CO

CMlCCOr-H^CO

i-h r-H CM

CI Ci CO t>. to c

CO to Ci CM UO CO Ci

iHHKOnOHNW*

'

Phosphoric Aci
in Phosphat
of Lime

-* 00

CO to

CM

f CO 3) to

-*Ci CM " CO to

irH CiCiCSCOCOCOtCCN
* l-H CO C i.-- C5 CI O
CO rH

CO to CO CM

CM UO 00 r-H -^ 00

HHSN

co to co co ec

r-H CM f i.O to i-h

to CM to .0-1 CO <* O CM iC. i.O i.O CM -*

CM O r-H Ci 00

arJ< CM IC t~ CO to tO CM r-H CO -*l to t~- iG CM
" 00 -*J1 CO CM l~- rH CM 'iHtO j)X->f OH UO
r( H SI * O rHi-HCMCOtO

CM rjl tO X

Phosphate Lim

Ci CO t- to

CM IO CO rH

to CM

** C35
rn CM

Lime

CM -<i<

co o co to oo cm co "C co 3 >.o 10
cm co oi i.o --H rfi cm -* . -# at x ^ ic

tO CM rHrH C5>CtOrHt^-rJ4
-*I<COr-HtOir: rH rH CM CM O
-rj< rH CM ^< rH

1-- tJ<

to CO
co

rl CM

116.7
233.4
350.1

468.

co t^-

00 to

Carbonate Lime.,

h* Ci CO C-

X '
3-1 to i
t- to l

Ci co co to

C5tJ< r-H 1(0 t 35 O0 tO
COC5COt>.CMC5tOeO
.t-rH*~Hj<C500CCl r-H
C5O5CNe0-*lC5CN-*f

31 CO CO t C5 r-i

co to *

OHU
CM <* tO

05 i>

STJ

.S
s *.;:

2
-1 "

a.2

<-5<~iC-J<-><-><-> _ ^ O

'-1 r -5.3

i>Jr.c,j~ cr?000'^^^

00

886

Tertiary Lime Formation [December, |

00

Organic Matter. -! j, y> 3 2 ix ~ l\

71 IQH

,, . CtOOOOOOOO >iOHC

Water as Moistur ::::::: I^.SSSSSSS^&S

1 71

Silicious Sand.

co o o -* co *< x 71 eo cr eo on
m - t. /. i --'-.--.'.'. ~. s / 1 - 1 - ;
71 -r ti .-./- :. ec edmOnMo iH

11 <* o ?. rn ti hcooooovh

71 ri r- 71

[nsol.

o ep os s

_... w f ^ 71 n * '-. rn ^ -j, oeo oc M o to ec

SlllflilP * - "' "- ' SHC9(0 09tOOni i- --o 10 to

uuiLaics.Q OOOC"-i?i ; C C SO CO CO CO "7 1

h x -c -r :! : : n ^ 71 -t i r. n m ?i >*

r-< 71 -7- -r f. -7 1 5

eo iC W Q iH

Vlnmiua and Ov-'- '" - '' * ~? -o co os to qo o
idp of Iron : m i- -- 10 ao t- tji is -* eo cs ri 71- <*< cn

BC -. TO 09

- 1- Z 77
f. 71 t

60 >-. ~- IB

7! d

' r 71 71

Z Z ~ ~

l-H 71 71 O

Chlorides

Sulphuric Acid,

Sulphate of Lime

Carb. Magnesia. o o 3

I- -rM I~ -rj" r- 1
I.O X I -* CS 'O I i

CO 70 -tf

71 r-l

:o o o e oo * c i- o t>.

X71 JOli

r-i (71 CO t*

O i-l 75

Plincr.Kmin A i ,1 CO eo CO rHOO nnnNM*

rliospnonc ACiat_ ^ c r< o oo eo c-i
in rnospnaie . ^co HnnM r-i h wriw^w^

of Lime

ec 7i eo
'

Phosphate Lime

CM * U * !0 00 O C0^XW*JIOO-JC0S00J>>'0 C 71 ;
C-1 -*f NrlM -rfl CS OS C

!N Tf 3 X C 71 71 r-l CO "*< t- CS CO CO -rfl CS -^1 lO tf< -rM TJ< *<

:0 00 eo ~r 71 rH CO *H'*XOi- -OCOtOOCCNM CO *
O r-l' rillr

Lirae

CO TO
l-H 71

co co eo

O CO i>. O "O CO CO
Mt- rl r-l rH CO CO

CO CO

-+ 71
CO r

i-O CS

x eo

-* 00

17 7-7,

O eo

CO O CO

to eo cs
eo co as

j. i - ' t

r-( CN

MTfOOrHWrl

oo eo co eo * cs CO

O r-l . . . Ol * 00 CO *- CO

co 'ONWcooo:: -77

eo -*
*- o

cc oi

71 O

O r^

co eo

*~ **

X tf CS

Jl<*HKl

7- - **f
1(7010'

co *o<

CS 00CS

t^. t CS

-* *C /~

r-l rl CO rl

O 3

a

^ o o
'm O "^3

: s

Su.2

o a

3-2

co C3

C 0

;|jooooJpo

rtSra, ^ ^

O O cc - - -

a

-2.S

0 CJ

8c
s

HSa

J^ o o

^ M O

Co"

r-e<=>'^0000'5 ogOOOOO-S XOOCrOOO"^ r-O

p1 o oooooo.SfaOooo5o.2foo o o.Sfo

SOH7l-)iOrtTjp'-|f)n^iOriT30nNTfCn'35rl

8 T| O T3 rrt

O

I860.]

Of Georgia.

7

/

i r i n 7i t

.- . : 1 r- i-l cc

Water aa Moist. .

9

i
--

X

...

RihVmifl ^niil - i - -r '

tT- " J O <-H r-t M

<-> 71 n iH 71 >

CO < 00 o

iusoi. oiucaics

r - \r -r -r < n ri . i -r r .-t i r* i

i-h i : -

--/ - 7 1 i -

A.taminaandOx-2* -; V-:

Ida of iron... ' -.-..:; v, ->!3 - ; ; ; - _-^

* i-i X> O 35 O 3i 1- i(5 35 JV X 1 -

Chlorides ... .-.; \' 7: :; = - ~ = - ;' :: -* - _---:->--- ~ : - - * - -

z z : -

! a> !

03 . .

Sulphuric Acid. .

:| :

. -

- . .

OOOC 7X

- -: 5 :

- :

. .

: ; = r - -

. ....... i . T C

Pi 1-4 CO

Sulphate of Lime

r. r _-. j i~ - . .-> ir

Z / -.71 .-!-

(. urb. Magnesia.

; " c ri M m it * :i-r . ^ - ;> i

N * M t - X -i M ."
O O 71

Phosphoric Acid -! "* - -_- 3 * '. J ! * J ^ ^ ^ *. w S " " ^ ^c

f

in PhnanlintP ' i-* " iC -" / EC i - * 71 71 -f -r i - 7-i r. r. 35 r. 3S 3a
1U I uo>puuieTr eo 00 O 04 r >- C i i - ..7. r-i go .- i ifi .1 .- X -f . :i

of Lime r-.~^r*S o

:

woo^o ri ji r-i n ro * o i^ o oof :i :

icora r n - j c W3 c -m >c

Phnsn'tp nf I imp~ CO 00 CO * i-H 00 <0 >* C* O CO WJ C-i W t- ~ ri ifl !fl 71 - 00 < -t1 r

nrlM rl ^ M * I.: n O i-l i-i r- 71 . ~ 5C

K/ <c (0

l^ SO -^ BO i- -r / :rr-.:M-.:-; :i r -r : : / 5UOO^OO

jT ;ma HNoe^QOiOeoN'* >V3n r. 71 d / - -co a i - : i - .: so
1jMU<- CM :0 -r '- : i^35i)<35*Q0t,3>NO)O00Ni-iOHti3iftC 3a /

M f J ,f C h if '/; * 7. M * M ^ t* -* - *? r. SC i - .~ . IJ - T S ~ i

^H -^ ^h r-i "N -* > i M * i r-< -M '. 1 7-

eo cn o o s jq

ej r. a o r. t- t.MO5.-aoo^soOnnH?)n-'": o

icoh^socc -:i^::>-:i <>i t. a. . ~p x> o* 71 sc -r. o ri

LdrUUUillt J-MIIL . qq .- t, gj 3SOX>00OT*<OJO O 5 O 00 t- iO -*< N Hi :i - ;. / i- - c M

rt so r-t t CM CO * X OC I- 71 ::/.-. / rH34 03^ea

a
'3

c

a

a

o

a a

o

O 08

a
o

'3

JK

a

c

is

"a>

t?

aa c

J3
B
3

.a :

ci

8^

a .

ft ' ' 'HP ' Or/)

w 0)a.ca oa.s cs0-3

_r coti cats c-os

s::!:|g|:::::oo|:::::g53;::::

- iS- SoS s

dish Brown

300
400

500 "
1000 "
ite Shell Lino
One Ton of
100 bushels
200 "
800 "
400 " .
500

1000 "
ite Shell Lim
One Ton 20o
LOO bushels

BOO "

400

1000 "
II Limestone
One Ton of
loo bushels
200 **

400 M
500

10U0 "

"g J3 -a i>

^

^

o

n

o
O

888 Tertiary Lime Formatkm [December,

The careful comparison of the individual elements of the
commercial fertilizers with the individual elements of the
Tertiary Lime formation of Georgia establishes the follow-
ing results and conclusions.

1. 100 bushels of the Green Marl contains four times
more' Phosphoric Acid, and as a necessary consequence
four times more phosphate of lime than one hundred
pounds of Phosphatic, Amonia Phosphatic, and Peruvian
Guanos, or of any other commercial fertilizer.

2. 100 bushels of the Yellow Marl contains eight times
more Phosphate of Lime than one hundred pounds of any
known Guano or manufactured manure.

It would be perfectly safe to apply one hundred pounds
of these Marls to any land in Georgia, and if the lands be
newly cleared and rich in organic matters we might double
and treble the amount.

The experiments of Senator Hammond and others have
rendered it at least probable that the lands of South Carolina
and Georgia will not bear as heavy applications of Marl as
the lands of England, Virginia and Maryland, and hence I
would not until Careful experiments have determined the
exact amount of Marl which is sufficient for our lands in
Georgia, recommend the application of this Green and
Yellow Marl upon sandy cultivated lands, in larger amounts
than 200 bushels.

When I have completed the chemical analysis of the soils
of Georgia, I hope to be able to speak with more precision.

It is evident, nevertheless, that even with this small
amount to each acre, the Marls of Georgia will furnish far
more phosphoric Acid and Phosphate of lime than the
expensive commercial fertilizers which we have shown to
be also liable to adulteration.

In making this comparison we have impartially compared
these Marls with the very best fertilizers in the market.

3. 100 bushels of the White shell Limestones Xos. 3, 11
and 13 contain a greater amount of Phosphate of lime than
exists in 100 pounds of the great majority of the Guanos
and manufactured compounds.

L860,] Of Georgia.

4. 100 bushels of the Maria and Shell Limestone which
eontai 1 the least Phosphate of Lime, contain fully as much
as the most Inferior Guanos and manufactured manures.

It would be apply 1000 bushels of the Bluish

Calcareous Clay, which we have R>t convenience cajled a
Bluish Black Mirl, although it c >nwi'n less Carbonate of
Lime than usually exists in Marls, to each acre of land. In
this amount we would obtain 610 pounds of Phosphate of
Lime, an amount at least twice as great as that contained
in a most liberal application of the best Guanos and com-
mercial manures. Hence with truth I affirmed that this
bluish black Marl would be a most valuable fertilizing
agent to the surrounding exhausted Bandy lands. The
clay itself which it contains will prove a valuable addition
to the lands which need clay. It is evident however that
this ealcoreous earth would not bear a long transportation
either on the farm or on the Railroad, for it contains too
much clay.

6. It would be safe to apply 1000 bushels of the Black
swamp deposit. Xo. T. (which we have called swamp muck
for this was the name by which it was designated by the
surrounding inhabitants) to each acre of land. Iu this
amount we would apply as much Phosphate of Lime as is
contained in 1000 pounds of the very best Phosphatic
Guanos, and in addition to this we wiU apply together with
the Phosphate 8221 pounds of Organic matters, and 6808
pounds of Carbonate of Lime. Although the organic mat-
ters are not as soluble, or as valuable sources of Ammonia,
as the organic matters, of Phosphatic and Ammonia
Phosphatic G-uanos, still it is w^ell known to every chemist,
that lime promotes the disintegration of the most stable
and insoluble compounds, hence the deposits of swamps
and peat bogs which are comparatively inert, are readily de-
composed and prepared for vegetation by the action of
Carbonate of Lime.

The value of this black swamp deposit would on this very
account be increased by mixing it intimately with one

890 Ti rtiary Lime Formation [December,

quarter of its weight of pounded Shell Limestone or oue
twentieth of Lime.

This would be easily accomplished, for the surrounding
hills are composed in great measure of Shell Limestone. It
should be borne in mind that a less quantity of the mixture
should be added to the land.

The remarks which we made with reference to the Bluish
Black Marl, or Calcareous earth,* apply also to this Black
Swamp deposit.

7. 200 bushels of the Reddish Brown Marls would con-
tain as much Phosphate of lime as is found in the Guanos
and manipulated compounds of medium quality.

To render these facts still more plain we have drawn up
the following table.

I860.]

Of Georgia,

893

- /

-: r

g-.a

' -+3

5 J

Gn3

3

Ch o
V.

O 9

- o

s g
CM Hi

|"S

rt "SSd

S
c rt

a o
"5 *

~ 3

I -

<

|l000pou,uls

mda

looo pounds S|3SUS22Si|gi

?fc

300 pounds g 3SS2SS

S2 BS5SSa.Hr. -I o -ii -i -i .i "Z, \z

200 pounds

loo nound*

..- r ci C -

e r 2

SB-S :<

c = 3 * i

c 5 Jg "O "O

3 a
= r-

:sq :6 :
oa -oc

e'e^SsS

||l^go||S|o|^i5|^S

!Joc|

x:

bushels I v. ?. 't '/ v. ~ i' x ~ a

300 bushels 5 g|ggSSgSS8SSo

; s a e* 5

B0 ! -r ' " T i ' T i ' ' -r DO 9
-; <C -.i r- <^ Ti X 51 c-r T> I

: : 2 : : :"S e 3

: : a - = = r - v 2

1 1 ml 1 1 ujj i

s,l' Ternary Lime Formation [December,

8. Id the preceding calculations we have left entirely out
of view the important fact that these Marls and Shell Lime-
stone contain Carbonate of Lime, which is considered by
the most experienced agriculturists to play even a more
important part in the economy of vegetation and in the
chemical changes of the soil, than the Phosphate of lime.

Thus in 100 bushels of Green Marl we would have 4383
pounds of Carbonate of Lime, in the Yellow Marl, 4302
pounds, in the other M iris from 200 to 4238 pounds and in
the Shell-Limestone from 7932 to 9221 pounds of Carbonate
of Lime

CONCLUSIONS.

1. The Tertiary Lime-formation of Georgia is capable of
supplying the entire State with the Phosphates and Car-
bonates of Lime for unnumbered ages.

2. If the planters of Georgia employ the natural resource s
of their State, they will have no need whatever to purchase
a single pound of Phosphate of Lime in whatever form it
be present in the market.

3. The application of Phospliatic Guanos and superphos-
phates to soils to which the Marls and Shell-Limestone of
Georgia have been applied, would be wholly unnecessary
and would produce no special beneficial effect. The truth
of tbis assertion has been demonstrated in those states and
countries in which Marls rich in the phosphates have been
applied to the soil.

4. In as much as Peruvian Guano contains a large pro-
portion af Ammonia and of organic compounds, capable of
generating Ammonia during decomposition in the soil,
it is far more suitable as an application to Marled lands than
the Phosphate of Lime and Phospliatic Guanos. The high
price of Peruvian Guano, however will be a serious obstacle
to its extensive use; and we shall endeavor to demonstrate
before we leave this subject, that the planters of Georgia do
not need Peruvian Guano or any other commercial fertilizer
as sources of Ammonia and of the inorganic compounds
necessary to the developement of Plants, and the improve-
ment of the soil.

I860.] Of Georgia. s!..

We will in the next plaee consider the relations to soils,
plants and animals, and the effects and mode of application
of the Marls and Shell-Limestone of Georgia, It will Ik- im-
possible upon the present occasion to do more than presenl
general and well established results and conclusions.

The whole subject will be fully and carefully discussed
in the Large report which we expect to present to the cotton
planters convention, when the Agricultural Survey of Geor-
gia is completed.

V. Relations of Marls and Shell Limestone to Soils.

That lime is indispensable to the fertility of the soil, has
been demonstrated by the universal experience of agricul-
turists, and by the important results attained by the ap-
plication of calcareous manures to lands of every geological
formation, and of every quality, and by the known chemical
and physical effects of lime and its compounds upon the
constituents of soils and of animal and vegetable manures.

The 'full discussion of the relations of lime to soils and to
plants and animals would fill a volume and must necessarily
be deferred for the present. We hope, however to present
such an array of facts and results as will lead to intelligent
and efficient action.

The following welt established facts will serve the pur-
pose of demonstrating the proposition that lime is indispen-
sable to the fertility of the soil.

Soils devoid of lime, no matter what other salts they may
contain are in all countries barren.

The addition of calcareous manures to soils deficient in
lime changes both their physical and chemical characters,
and if the other salts necessary for vegetation, be either
present as constituents of the soil, or be added in the form
of manure, renders them fertile.

Chemical analysis has shown that lime and its compounds
are present in all fertile soils.

"We would hope that those who deny that lime is neces-
sarily present in all fertile soils constitute but a small class
amongst practical agriculturists.

894

Tertiary Lime Formation [December,

To place this proposition in a clear light and to demon-
strate it beyond all contradiction and at the same time to
develope important facts to guide the planter in the appli-
cation of lime to various soils, we have drawn up the follow-
ing tables which embody reliable results obtained in Eu-
rope and this country.

In every case the entire series have been selected
so that the examples brought forward to prove that lime is
a constituent of all fertile soils are free from every objection.

TABLE 20. ANALYSIS OF THE SOILS OF DIFFERENT LOCALITIES
IX EUROPE. KANE.*

1 No. 1.

Each soil dried at 100'

CONSTITUENTS.

Potassa

Soda

Sesquioxide of iron...

Sesquioxide of manga
nese

Alumina

Lime

Magnesia

Sulphuric Acid

Phosphoric Arid

Chloride of Sodium....

Clay

Sand

Organic matter, re-
mainder of the mois-
ture

Loss

035
o o

No. >.

0 160

! 0.298

3.298

trace.
2 102
0.357
0.202
0 . 025
0.121
0.017
14.920
75.080

3.123
0.297

-J. ,-h

5>

O O

0.123
0.146
1.663

trace.
1 . 383
0.227
0.153
0 017
0.152
0.030
9.280
84.065

2.361
0.400

No. 3.

p ~

0.068
0.110
1.202

trace.
1.125
0.481
0.140
0 013
0 064
0-067
5-760
86.797

4.209
9 025

No. 4. | No.

3>

0.151
0.206
1.543

0.988
0.366
0.142
0 . 026
0.193
0.009
4.400
S8.385

3.672

= 2

_

C_

8.*

0.583
0.306
6.047

trace.
5 626
3.043
0.105
0 023
0.159
0.023
17 080
60.947

5.841
0.217

No. 6.

uao

-i O
O (

100.000 100 000 100 OOo! 100 0811100.000 100.204

0.534
0.0S3
4.510

decided trace
3.065
5.538
0.052
0.113
0.222
0.067

SO. 702

5.328

'Phil. Mag. [3], xxxi, 36 and 105. Liebig and Kopps Annual Report in Chemistry, &c., vols. 1 and 3, p. 32S

I860.] Of Georgia.

TABLE 21. ANALYSES OF SOILS OF EUROPE*

895

CO "*

,^

CO rH

^,

-

u

c: -- i

< r-H r

o 5

. O

-

*a

T3

a

3

CO

C

9
4)

ft

5

-id CM OOOOO "r-iOr-iOOOO

-.' rH r-

00

g

*1

ac eo os

NC i 5 - 1

i :n -

, -

~Z

5 S oi

- :. - - :. m -t -t ::

s, SB

:r

' co d is ? i d d ih c'
to

-_

rH -f

Mf

r- O* ao*

<z><6(6<<z>3*d>?\^<6<6<

^

O ^

d d

.

-* "* 1- T- b

1(5 fl O h O it r. fM :M-

r - J .-.:.-/- r.

o

C
S3

. E

i

r i-.:oxh<h<h.--

5

Mr-HOOOOHOO(Hr. CD 60 r- O

ModRo'ddddrido'do'dd

' 0 d ' -<r -

T3

i-

O

|

MS

3 g

i ao ao

l)Hi|- 9) - CNO J)
)QSO -d< CO : l

LOUS

2.671

1.078

0.732

o

l-H O r-l

o

Cj

-a

30 f< >.0

d d <n'

5 i i-H o t: o o
e ' c> * i-i <6<6<6<6ii

o
d

o

rH

.

i

o>no)

rH B rH 31 S IO O 5)

eo -H4 o >o -h<

CO

d

g

/ - :i :

CM hJ< to ~r 09 <-. 39 oi

co i~ eo o >.o

CO

fl

CO

n

-r 01 -7. SC

rH c bq soee^jq

O CO CM 'rH -CO

(O

C

<

o

ridON

d " ' d " rH rldddd

' e d cm' ' d ' d

co ,

09

r~l

c3

a

K>* Oft m

s te 01 ~ oj

OO 9k CO -o

t~-

^<

i

cc

cocoa r.

a do hB -h oi co cc

O O Oft CO o

CO

O

bC

rr-CiM

go Cft 00 00*0 hJJ o

- - f3 CO -HI -TjH .

' co "do " eo

iq

4jJ

rt

ri 6 O N

id 'd "d 'i-idddd

r-i

a

co

o

ci
O

-a

rfl

OfHQ

CO J rH -* r-H CO O O

. * o mo i~- >o

co

,v

I - J - - - 0

^i r. co i-h n r. :i i - :

t- CM >C CO i-H OS

n

00
H

o n-o

O O CO I- IO -# r-i -^

-^1 tH O "^ " r- CO

CC

o

jidoio

d * d d ' >--:' cm d d d d

' r-! -r> cod "do*

d

en

+

o

~-

OS

r- X i- GO

i> >e to o !-**- o r- eo

O OS CM tp -& Ol

i *

CO

4>

V

b>

09 09 09 CO

O . . ;o 1- '-O CO r- r. :? .

S O t -rji to CM

-*

pq

*

>1

CS

P

rH oi to n

cd d d t}<

_rJ - :: i- 0J)Mr-i
^3 ' ' d cm d " ni d d d o

-r c: oi cm ttn

" oi * " * d d r-i d

CC

d

s

1

i-

o

1 . . .

o o o

00 09 "M 09 SB JC '0 >~ t- -S

CM t- X O hi i n

o

S.2 g

ih O CM

>0 D O O 'CM -t--OS 00 CM C

^t< OS -i* * CO "* CC

o

CO CM i-h

D Z D C_ Ci -rti uo O O O

w c oa Os c5 CO O

o

P5 0.2

r-id *-T

* d d d o * cm ' d d d d o

" eo' >d ' d d oi oi r-

CO I-H

o

a bb

O l-H CM

r-H - -M O -* CO I O ' 0 X

CO rH 01

co

-'. ~. '! ''.

O c ^* w >; oo r_ oi -M

CO rH *- i-h

o

"S S

* d d i-i

Id Idddrndodcq !

'.aa **: * d

Oi

35 *

1 tli

si

a

2

CO o

05
Ol

O CM lO

r-H o t- -CO t- 01 :: >~

r. i- oi eo co eo eo

~

Sgg-

3

E ri

O rH H c-. OH r-< o

Ol i-h . 31 ro 0-1 cs eo

OS

.

^_

rid H

'.<6< Id '. z> '. d d I o* d

! t^ i-i ; co d d i-i o

31

> h h

o

CO

31

rr:

~"

g I

eo .- -# .

ooooioe^ai> x :-

lei -. iioc

ir:

CHJ1 .

OJ -r D O r i-j OS t; rH 03 ff

01 i- -CO . lO^l

3

te>3 s

s$ d d :

; o d dodddoio'do'd

: d r-i : d : ; ~

co

co

-.

Cv

. . . 0)

X.

. . .IB ... .

o

. . . o

c

a

e cj

a o s

S o co

o t

ts

c ^

5 i a ; : ; ;

* "O ti

o 5

g :o : : :

1 8-c

a

^2'I'S ^ : :

id'S

: r] o-r * M M -

ci ;

o s * m ) -.2 :

c*itca5;s'S5j:C5oofl

'3 -

tj"ooB :/.-

boo fijs-r 5 O-o'S'S'S - 2i 22

ilori

icic

s([ui
squi
umii

ne.
igne

t;iss

-._ .-> * 3 ja aa z = 3 5*3 .SJ| o c

~ c -_, .~ - 0 -

I

U S5 ffl O QQ O U DO Oh J. XX<-<H,a

O y. x oq < ^~ x

;

Q

s -v '

^~

9

2

|

a .

olublc
i dilute
iydro-
hloric
acid.

Inso-
ible in
dilute
it dro-!

hloric
acid.

1

w

BQ.S* J

_5 - JS O

'Annual report
vol. lii, 1849, p. 465

896 Tertiary Lime Formation [December,

TABLE 22. ANALYS )ILS PE.*

u

o
M
o
O

E

M

9

"z

~

3
FH
-

o

c

71

3

i- '0 X 71 -r- ec r. - -
j z 7 I 7 i r. r. ' cc r_

i-J CQrH i OHOHC

7i ' ' tj* O* OOril : 5 D p

o

X

-' D
X

L408

x

s

X

--

:

"3

1.84

0.18
0.52
2.45

0.009

1.60
0.20

0.18

94

' Z

KCpOCON

c .-. X

z ridd

-

'7

z

a

9

o

- z

-
i -

rA<6

8.615

o'.oio

0.077
0.040
0.057
0.701
0.459
trace
0.810

2.1162

0.641
0.102
0.047

t-

z .o .--.

71 71 71 7: Z -:
' Z ' Z M Or! i-i

X

X

:

3a

:_-

t-

U

9

pq

n
a)

tK

99

=3

cm

o
"3

X

* -r-
_ 7!
O "
D

0.017

0.101
0.081
0.012

L55S
trace
1.184
0.978

0 "1,
0.121
0.095

89.908
0.768
trace
6.145
L.901

0.217

0.018

X

-.

o
QQ

tO BO

71 '

::
rn d

s

0.004

0.040
0.107
0.008
L.680
0.119
1.690
0.166
0.148
0.122
0.095

| 8.045

0.868
0.155
1.884
0.868

r.'

o
3D

'7 71
X
71
r-i

71
>7

7>
cm!

0.006
0.005

0.040
0.100
0.014
1.652
0.194
1.576
0.1 11
0.186
0.104

L.400

0.860
0.940
1.040
0.890

X

EC

33

3a

1 Z

d

C

o

ffl

a

c

N

rC

0

c

-S

O

X

pq

Cm

0

3

.

:^

o

O

w

72

o g

-.

2- X BC BQ
71 . 71 O

3 C r. Z

71 35 - or r O t: - -. r. ::

:: r-.7l- QOOOOOOH I- 71

71 71 c r. r. ol sc bc

odd ' 3 i: ed

CO 1.7 71 X ^ 71 -1 x --r

o co i- 7i - r r-

>OOOCOOOO)C>

*

r. . - -
C Z i-
t t- CO

' r-<

.r-ioacc

X X M 71 X

-

' ee d O i-4 o

-71 71 X 71 O C Z 7) 71 X 71 -

S - BC CO - CT X 71 1 - 7! CO

i-m i-h >oo,otoHioa ;

r-* cm' do * cm' rH d

r c t: r r

X X 7 1 x

71 -r '7 -7 X

c o
- a

j -

-

o c>
w s

SO C -. CM CM CI

X t^ o -t z

00 C I - o

rH *

17 f- ~ BQ
r cr CT -. 5C r-\

^T 71 rH O

BDNOOOOOC X
^- :t ~ ct l-

i-h rn t-0-r-00

I rH

r: O O N 7 O - I - N " O

- x bq - '7 r x - r ~.

c = : = 7 j z -r 7i

'oOOOOr-idvio d d d

i- - . - r. n -"* c:

-. :: :

. t- cc :r ct

' .7 ::' d dr-* '

lOCOCS 71 X C7 71 C (- - 71 71 < 71 r-

l cr i - .7 :? Z Si CC 71 :: 3a Z ::i-

r. r r. 3, ~ O o O C -cOi 7

CCNOXON71X
! - CT X . .

iooooodr-ioooooo ' cm ddddd

m ? a -

_~ 0 _-; -'

u S5 a o x

o *

p of]

5 2 . o<*

2 c H ^-

-5-= :^-
-7. S = -'

Z - c-
Z 3 tX

- w H X ->'

-3-33 =

: x QQ x Z -:

y. 7 _3 =
X 6 X X X <

~ . - '

111

i
i : *

00 c o

- - 3 .5 _

HUM

Annual renort of the Progress of Chemistry and the Allied Sciences, by Justus Liebig and H.
vol. Ih, 1S49, p. 4C5.

Kopp,

I860.]

Qf (,', orgia.

TA1

-ANALYSES OP SOILS OF EUROPE.4

__

-f ' M O

0

!:

o*

w > :r o i-

S

-' ' -*

&

m

i-I c

1-

O

>-~ '

CO

r.

a

1

}

. . 1 -

5

'SQOOQQHHH^gOHC / 1 -

-

0

o
X

l-l C M " O i-h ,-** ,-; o ;' D =j ' Jjj -" '^icj " C S

= i

- 3

BONO

I - :
*rl h Z Z Z z : : SC

0

1 1 - 1 - 5

so : s [ddo'd * f-< d

0O1H cr ~' -< i-i ~ d

'

h

p

d

"228S8S ^'^';= -O -OOOOOO CO

c / .-. i - o i i co O eo

-

- ' cm - " - -' >> "' -> :t cm cm Z cm . bq S cm -m .- /

Q

O O O O O O i-H ' rH O O O O * T. 'OOOOlHO 1 -

- ;

'8

t^

j

I

N

h

I-

-CO CO I- O CM CO Cs Ol -NCOONN **

'

3

' ' -. ' -'. "~J **: "^ a

; 1 - t - :::.-..--:

. 10

'D

~r

' " ' i-h (M* O i-i

O

' -

CO

r-

- r

PS Bja

" I oc N r -- ee

;>i 0 ^ i- r. ?i h 0

B

3

T. o - z z .oa ^coo o

"\ '. '.' T! *\ ~: ^

BO

" >' 2 o o o d

ic i-I . CO rH i-i i-i 0 d

f-

cr>

t-

~* ~^-

jj

d

c -ioho fr- i-h o <yj

<M Ol CO O tH iH H

<M

* T1 'Hh-QOO -- r '**< - t?i i~ t- n - N C 7

i

_n

1 - - - 1 - 'OOHffl tt ^h , c O t~ 'O CO CO i-H Tji >r

CO

h

jt

i-h " * *f-iooo'o "t^O 'eoddric

d

M

co

30

J:

O .-( O -* TH .
CM CM CM 1- X

i
0

z

3

. . . . ^ . egoo <

e

g

BC tjh it D rH o

1 1 as '-r r. 3

i>;

fcSj

M " d ' S d <z> <z~' '

' >#' oi d d ) '

X

d

39

,w

~.

1

i ,3 - f.

-

o o >e^i - to eo o o

O "* UO t- t}< IuO C

<*

'TN i- -O i-i O 'OB >0 CO i-> cj

I ' I-H ^ IO CO 10 0

OS

2 S

X

t-jC * -ft 0 -IOOH cj

35 0Q " X 1-- 1 1 If

I-

8.0

do r-J ' -S "do" ' o" "dec" ~

Oh 'ridriric

00

d

s

oo * '"

!

s

71 M O 39 >~ r- X 'Z ea i- it -r r. X 1 cr 8C f- cr i-

*

o -

<t i - cr :: : i: :i : : 'ti-i-:. mti -^-i- r > r^ < ' -^f -rt

X

i fi "

3D 39. ,- S r - -_ 7! r i- -r - 1- 9Q s> BO cr eo .-_ z
! i ~ ' SO rH r-5 D i-J i-J tjJ -*' odd * 00 d " -J 00 O f-J c

cr.

OS

be

cr

r- O o cc cc o i-t c: x x o so 351CC

,_

s

>

t- -m ?i - / x ec c & *oa q

-*

^

o

. -. _ . -q, 0 * jiomi-o a t}< c-. t- cs

^*

u

if.

o*

co' d ' i-J 0" i-J "i-i " -* cd d d d 'co* 1.0 t^ e4 *

to

CO

i__^

p

I I

w

X

.

1

0

O CO c

0 0 0 0 0 0 c

0

. oh 00 ? r. -.= cr tr

os oc 0 co 10

CM

N -r

1 - .- "* 0 g t- lOHiqc

' " - ' '""' '". '". "! ''-

CO

CO

" ~

' ti ?i i

'^JL-

CO 0 0 c

' 83 ~ ' CO* O i-<' 1-

0

. -_ ....

. . CC

M

. . 0

ca

C

a zt

Z bt

0 bC

j . j ; ~

.z.

z,

ss's i'sa

rz
7.

a H

O 2

at -.H c

~ ~ ~z 0

r

aoloSRHji .2

*1 S h cj :-2

- C C - . '- cj

z I

Ud S ti'S 2_a O O a . go ~

X

3d .r

J

^ /

350 m ^ i x og ac tn < p= x

w x x x < S x

t

0 t> , ,,

c ,

ci

'S

-

c
7. I

"IsS ^

'3

/. s

S ~

O

* o

x = "J

'Annaalreporl oftbe ProgresB of Chemistry and Allied Scieiicea,by J, Liebigand 11. Kopp. roLS, l64y, p.4t>5.

808

Tertiary Lime Formation [December,

o o o

oo

a

' ." o

2.77
0.01
1.69
0.23
O.IG
0.39
0.11

co

OB

oo

9
eo

"
5

oc
co*

. OC

. eo oq oo io eg io

l-H I-H Tjl O CM H

CO

os

CO

. . .

cm cm

9

(NOhOOOO

bvt

X

,H

u

9

-

o3

1

U

t3

p

c3

f-

1

e

*

S

a

Jl^O

C,'

BO 2

K-2

5 a

t2 P

3 rt

0

QQ

X

itj

7i

3 3

E

WJ5

CiS

^ P

co

. . CM

. ,

<a

i.O (N M 00 OS X

0>

. io 04 . . .

*

eo

. . . co eo

CM

O r-

"* 1-

o

. ic > i . .

oo

C3

*- CO CO lO

oS

..t~ . . .

M

"*

' *

* CM

&e4o

" >o cm

-

CO

OB

>*

r-l

-

o on

CO 1

'7 CM *

. IO oc

"*

CM 00

OS

0-<*lOSCO">r*-tJ<-^<OS

a

. -<* r

co

I-H

. f-i

-tf H IO

3

. CM 0C

-c*

"3<

''

' CO

-3 cm

' CM "

3B

co

36

oo >*

1^

SJCOCM-#CM>0

v

. tj< CO

*

CO

oo o

s~

O i CO CO CM CO CM

g

l-H X>-

eo

C3 00 1~ il CO

T 1 1C

S3

. H 00

QQ

Tt<

7i

* T 1

rH

J3

CO r-l

CO

93

K.

*

-*

i-

<a cm

UO CM

0)

.^ a> . . .

- >C T}<

:

O OS

I-

>* -C*

eie

i

ea T-i

CO CM IO

9 cc

. so as

-3 i i

OS

. i . . .

a>

.fl

-t^>

O

n

"S

JZ

O -> X

o

,

<D P

tea

Ul

*- a3

P

*H 0> * r-H .

co o os o

co e3 co os

' ^3 ' oi

Q> rH r-H

O CO iO

OS # CO

is ' ' '

as s

CM O

CO 03

r, cc

>.o c"j

CO CO

co o

-r* o
1- C3 xf

43 CM 43 r-l

-* C> co * ~ eft x
os o co z. co cr.
cm p 1- IC. : 3 30

i-H 4^ i>* ' " CM

!

K.'

r-t O >0
CO l-H CO

CO
>C iO
CM

Ci
-- 9
IO

2- J-
O CM
00

o

CM -^ CM -CM CB

''' " -*' is

CO
^ CO

t^ CO CM

co 'CO C5 rH co

i-H i

co
Tji

t^ I-H t-

7

W 2

- s

COt~ OHM

CO ^ CO O r- . -+ CM

r-H-J1CMCO 08tHCM

l-H " 4* "

rH o> OC CO O CO
CC CM CM i-h O IO
CO CS OS OS CM C3 CO

4^ "'' i:

co oj i~ io a>

CO W CO CM ic O
* OS 03 CM 00 ** 0 SJ

CO r-H CO CO t ~ S-5

-^ co co cc ~# i-h

OS rH IO CO

''' "'

1^ i-H CM r-H
CM "

OS IO i-h . . ic

_-. . ~ ,_ . .00

CM CO

CO CO* * " i-H

co oo -^ co ^

t CO 00 CO CO

CM ^ r- :o

a

C bXI

OJ "

S'C o 3 h H d
p - ~ .2.2 c

;g SvS'C SJ5Si2'i3*3*3

. . . . a>

: : :c 1

: :.h to

o . a

: : cjc:

.{T3'T3 O

OS5

WOcQQQaoPkQD y. v. < S x D x x x ^Sft x

c:-^ cc

tX 3 -

2s?'

,.2 a> o.H .

o -e &- t-T3

* -3 ^ 'O "S

^^3: iC-3: C3

IS.il).]

Oj Georgia.

899

Table 25. 1 'omposition of the Boils of Massachusetts,
ikccording to Prof. Hitchcock. Geology of Massachusetts,
by Edward Hitchcock, L. L. D., vol. L, pp. IK \?>.

NAME AM) LOCALITY or THE soil.

a

i

o

r
g

J-

1
E

c-1
8"

-
3-

o

S

a>
O

r

3
o

6.2
20.3

/

p
ST
Q

re.

n

9.8

2.3
1.3
3.8
3.4

3.2
2.4
1.5

i ,-,

1JI

2.:.
1.5
4.S
4.S
3.9
4.4
3
o,:
8.3

8.6
8.:.
0.0
8.7
0.0

0.3
3.2
6.1
4.1

7*.6
4.4
6.0
3*1
2.1
1.2
2.1
."..4
5.f
3.8
3.8
4.7
2.t
9.5
5.0
6.1
6.2
7.9
4.1
4.4
3.0
8.1
r. .1

0.7

2.-
2.1

1.1
3.1
.-. j

Vi

2 7

v.

6.C

6.1
8.(

6.1

6.:
8.(
8.1
8.8

a

.

g

ST

C
.

I.:
1.9
1.1
2.4
J s
0.8
1.2
i 7
J 3
0.8

i.

1
S

y
B9.6

94.1
94 i
92.8
98.2

96.1
09.fi

.81

b\

2

\?
8.8
3.0
3.1

1.2
9.9

1.4
3.0

1.9
5.0
3.5
3.0
1.5
6.3
6.1
4.9
4.9
42
0.5
1.7

1.7

0.8
0.7
3.4
8.2
2.5
2.7
3-0
4.5
3.9
5.8
3.1
1.5
1.6
8.6
2.5
4.6

1.0

2.6

1.8
2.S
3.7
5.6
2.6
3.5

3.0

."..i
8.:
2.8

5.5
6.0
3.0
5.1
4.5
4.2
5/

4.7
6.8
4.8
0.8

6.:

If

h

; 3

~65.

40.

25.
58.
38.

1

18.
100.
70.

40.

30.
126.
122.

98.

98.

84.

10.

34.

34.
16.

14.
68.
64.
50.
51.
60.
90.
78.
116.
62.
3d.
82.
70.
50.
92.
20.
52.
36.
56.
72

ii-j;

52

70.

60.
72
70.
56.

110.
120.

60

102.

90.

1 84.

, 11".
M

io.;

64.
180
M
18

I 124

V.

1

OS

15

a
9

Alluvium, Deerfleld

0.9

L.e

0.9

1.1

0.6

0.7
1.0

0.8
0.5
1.0
ii.:.
0.8
0.5

o!s

0.9

0.6

i.i

0.4
0.(1
0J

II. '.1
o.os

0.35
0.3

O.T
O.t)
O.S
07
0.8
1.0
1.4
1.4
O.S
0.5
0.9
1.6
O.f-
1.1
0.8
0.2
0.8
0.6
2.0
0.9
".:>
1.0
1.0
1.0
2.0
4.2
fi.O
3.3
0.6
0.8
0.7
0.7
0.6
0.7
0.7
0.5
1.6
0.6
1.0
1.1
1.5

1.9

1.0
0.6

0.7

J.I
1.6
0.9
L.6
2.8

1.3

3.6
0.9

2.9
2 -

L7
O.S

1.0
2.4
1.6
1-8
0.9
8.0
o.t
1.6
IV.
jj5

8.8

0.1

O.S
3.2

2.44
3.45

do Deerfleld

2.68

3*68

do Northfleld

>l" Norti ampton

do \V. Springfield

do Westfleld

2.55

S. (6

do do

do Stookbridge

do Hadley

do Sheffield

do Deerfleld

2.8, 91.5
5.2 91.8

2.4 98.6

1.5 95.5
6 B RK f

2.46
2.66

do W. SprlDgfleld. .

2. i.il

2.81

4.6

4.9
:..9
4.9
0.0
0-0
4.4
2.3
0.3
l.r,
0.0

2.6
0.5
1.2
4.2
1.1
2.4
2.8
0.8
1.2
o 7

lis

0.8
2.3
5.2
2.4
1.5
5.S
4.6

4.!'

5.9

4.'.'
0.0
0.0
4.4
2.:
0.8
1.6
0.0
3.3
2.1
2.3
1.5

2.H

5.2
5.3
4.2
5.2
5.1
3.1
3.4
5.5

3 e

6.8

:>.:
2.-.

1 7.0

88.9
89.6

88.9
88.2

9-. 7
-.14.6
91.0
90.8
9*.S
T8.1
99.6
LOO.
96.6
92 5
90.1
B8J
94.1
97.5
88.1
-1.2
S9.2
92.1
92,1
90.0
92.6
94.6
92.9
91.7
90.8
-.12.-
37'0
85.0
87.0

S2/2
91.7

'.10

89.2
92.(
98.8
92.1

94.3
94.6
91.5
*7.>.
97.6
90.0
86.1
87.4
. 99.1
B9.7
89 -
B7.J

-T.i

8.8?

2.34

2.89

-'.'7

de Sandy Warcham

2 .37
3.60

n 07

do Sandy, Sheffield

2.66

do do Truro

i\o do Barnstablo

7'1

do do Gloucester

Sandstone, ( Red I 1 >eerfleld

2.71
2.53
2.43

do do Wllbraham

1.0
4.2
0.6

2.6(1
2.46

2.51

Graywacke Soil, Dorchester

1.8
2.3
3.1
1.9
1.9
2.1
2.4
1.2
1.9
0.3
1.8
1.8
0.5
1.9
4.6
1.8
1.0
2.0
2.:.
1.4
1.1
1.7
1.5
Orl
0.8
0.6
1.*
2
8.9
1.0
1.8
l.')

1 0.9
U
>

1 0.2

1 I

2 0

l.r

i.'

1.3

3.0

1.5

08

0.8
3.2

1

1

1

2.37
2.43

2.34

do Walpole

2.31

2.34

2.4-

2.44

2.40

o 1^

2.45

2 45

2.44

do Attleborough, east part

2.48

2 21

2.25

2 .",2

2.31

2 35

Limestone, < Magnesian) Marlborough,

2.4
2.89

: 56

2.46
2 58

do do Richmond

2.39

2.46

2.89

d >!.. St.^ki.i-id-c

2.45

do do l'itstield

2.39

do do Sheffield

2*1

2 8,9

Mica Slate s.ii. West Boylston

do do do Webster

2.31

2.81
9 99

do do do Stockbridge

Mica Slat.- Soil, Chester Village

do do do Bradford

do do do WestNewbury

do do do Methuln

2.40

2.41

.,.,,

do do do PeppereU

2.27

I

900

Tertiary Lime Formation [December,

TABLE 36. 80IL8 OF MASSACHUSETTS-CONTINUED.

NAME AND LOCALITY OF THE SOIL.

do do do Norwich,

<ln do do Conway,

do do do linsself,

do 'I" do West Newbury,

Talcose Slate Soil, Chester ."

do Charlemont

do Bucket,

do Howe

do Mount Washington,

Talco-Micaceous Slate, Florida

do Hancock,

( im [83 Soil, Tewksbury

do Stow

do Bolton

Uxbridge,

Mention,

do
do
do
do
do
do
do
do
do
do
do
do
do
do
do
do
do
do
do
do
do
do
do
do
do
do

Tyngsborongh,..

Hohlen,

Dudley

Templeton,

Rutland

Westminster,

Boyalston, ,

Fitchburg,

Petersham

New Braintree,

Palmer, ,

Enfield

New Salem,

Leverett

HardwicK,

Ware,

Grafton

Bumtidld,

Leicester,

Otis

Becket

Sandesfield,

Tolland

Northficld

Buckland,

Wareham,

Stonhridge,

Id

EX

9
a

B

<t>

o

"

g

p

i

do Bnmfielc

do West Brookfisld,

do Oakham

do Athol. decomposing Gr.eiss,.

Granite Soil, West Hampton,...

do Concord,

do Duxbury

do Andover

Sienite Soil, Lynnfield

do Marblehead

Manchester

Qlouchester,

Lexington,

Danvers

Newbury,

Dedham,

Wrentham

New Bridgewater

Weymouth

Sharon

Mansfield

Abington

Porphry Soil. Kents Jslaul,

Medford

Porphry Soil. Maiden,

do Lynn

Greens! one Soil, Ipswich

i\<> Woburn

do Deerfleld

do Belchertown

0.6
l.i
0.5
0.9
1.0
0.6
1.1
U
1.6
2.0

I'll

o.s

1 .0

0.9
0.9
0.7
0.6

1.4

0.

(I..

1.2

0

0.6

o

ii. I

0.8

0.6

1."

0.7

0,

0.6

0.6

0.6

o.l

1.::

1.1

1.1

L5

1.0

1.0

o.7

o.l

0.4

o.r,

0.6

o.:;

II.

0.8
0.5

n.T
o.r,

0.6

o.i;

0.8
0.6

O.T
0.6
1.:;
1.5
0.7
0.7
0.6
0.8
0.8

0,1

0.8
1.6
0.6
0.2
1.2

l.o

II

!:;

8.0
8.1
8.7

l.l
2.6
1.7
2.4
1.6
1.2
2.0
2.1
J :'
2.1
o.i;
l.i
i.:i
2'7
1.'.'

2 2
l.*9
l.o
2.4
1.7
-'.1

V.r,
2.8
2J
1.9
2.1
l.o
2.8
1.8
2.9
2.5
8.9

l.o

2 A
l.i
J.-",
1.1
1.6
l.l

3 7
l'-J
1.6
0.8
1.6
1.4

0.8
I.-
2.i

1.0

l.o

0=8

1.7
1.1
1.6
8.3
2.6
8.5
1.8
0 7
1.8
o.l
2.41

2.0

i

6.0

5.4

5:

6.0
5

3.2

;.:;

v>

5.8

3.9

4

8,8

3.2

5.2

l.o

5.4
2.0

o.l

o.i;

l.o

4.8
1.2

4.*0

5.1
5.1

6.5

Ii

u

7.o
5.6
2.2
2.6

<;.;i
1.9

2.7
5.7

S.7I
5.2
U

'7

c

b

f

.. - -
- - .2.

4.8 a9.8

1.0 90.7

6.0 -7.01
.-..7 B5.5

2.1 92.8|

2.2 92.0
2 2 -2 0
4.6 -7.2
1.7 B7.5
J.4 34.0

2." 8.2

I 2.8

90.0

-:, 1,

8.0

90.6

91 A

1.8

1 7

l.i;

4.1

5 8

8.6

B7.9

.;..-,

4 -

-7

6 :;

BR 2

_> -

^.^

4.9 84.4

2.7 91.9

8.7 89.5

1 '.7 91 5

2.1 91.2

2.9 B9.1

5.4 -7.0

i

2.0 B9 -
0.6 95.8

8.8 94.0

5.1 91.8

2.2 91.8
5.8 92.1
4.U 92.4
2.0 88.8
2.0 92.5

-0.2

98/.
87.5

88.0

86.1

-7.7
91.8

1
<>.-2\

I 89.7

3.1 1 83.
3.5 70.

6.8
2.8
8.6
8.8
8.8
8.5
8.4

5.0

5.8 106.1

5.ll 102.1

4.6 92.1

5.4 108.

8.4 68,

4.5 90.|
6.7

116.
46.
70.

8"
lOo!

0.9
2 -

8.0
8.0
2.2
2.5
2.1
1.4
1.4

4.0

2.8

,.:.

.'.,'

8.6

4.0

1k\

121.

98 _

los.
71.
104.

88.
B8.

n;.

80.

56.

130.
100.
106.

124.
-<
74!
80.

71.

51.
6.8 126.
6.61 182.

6.8 136.

5.9 11-.

6.0 120.

SOILS OF ILLINOIS AN1> OHIO.

Bushville. Illinois I 0.6 3.4

Sangamon ( 'ounty, Illinois 0.4 1 2%

County, do 0.4 1.4

Peoria do do LO 805

altey, Ohio I 0.9I 2.1

1.5i 7,1 2.".

1.3 4.9 6.6

8.3 7.6 1 18.8

3.11 4.S

UP 6.7

84.6 6.::

96.6 6.8

B7.6 5.7,

88.01 5.31

GO.]

'[I Georgia.

901

oTangane
'hospha

- 1

1
*

of Alu- 1

>o

|

to

Vlunihm

1

f2 9) 3 yf cn >5

s

8S

1

">

n

^

1

of Iron.

1

8

- to

9q

r~

o o

>0 T

M

Phosphoric Acid . |

-

v

tf

Sulphate <>t Llmel

3

_

i

cr

Chlorine

o

-

CO

K

n

Phosphate of

3283

B33S3

rv|

Carbon

Potash 1

S

u

H

Carbonate of

o

isia 1

-

a

1
Magnesia

UNO

oo co co
3 _ v .-, _

go aen

88*2888. i?

" ''-* *

o o =' * 2 6 S 2

P

Carbonate of

5$ s

-

= -> io rs =?

<c

o

<

Peroxid

e =

-

:-< - c: =.

oe

w = =;

-"-o

a l: u ^3 co

O

8 of iron

Sis

S8PS5S

00 >0 t-

co ~r nw

Zj

niul alu

mna

N i<3 (M (N CO t (N (M N

K 0

cn cs r

CD CD CD =_ 03

Oear*>oc>coe -

X

c-:m-C--

S

=S Co CI 91 EC

t^^r-i~t-t-cet^cohtt-.:

*

Organic

SS

X

= >~ (N C
~v ~t \2 ~ =:

IN c -

HOOM

><

3

WCNCN

V t" 1- co <*< oc

_r ~i r- 'O co cc c< M N 0)

CD CD C3 ~ '

;; .- _ ,-

-

u

= S ^ *: -

.- o N

~ 'C

N Bj

K

-&n

e ? r~

''

<

fc

fc<

o

*J

m

jS

J

-

i i

o

^d

2

cc

o

, , , a , , ,

W

pn

O i

3

J

H

fej

g

_-

3 gOQ

MI..

o 9
gj -

c c -" ~

u =H = "3
= - -.T rj
gS.oo u

O

o

o

*->
en

w

si
H

3
A
u
o

Q

<

:

"3

X

v.
O

o
n

*3

*5

"3" "

Si

o

"3 : -'

-

rpisaa- -

3 C OS - -* X -

ta g 5 s 2 o-S =

ChU KS W m CtJ {? fe

.5 g S gg *

- ^ dd ^ ao o 2
5S S 3 3 s

1

CO

u 2

'3 !
CO

1

S33SS3

3 3 S S 5 3 3

(M

2

;j

3 S Ms 3

o

J

no

0

^T

3 3-333

r ; ' z

3 3 3 3 3 3 3

CT

H

<

3

3

VD

H

25

pa.

w

Q

<
0

=

3 S g^S 3

P

n '

:;::::

z : ' '

3 3 3 3 3 3 3

u

o

<

1

a

H

002

Tertiary Lme Formation [December]

pq

<!
H

Potufa

*

Phosphate of Alu-

8 a

Aluniina

Peroxide of Iron..

Phosphoric Acid..

Sulphate of Lime.

"

5

C EN c <n
-<r <N CM

Chlorine

CO

o

Phosphate of
Lime

s

Carbonate of
Potash

Carhonate of
Magnesia 1

Magnesia

^<

s

-f -r 'r

'

'__

trace
.86

3.0(
.70
.22

" ~< '" 3 -. ;-. " " - "' <= n y 0 -j

Carbonate of
Lime

~M

:

X

i .~

2

;j

^.^.~.

M :-'- -1 ' ' M -J -j: ~i ' -i

Peroxide of Iron
and Alumina

to

_ o o _ s
T t "1 *9 "3

ID co c' so' tfj

EC 3J - "I

:?

N N - '0 -r ~ _ -.0 M _ ^ ; ; . ^ _ 1 - so

~ , : ^ ^ "! ^ ~ -. -. *"' -. ~i 'A -. ~. . - -

35 :: of f / SI C0 7- Pi 00 CO03OO0D09t090Sr>

f es

~

tO

s

t

c cc in

0 N 3:

X :c -.o t-

X

s 55ISifl so c 35 c

10 f- cc r- : c: 73 -.0 -0 r* c - - 3
xt-^i~^t~^r-K:: s r- co -o

Organic matter..
Water as moisture

Eo in 55 K 5 2 ^ c 115
r^ -7 ^ * <N ed -<r c: to r> -

*0 'C '-t *C C :c C ^1 ^0 3

53 NO>OOOt< N ~i -~ "< t- N "5 00 CN l>

-r rj -r -" >* n *C '- =; CO ' >fl -r -~

_ :c

<N to 10 CO cc to 'C 7< t- W 10 -: IQ M

cni^ e~co<: c c icl

< o o 85 o
rr c^ e>J n n ~~i-i ~ <6 n

- ' S =rr
'rm '^ ci a

* ^ a(3

WH

"- _-

s

a . ' = C
I ' J= z

~ - ^ *

. - X =

- V. 00

0

wX '

J 7 --:= t.

< 1

v 0 0 0

.Cj X 0 -

= u.o

H

0

ta = s^ o

f. CO *5 /!

si

J-l

<

- >

X

0

55

3

a

H

E

60.]

Of Georgia,

Potash.

M

n. ilia

Peroxide

Phosphoric .viii..j
Sulphate of Lime

Chlorine

Lime

Carbonate of Pol

ash

Carbonai

i ed i

- - r s 1 - 1 .

,--- a

tte of
Lbue

-

i : -i c .

and Alumina.... "L " H' "-,: ' ~ :: ~- '

(eioooooa o <e > ic > <

. - - . . - i - 1 - : .

:' -': -Ti I

i - 1- t -

-

Matter ..

- - 1 z *:

- ! SOt-

. W K3 .-

-

ooonoi i-

/ - z - r 1 - Z

am

(Nrj.-MIM^ -Tl ^J

CC -J> i - -c / - t~ -r -.c -w .r.

1 1 '

a- - *3 . -j

=:i

e 'Bo'

. *'-_

o g
-=

S | B.w5

t| lis i ill 1

Il^fgfl&S'

* - - - =-'

004

Tertiary Lirm Formation [December,

71

pq

<

d *

2 23

s 5

50

3 J

^

- -

X

m ci r? ci i

/. i-i-r. -c /. i-i -i- j. / ~ i- - - : - .-i- j

SO K5 I - C 1 I - I - -
; r ^r r. -:/. .-. - z -_

li&gne

Suits of Lime,

ron and Alumina not -^;: '-^. ".-.v. -.:-'." '-".-.
separated , -^-^i"5" '-'-'- " 2"8"**"0

Alumina,

Oxide of Iron,

Insoluble Silicieus Mat- ~.':'."-'- - -. .: - -. -. = . ". -. :--_- - -.='.-. '.-. -" '.
tor,

Soluble Mineral Mat-
ter

--

Vegetable Matter,

t4 00 iO OS OS -t -r C i 3

- -- : tOC <C

Water

-

>>fl D,
~f

III

w P r- -

:

as o ; j

"Si o : "3

I.. fc

a - .as

: I*

~"i 7>*#l

B-= *

" t-._ - - -'.

1-5 A

x^^^^ -/:>', s

aff ffl _

' 'i- -=?-

3-s - a

12

il

SO, .= - - SO

o _~ -rj3.Si -i! - - - - - ;

I860.]

Of <;, rijin.

905

-
<

1

'

r

i

-

I' ass

55

.

o

a ooo

'

....

"odd

*

1

.

/ /

!

Iron ami

d oeeoo ~

-'-

....

3

Alumii.:i

'' ~~. -"" - .

.

ri ' '

rated,. .

^v

i- i-

o'i-i~ N

00 w

t-

',- 5

Alumina,

....

=

T -. I '

o*

CI O

^ K9

H ^)

:
ter

Jr. :.

Sill

_ -. 1 -.
-i '

so*

i c> -v ao*

....

M

CI /

r rt t - -

= / 1 - J,

- ':"..-

Minu.il

M:it-

.-.:

tor

00

-c '

r - i - i -<-- : -
l- 30 = ' I- - ' - ' "" 2

' ,' ' r

- Matter,.

-' D -':' " t

-' - r i - .- .' ed

i - C r - ec

eo<>

bq a> vh

- - i - *

Q * *

_ _

- 1' : :

' '.!': :

-' -

: : ! T ej

J :

a
o

&

: : - -I

s

.z.

>Be

-' :

; ; ,q E 3

II '

s*

|

-

5 :

B

ij ;

DO

3

i "

1 :

_ .V

>

-

c O

3D

a :

' ! - i 5

-

r

_2

--:

H

-

>>

|
at

go

o

i

_ 5

e| ;

S ;

: = ! '-~x~.

5

c

ii

' :

% l^t

2

a

J

-r

^d :

3 : : : _ : = = --

s

0

5 3

?

. z

:2

-i

1 C j

= ad

^3

Jog -:^ ia^

qa

"3

-

:

fljs

c

-r =

: 3
: >

C

a e

~ r r

fe

: o

\

<

- : a o a

w - -"---
r- 0 r -"

: <S : :#

O _ >

col

Z '

> r

3

<

>

1

1

gc

- '

a

= ~

i

7.

i

-

-.-

J :2

d d o

= <
<

i

2

-444i

_ :

S =5~"~ - -~

i

S3

^ =--

a

a

2

-j

E

90

906

Tertiary Lime Formation

[December,

CM

<

"l-"e>

- , _ _ i .
- .- i r.

. - . t A OS : : - z. ~ p i - : :

. I

Magnesia

d

o
d

-'

tr.

tr.

3

53 C

d d

Salts of Lime,

d~

so'dooo"

o^h*

-i ce > 6 1 1 . : : -. - : : i - c i ec ci j

o'o'dd - i - doddo ~
o

i Alumina not
separated

d so* oo os-J

f't -i-

:

i

to*

=. iq co ~< iq
' id .-:' i - o

Alumina,

1

1 S o
ci c> '

CO

1

O t- OS
CO* V ~.\

1-

<N

Insoluble SiUciousMat-l!

I I v= t-i- lO '

".x-.d:T.::.dd-i - .:

Der , i - osc-ooE-fc-r-oooo =-. l- 3000

luble Mineral Mat-; =.-.'% -". '! '.-" gw. -*: -I':-.r -. '
ItT cot- co oo .-

f - - - x _ C ?> c

\ egetable Matter, ^.^r^^'Txi:-;

'-.::. "'."".--" ~. ~! '-. ~-~. '-.': ".

t~ r-i -9- CC O

:I"

50
"2 2*

1 :

;*y . ,,c(

aSf% <fiji

o

es g - 60 P.

5 C S|S 3

:b :"* :

l$ih* \ ;

_ -~ . .< i '- '.

-/.--- .woo-y
a > gts-d z -

uooeo x; ~

W 9 I ;

^ t.g.2r*c

gwco'e "

DQ

r:.i'2

,2 ' -

a*

a '-

= = 5 8 8 8= 8l

tfe ^^

I860.]

Of Georgia.

!('

TABLB28 COMPOSITION OF THE SOILS OF SOUTH CAROLINA.
Report on the Geology of South Carolina, bj EI. Tuomey, pp

c

/

BE

/

~

r

i

ft

1

f

3"

1

5

1

C

a

B

0

1

NAMES AM' LOCALITIES.

E
B

re
0

B

a

0
F
a

2.

>
ft,

/

s

traci

.

6.20

if

2.40

Granite Soils l iilon

6.60

.20

.50

.. Hills. Grindal Shoals

.41

.60

2.00

.. Saluda, near N

Perry

s.eo

1.01

.60

BO.OO

,. in

8.00

.. Newberry

6.20

*!04

.Oti

5.20

1.78

.. Monticelfo

7.00

1. 00

' ; ';

30.00

j. 70

.. Peay'sFerry

2.00

.50

t raw

76.00

S.00

8.10

11.40

.. Liberty Hill, Kershaw

District

1.00

.40

74.00

10.00

3.50

8.92

.. Chesterfield

I. on

tract

86.20

6.60

2.60

: . . York village

1.40

"M

.08

71.60

9.40

Gnelst - i Id

1.40

1.01

80. 1"'

".i<i

VM.HAiU,-

1.20

.60

.7."

83.00

5.40

2.00

7.".-.

.. Tumbling Shoals

trace

80.00

7.00

4.00

".80

Lnderson

1.21

5.40

2.30

2.10

.. Spartauburg

4.20

J. til.

trace

2.00
.40

VM

.50

10.10

2.60

11 .80

(; reenvllle

3.90

. . Glassy mouutain, Green

vllle

f.,00
8. IX

"so

1.00
.90

.0(

l.OU

66.60
70.00

11.60

10. 00

2.40

.40

.60

.. PejidletoD

.. residence of J. C. Cal

noun

.80

.11

80.00

2.00

.70

6.80

Trap rock soils -Flal woods

9*90

2.60

tract.

' ! tc

52.00

22.10

9.00

4.88

Meadow Woods

.{.40

L.80

.60

trace

19.30

11. in

7.90

ETiahlug creek, Chestei

near Cambridi

1.90

truer

2. '.Ml

.20

60.00

beville

10.05
2.21

.10
trace

4.00
3.00
2.00
2.19

t race
i!6o

.90
.60

"50

56.00

20.10
16.60

13.56

6.20
7.20
6.80

Fairfield

6 90

Yorkvllle

2.50

Hornblende Slate Soils Laurens..

9.91

.... Greenville...

!.;

traee

2.00

.05

68.40

7.00

4.05

.... Pendleton...

5.00

1.60

"m

t race

70.10

12.00

8.00

2.80

the Mica Slates

Abbeville* .11

6.90

.60

1.0(

.70

74.3o

S.40

6. Oil

2.00

.. Greenville

7.00

trace

1.00

.7'

.St

69. l"

9.30

4.00

. . Pickens

.40

1.01

.25

79.60

6.40

5.00

8.96

Soils oJ s Lancaster.

6.*

1.60

5.00

3.00

6.00

4.50

trace

1.90

30.00

6.00

2.00

5.60

if Clay Slatesl-Edgefieid . . . .

2.41

trace

;:: .-i

80.72

Columbia

6.7(

Kim

.51

.40

10.40

2.00

1.70

Lexington

5.60

.50

trace

.30

9.00

1.90

Soils of tertiary formation Aiken..

8.50

trace

.50
.40

tract.
1.60

77.00
81.00

5.50

1.005

3.50

S.00

.. Lexington

6.M

trace

.60

so. 00

5.60

3.00

4.: 30

.. Richland

9.00

l.lin

".hi

76.50

6.60

2.40

4.00

.. Bennettsville. .

5.40

.SO

l.Ot

. . . .

77.30

4.80

5.00

5.70

.. Orangeburg .. .

5.6l

2.00

.50

tract

66.90

9 . 61 1

6.00

9. Ml

..Lang

7.00

..f.

1.56

1.00

.50

71.00

B.60

4.00

'.11

' .. Statesburg

4.40

.90

trace

80.30

ti.60

3.70

4.10

.. Darlington

3.0

.06

70.110

8.60

5.00

-. 1

Marion (Mi...

s.a

tract

".40

7-.""

6.60

4.70

7.16

.. Beaufort

2.

*;6o

S6.50

6.00

2.00

2.30

.. Horry

9.7

.40

trace

67.00

9.60

5.60

7.65

. . Barnwell 1 > i s . .

11.00

1.00

trace

65.00

10.00

4.30

8.70

Alluvial Soils Tide Swamp

27.01
24.00
14.0C

1.00

.80

1.00

1.00

.50

55.00
60.00
70.00
55.00
57.00

5.50
4.80
3.50
5.00
3.00

4.00
4.00
5.00
4.00
5.00

7.00
6.00
6.00
7.20

Bice Land '.'.

1.10

' 'M

' ! ii'

9.20

3.00

9.40

lo.oo

.80

.a

trac

64.00

41.40

9.80

28.01

\\\\

.50

60.00

4.00

2.40

6.10

The comparison of these results, developes facts and
principles of the greatest value to agriculturists.

We shall in the present report, point out only those more
general facts and principles which hear immediately upon
the relations of lime to soils and organized heings.

908 Tertiary Lime Formation [December,

Mv investigations upon the soils of Georgia will not be
completed for a considerable length of time, and I have not
therefore classed the partial results, thus far obtained, with
these tables. When completed, comparisons will be insti-
tuted with the facts here recorded ; these tables will, there-
Tore, independently of their present interest, be valuable
for future reference.

In examining these tables, with minds occupied with the
present subject, the first fact which strikes our attention is,
that soils differ greatly in the proportion of lime.

(a.) The Proportion of Linn varies in different soils. C
and i nihil mi of this variation.

If we knew with certainty the chemical constitution of
the rocks from which a soil has been derived, and the
changes through which it has passed, and the various agen-
cies, chemical and mechanical, to which it has been sub-
jected, we could, in a general manner, not only predict the
chemical constitution, but also give the efficient cause of
the presence or absence of the various constituents.

Whilst it is an established fact, that all soils were origin-
ally produced from the disintegration and decomposition of
rocks, effected by various chemical and mechanical agencies,
air and water, heat and electricity, currents and waves, and
by the slower actions of the vegetable and animal king-
doms ; nevertheless, it is often difficult to determine with pre-
cision the rocks from which soils have been derived, and it
is still more difficult to determine the various agencies to
which they have been subjected, and the various chemical
and physical changes through which they have passed, for
soils are often derived from rocks hundreds of miles dis-
tant, as is the case with the soils of the Tertiary and recent
formations of Georgia.

When avc reflect that the continents now inhabited and
cultivated by man, have been in past ages submerged for
unnumbered centuries, and that the surface of continents
have been formed by the materials resulting from the old
rocks, wdiich appear to have been first in a molten condition;

I860.] Of Georgia, 909

when we refled that the materials derived from the disin-
tegration of these older rocks, form strata thousands of feel
iii thickness; when we reflect that the continents have
been subjected to various elevations and depressions, stand-
ing out for thousands oi' years above the waters of the

ocean, subjected to the slower action of the atmosphere,

moisture and the vegetable kingdom, moved by the forces
of the sun submerged for thousands of years, subjected to
the action of mighty and irresistable currents, which have
conveyed the disintegrated materials thousands of miles
from the point of disintegration, we will have a clear
explanation of the fact so important to the agriculturist, that
soils do not necessarily correspond in chemical constitution
with the rocks upon which they lie. We have in the coun-
ties of Screven, Burke, Washington, Jefferson, and many
others, in the Tertiary formation of Georgia, a clear demon-
stration that soils do not necessarily contain the same
elements as the formations upon which they rest.

Thus, in the region of country to which w-e refer, we
have first the upper layer, the surface soil, composed of the
products of decaying vegetation, sand, ckvy, and various
inorganic salts, necessary for vegetation this varies in
depth from one inch to one foot. Beneath this, we have a
layer of sand, pebbles, and clay, varying in depth from one
to six feet. The pebbles found in this second strata, or
more properly Bubsoil, appear to have been removed from
northern regions during the last great geological deluge,
which took place after the elevation and consolidation of all
the rocks, and subsequent to the deposition of the tertiary
clays. In Richmond, and other counties lying to the south
of the primitive region, we find that not only were soils and
pebbles removed to great distances, by this last great geo-
logical deluge, but that large masses of rock have been
transported by it, and deep excavations have been made by
the currents in the tertiary formation, and tilled with sand
and pebbles; and that in the rallies of Burke, and other
counties, the joint clay has been almost entirely denud-

910 Tertiary Lime Formation [December,

cd and swept off by this current. Beneath this bed of
clay and pebbles, we have the joint clay, resembling chalk,
but differing wholly from it in composition, containing only
a small proportion of carbonate of lime, apparently depos-
ited at the bottom of a deep still sea, for it contains no peb-
bles or rocks, of any size, and but very few organic remains.
Beneath this bed of joint clay, which varies in thickness
from 6 to 60 feet, having in certain localities been greatly
denuded by the last great geological deluge, we find the
marls and shell limestone of the Eocene formation, which are
known in some parts to be more than 300 feet in thickness.
Now, whilst the lowest formation, the snell limestone is
almost entirely composed of carbonate of lime, with little
or no sand or alumina, the joint clay, immediately above,
and resting upon this conglomerate of fossil shells, contains
not more than from J to 4 per cent, of carbonate of lime,
and is composed of sand and alumina, and silicate of alu-
mina and other bodies; and the yellow clay and drift
materials resting upon the joint clay, contains still less
lime; and the soil which the planters of this region culti-
vate, contains very little more lime than soils which are
entirely removed from lime formations.

With truth then we may affirm that the examination <t
the chemical constitution of soils reveals great and leading
truths to the agriculturist.

If the planter takes the view that soils are in every case
derived from the rocks upon which they rest, he would in
Burke and Jefferson, and other counties where lime forma-
tions underlie the soil, affirm that marling was useless.
because the soil must already contain an abundance of lime.

Chemical analysis corrects the error, and leads to the
inauguration of that system of culture by which the treas-
ures so bountifully bestowed by Providence, will be made
to restore the abused and exhausted soil to a degree of fer-
tility superior even to that possessed in its virgin state.

There are countries, however, in which the soils have
been derived from the rocks upon which they lie, and the

L860.] <>/ Georgia. I'll

character of the soils have been in such cases determined
by the physical ami chemical composition and properties
of the rocks.

Thus, in the Highland district oi Xnv York, there are
two distinct varieties of soil, derived from the same class of
rocks (the primitive rocks); the one derived front the ordi-
nary coarse granite, called potash felspar, contains a large
proportion of the silicates of alumina and potash ; whilst
.the other, derived from the lime felspar, belonging U) the
hyposthene rocks, and composed in great measure of labra-
dorite, and devoid of mica, contains a greater amount of
the silicates of lime and alumina.

The soils derived from the latter, are more suitable for
the cultivation o[' wheat than the soils derived from the
potasli felspar, because they contain more lime.
v The soil of the old red sandstone of New York corres-
ponds in its general chemical constitution to the rocks from
which it has been derived. It contains but little lime, and,
under cultivation, is speedily exhausted, and in order to
produce crops, it has been found necessary to add lime with
all the manures.

The soils of the wheat district of New York, embracing
the central and western counties, which are considered to
he equal to any wheat soils in the United States, do not
appear to derive their valuable properties of yielding large
crops, and of remaining fertile t\)V long series of years of
continued culture, so much from the organic matters, as
from the inorganic elements derived from the rocks upon
which they rest.

The investigations of Professor Emmons,* of Xew York,
upon this wheat district, which extends from the south
shore of Lake Ontario to a line' drawn through the middle
of Cayuga and Seneca lakes, have shown that the great
fertility and inexhaustible nature of this wheat soil is d in-
to tbe fact that it has*been derived chiefly from the decom-
position of the calcareous shales associated with the lime

Natural History of New York Agriculture, vol. 1, pp. 272-27G.

912

Tertiary Lime Formation '[December,

stones of the Onondaga salt group, and from the grey and red
marl of the Medina sandstone, and from the calcareous
shales and slates of the Ontario division.

That the composition of the soils of the wheat district of
New York corresponds to the composition of the rocks from
which it has been derived, may be determined by compar-
ing the constituents of these soils as recorded in the tables,
with the following analyses by Professor Emmons, present-
ing the composition of the most important rocks from which
these soils has been de :ived :

PO

P3

00

<

DO

2 2-

crc g.

o J3

g 3 S

w - W -T3 <*

T S

to

i a>

grceni
d shale,
e form
ystals o

nicul ir
ith the
d gree

3 O S> o

: o 5 -*

P O
CD

s

Ct>

sh mar

conta
of the
f chlor

3. 3 .-

a

estonet

hard.
n shal
j comp

O

a:

. crq

<

g o

. Co

. aq

1 succeedir

ning cavit

hollow ci

ide of sodi

rock occu
id green s
larl

com-
The

cs pass
-\ct lime

Analysis

Analysis

3 - w .

. P -:.

by

by i>r.

. p^

. P,

<Ts^r

13 70

Dr. Beck.

Jackson.

Carbonate of Lime

10,25

43.06

20.G2

.30. SO
25.24

1 1 .20

25.08

0.7

Soda

2. i R

Magnesia

5.75

0,10

2. 1 7

k26

18.80

12.87

Phosphate of Alumina

0.14
0.87

Organic Matters

0.57

5.00
1 00

2 51

0.00

Peroxide of Iron and

Alumina

6.35

G8.25
1 .00

14.98

68.86
6.48

13 36

34.56
0.56

3.30
0.23

1.3.50
1.41

10 08

Water

1 Is

Soluble Saline matters.

consisting of Sulphates

of Soda, Magnesia,

Chlorides of Sodium,

Magnesium and Cal-

cium.Sulphate of Lime

and sometimes Alu-

mina

0.68

8.63

5.50

Alumina

5.3.3

3.3?

Peroxide of Iron

a trace.

1 .25

3.274

I860.] Varicose Vans of the Legs. 918

Treatment of Varicose Veins of the Legs and of Varicocele,
From a Clinical Lecture, at I diversity College Hospital.
By John Erichsen, Esq., Professor of Surgery and Clini-
cal Surgery.

I am about to direct your attention to-day to the treat-
ment of a disease of sufficiently common occurrence ; name-
ly varicose veins.

Varix may occur whenever the veins of a part are sub-
jected to pressure, and is met with most commonly in those
of the lower half of the body. In the inferior extremity
this is owing partly to pressure of the abdominal viscera on
the inferior cava,, partly to the weight of a long column of
blood in the vein, partly to the pressure inflicted on the
deep veins during muscular action, causing obstruction to
the onward flow of the blood. The veins of the spermatic
plexus arc also frequently the seat of varicose enlargement
from causes of a similar nature.

Varicose veins of the lower extremity, in the majority of
cases do not give rise to sufficient annoyance to need opera-
tive interference. Usually palliative treatment, such as the
pressure of bandages, elastic-stockings, etc., suffices to alle-
viate the slight inconvenience occasioned by the loaded
state of the superficial veins. It occasionally happens,
however, that this condition leads to such consequence as
to produce serious interference with the health and com-
fort of the patient. In such cases palliative measures are
no longer of service, and it behoves the surgeon to effect
the radical cure of the varix by operation.

Operative interference in varix of the lower extremity,
may be rendered necessary by these conditions.

1. The veins being of very considerable size and very
tortuous, they may by compressing the nerves, produce so
much pain, and so great a sense of weight in the limb, that
the sufferer is unable to make any exertion, being even
crippled, and so far disqualified from entering the public
services in a naval or military capicity.

2. When an ulcer occurs, and refuses to Jieal, in conse-
quence of congestion of its capillaries, the granulations be-
coming aedematous and the surface sloughy and unable to
cicatrize.

3. If a varicose vein has burst, as it is called, that' is to
say, it has opened by an extension of an ulcerating surface
through its walls, an abundant, alarming and even fatal
hemorrhage may take place.

58

914 Varicose Veins of the Legs. [Deceit

These are the three reasons for operating in eases of vaJ
rieose veins situated in the lowest extremities. Surgeons,
however, have been loth to operate in those cases, because
they have dreaded the effects of exciting inflamation in th<
veins, which may become suppurative, and so run on U
pyaemia. This danger does exist undoubtedly, but it must
be exceedingly trilling if the operation is properly conduct
ed ; for, on looking over my records, I find I have operatec
more than two hundred times, in this hospital in such c
and have never lost a patient, nor never had a case of sui
purative phlebitis or of pyaemia. The danger is slight, ii
the precaution of not opening the veins is followed. If th<
vein be opened, air is admitted into the wound, and the ad-
hesive inflammation is not set up, but the suppurative fori
arises in its stead whereby pus may get into the circulation,
and pyaemia follow. Therefore, the chief object is to con-
fine all inflammation to the adhesive kind; whilst this i<
present, there is no danger.

There are many modes of treatment in varix, all having
one object in view viz : that of causing occlusion of the
A*ein by the adhesive inflammation. But, in my opinion,
all measures should be avoided which include opening the
vein, whether this done by caustic or by the knife, as they
are extremely dangerous, by leading to suppuration within;
so, also, are those plans of treatment by which we break
down the exuded lymph and coagula, or open up the vein
even when occluded.

I shall not enumerate all the methods before the profes-
sion for the radical cure of varix but proceed to describe
those which I have for many years successfully employed in
this hospital. The plan I ordinarily pursue, and which you
have seen me adopt dozzens of times is as follows : A hair-
lip pin is passed underneath the vein on one side, and its
point brought out on the other, a piece of elastic bougie
about an inch in length is then laid over the vein parallel
to its course. Then, by means of a silken thread twisted
over the bougie and under the two ends of the pin, the
vein is compressed between the pin and bougie. In .
forming this operation there are one or two little points to
be observed. The first is to be careful not to transfix the
vein- with the pin ; if the vein be opened, and the pin lie
across it, there is danger of suppuration, as the pin act
a kind of seton in the vein. This inadvertence is avoided
by dipping the pin deeply whilst passing it under the vein.

I860. | Vari 01 Vi ins \f th L

In this way there is do risk of piercing the vessel, [f ;i
drop or two of venous 1>1<hh1 exuae, by the side of the pin,
through the puncture the vein has been perforated and the
Instrument should be withdrawn and passed again. It" the
vein is unharmed the operation is bloodless. The second
pointi a thai the ligature should not be - as to cause

Ulceration by strangulation of the part.- compressed, [f the
threat be moderately tight only, and the pin made, as ii
generally now is. of unoxidizaDle iron it is quite passive
and dors not rust, hence i irritation is avoided.

The bougie and pin should remain about ten days, at the
end of which time the vein is converted into an impervious
cord of plastic matter and coagulum. \\ hen this is at-
tained the pin may be removed, the limb bandaged and the
patient may leave his bed.

It has been objected to this and to all other operations
for varix that the cure is not permanent; that the varicose
condition is apt to return ; that the same veins perhaps are
not affected again in this manner, but that others speedily
assume a dilated and tortuous state. Xo doubt this is the
result in some instances, but in many cases which I have
had an opportunity of examining years afterwards, the cure
has been permanent; and, in the meantime the object for
which the operation was undertaken is served.

Another method which is much used in France, and
which I have occasionally employed myself in this hospital
for some years past, is that of injecting a small quantity of
a solution of the perchloride of iron of specific strength
into the veins by means of Pravaz'sscrew-svrin^e. In this
way the blood contained in the dilated vessel is made to co-
agulate and thus the passage through the vessel is occlud-
ed. The adhesive inflammation at the same time being
excited, permanent obstruction is attained and a cure effect-
ed. This, though a valuable means when the vessels are
knotted and sacculated, is not, I believe, so good a one as
the pin and ligature, because I have seen it followed in two
or three of these cases in which I have had occasion to use
it, by circumscribed abscesses and even sloughing of the
adjacent parts, though no fatal result has yet occurred in
my practice. On this account I consider this mode of treat-
ment undoubtedly more dangerous, and I think it ought to
be confined to the cure of those cases only where the knots
are so large, and so clasely matted together, that the pin
cannot be passed underneath them.

916 Varicose Veins of the Leg*. [Decembei

The next distribution of veins liable to varixis that forn
cd by the spermatic plexus. Dilatation of these vessels-
varicocele is often met with in young men ; and muij
benefit can be afforded by paliative means, such as support J
ing or compressing the tumor in various ways; for instance
by raising scrotum in a suspensory bandage, or by wearin
a mocmain truss, etc., and one or other of these contrivaii
ces generally gives sufficient relief for the patient's comfort
But I have found it necessary to have recourse to more ac-
tive measures than these, and to adopt operative treatmeni
in three of these cases which have presented themselves
during the present session. The circumstances, for whicb
operation may be and has been practised in these and simi-
lar cases, can be arranged in the four following categories:

1. The existence of a varicocele disqualifies the sufferei
from admission into the public services. This, in my opin-
ion, is a perfect legitimate reason for operating. One ol
the cases on whom I recently effected a radical cure was
that of a man in the prime of life, who, wishing to enlist in
the Marines, was refused solely on the ground of having a
small varicocele. This I cured by operation, and the man
afterwards entered the service.

2. In cases in which the presence of a varicocele of oh
dinate size causes a distressing sense of weight and pain in
the loins and groins, and often inability to stand or walk
for any length ot time, in these cases when the patient is in
continual discomfort, or more or less prevented from pur-
suing his avocations, in fact, quite crippled, it is perfectly
justifiable to resort to operation.

3. When atrophy of the testicle is a consequence of the
pressure of the blood in the veins.

4. In cases also where the pressure of the enlarged veins
on the spermatic nerves produces repeated attacks of sper-
matorrhoea; and these cases, gentlemen, are by no means
uncommon. These are, however, more frequently met with
out of the hospital than in individuals of the class who ap-
ply to such institutions for relief. In tact, young men of
the more highly educated 2lasses are very subject to it, es-
pecially these who habitually lead a sedentary and studious
life, as for instance, young clergymen and lawyers. In
these persons a peculiar hypochondriacal state is brought
on by the tendency of the mind to dwell on the condition
of the genital organs, and the patient is constantly fidget-
ins: about the local andtamnble disease he observes in them.

.800.] Varkosi Vi faj of // I. 917

pis was the case of the patient on whom you recoiled I

lerated a shorl time ago for double varicocele, and who

as received a better education than most hospital patients,

pr ho belongs in some degree, to the medical profession.

anxiety with regard to this disease, though the veins

ifteeted have been perfectly occluded by the method pre-

ently to be described, is still so greal thai at hisearnesl im-

jortunity, I removed, last week, a portion of the scrotum

vhich happened ather more pendulous than is usual,

>artly in order better to support the testis, and partly thai

lis morbid feeling on this subject mighl in Borne w

suaged.

Xow how should the radical cure of this condition be

[reduced? To this 1 would answer By exciting adhesive
nflamm the spermatic veinsthrough an application

of the same principle which sets op that process in the veins
of the lower extremity. There are several different ways
of doing this; some are very objectionable. The twisted
suture, as applied to the veins ^i' the leg, induces two great
irritation in the scrotum, and there its introduction if often
followed by violent inflammation or sloughing; or by open-
ing up the cellular tissue of the scrotum with asdema, and
even purulent infiltration. It is better, I think, not to use
this method here, indeed, 1 have twice, in the practice of
others, seen it followed by death. The plan I have adopt-
ed for some years is that suggested and practiced by Vidal,
a distinguished French surgeon, and is as follows: The
deferens readily distinguished by its round cord-like
Feel, is first separated from the veins, and intrusted to an as-
it : next an iron pin bored with a bole at each end, is
passed between the vas and the veins, and brought out,
first notching the scrotum with a scalpel at the point of per-
foration; then a silver-wire, threaded on a needle so con-
structed that the wire .shall follow it without catching, is
passed in at the aperture of entry of the needle, and then
carried between the integument of the scrotum and the
veins, the wire is brought out at the second puncture.
Each end of the wire is now passed through the correspond-
ing hole of the pin which is twisted round and round re-
peatedly, each turn causing the wire to be rolled round the
bin, and so tightened till the veins arc firmly compressed
between the pin behind and the loop of wire in front. By
this means the scrotum is quite free and uncompressed, and
there is no danger of arousing inflammation or eedema.

918

Persulphate of In

[December.

The wire should be tightened from day to day, as it causes
ulceration in the veins, until it lias completely cut through,
which results, usually, in about a week or then days. "M i
while there is much plastic matter thrown out round the
veins. This finally counteracts and obliterates their chan-
nels. This method is an effectual and permanent cure ad
we had an opportunity of seeing, in the case of a porter at
this hospital, on whom I performed this operation with per-
fect success, for he remained here for three years after the
operation, during which time lie was perfectly free from
any return of his disease. Of late, I have been in the habit
of employing a simpler method, one which you saw me
adopt about ten days or a fortnight ago. I separated the
vas in the usual way, and then made a small incision, about
half an inch long, in the front and back of the scrotum,
afterwards passing a a needle armed with silver-wire, as be
fore described, between the vas and the veins, bringing it
out behind, then returning the needle, but this time carry-
ing it in front between the veins and the skin, and so in-
cluding the veins in a loop of wire without implicating the
scrotum. This is then tightly twisted together so as to con-
strict the inclosed vessels. The plan had a similar effect to
that of the wire and pin combined ; by repeated tightening
the wire gradually effected a passage, by ulceration through
the veins, which were obliterated by the same process.

It has been objected to this and similar operations that,
athrophy of the testis may take place from its arterial
branches bein^ included together with the veins, but afl

ITT

the spermatic artery runs near to the vas deferens, it is held
out of the way with the duct, it escapes, and the chance of
that mischief is avoided. Xevertheless, atrophy of the testis
may coexist as the result of long continued pressure of the
blood in the vessels of the gland before the operation was per-
formed. British Medical Journal, Feb. 25th.

In Brooklyn City Hospital. By the Injection of Persulphate
of Iron. By James M. Minor, M. D., Attending Sur-
geon.

The following cases possess the double interest ^i' novel-
ty and practical utility.

There are none of a similar character on record, except
those in which this treatment was adopted subsequently to.
and in imitation of them.

".J Persulp) Iron. 919

Jt will be observed thai I have introduced a case of
. treated with injections of the perchloride of iron,
among cases of varicose veins, treated with the persulph;

In aoing so, I have violated the harmony of pathological
relation, in owlw to illustrate the efficiency and innocuo
ness of the preparation of iron. The Brs1 case was in pri-
vate practice, the others were treated in Hospital.

Case 1. Popliteal Aneurism cured by the Inj(
Perchloride of Iron. On the 9th day of November, 1857, I
was requested by Dr. Jas. Crane to sec Mrs. T. I found a
small, pulsating, superficial, aneurismal Bac, between the
right labium and thigh, about the diameter of a Madeira
nut, and projecting about half an inch above the surface.
Prom it projected a small nipple-like, or rather tubular, oft-
hoot, from which, previous to its ligation by Dr. Cr
arterial blood spouted per sodium, Mrs. TVs account of it
was, that about seventeen years previously she had received
a sever-? blow at that point while entering a stage-coach,
frem the heavy iron hook attached to one end of the "back
strap" of .the middle seat, causing very severe pain at the
time, but of short duration. Is not absolutely sure how
long slie has felt pulsation, but thinks that about a year
since it became very distinct, and assumed the purplish
tinge it now has; pulsation was more active at every men-
strual period. A careful examination, by alternate pressure
upon the femoral, and at a point posterior to the sac, shows
a supply trunk, probably from some one of the perforating
branches of the profunda femoris in front, and the obtura-
tor behind.

Upon consultation between Drs. Crane, Isaacs, and my-
self and at Dr. Isaacs* suggestion it was determined to use
injections oi' powerful styptics. This course was adopted
in view of the manifold difficulties in the way of an effort
to tie the supply trunks.

There were four several attempts made, at intervals of
about a week, with solutions of lactate, m-uriated tincture,
and perchloride of iron, using at the same time Signoroni*s
tourniquet to control the circulation through the femoral
artery, and lessen the tendency to wash away the newly-
formed clot. It was impossible to exert much force in con-
trolling the current from the obturator artery, as the fin.
alone could be used.

The solution of the perchloride alone sufficed, with aid
of the tourniquet, and the recumbent posture, to effectually

!>2<>

Persulphate of Iron.

[December,

coagulate the blood and block up the sac. The pain caused
by the perehloride was very severe, and continued for twelve
hours, and was followed by considerable inflammatory ac-
tion. It was completely successful, and Mrs. T. reco\ <
with entire obliteration of the sac. The tourniquet was
kept on for some days, being loosened at intervals, to lessen
the intolerable pain caused by the pressure. The filling by
granulation of the cavity left where the coagulum came
away (which it did by ulceration) occupied some weeks.

The notes of this case having been lost, will account for
the omission of some points of interest. They have been
drawn out from memory, and by the aid of the patient.

The following cases of varicose veins, treated by the in-
jection of persulphate of iron, occurred in the Brooklyn
City Hospital, the notes of which are furnished me by R.
P. Moore, M. I)., llouse-Surgeon.

Case 2. Varicose Veins gf Leg Injection ofPersulpha
Iron Cured. John Towle, admitted on March 1st. 185CJ,
(Dr. Enos on duty), with ulcer from varicose vein on k _
live years' duration ; it has healed repeatedly, but again re-
opened. Ordered poultice, and rest in recumbent posture.

April 25th. Ulcers nearly healed. Injected licpior ferri
persulphat. gtt. x.*

May 2d. Veins obliterated at point of injection; neigh-
boring branches still viracose.

May 20th. Ulcers entirely healed, and patient permitted
to go out on a pass. Returned drunk, with abrasion of
newly cicatrized suriaee.

June 13th. Discharged cured.

Case 8. Varicose Veins of Scrotum Injection of Persul-
phate of Iron Cured. J. T., aged 22, American, admitted
under Dr. Minor, Oct, 24th, 1859, with varicose condition
of scrotal veins of left side. Has enjoyed very good gen-
eral health. For six months past has suffered much pain
from distended veins of scrotum, extending through sper-
matic cord to inguinal canal of that side, and also in the
testicle ; can obtain no relief except in recumbent posture.
Ordered cathartic. Suffers with languor and debility from
involuntary seminal emissions, after which the pain is much
aggravated.
"Oct. 28th. Injected four drops of a solution of persul-
phate of iron (four parts of water to one of persulphate)

Officinal solution contains 43 per cent, of the solid presulphate.

I860.] Persulphate of Iron. 921

with Pravat's syringe, as modified by Tiemann. Patienl
was made to stand erecl in order to till the veins, and make
them more distinct and prominent a necessary precaution

in such loose tissues as are found in that region. He faint-
ed, but was soon restored by placing him in a recumbent

posture. The operation scarcely caused any pain, either at

the time or subsequently. A linn coagulum was formed in
thirty seconds. Ordered cloths dipped in water to the part,
and recumbent posture.

Nov. 3. The clot formed by persulph. ferri gives indica-
tions of coming away by ulceration. Has felt less pain in
cord since operation ; nor does he feel any pain at the point
of puncture.

Feb. 6th. (lot came away last night, leaving a healthly
granulating surface.
26th. Discharged.

Case 4. Varicosi Veins of Scrotum Second Injection

I fI ames Taylor was admitted a short time after his
discharge in November last, with varicose condition of oth-
er deep scrota! veins near the cord. The vermiform mass of
( nlarged veins around the point of former operation are en-
tirely obliterated. Has been variously treated since second
admission, but without resort to operative measures.

Pel). 14. AT'ins increasing in size, attended with pain.
Injected three drops of a solution of persulphate of iron in
the proportion of one part persulphate to two of distilled
water, followed by immediate coagulation of blood, as on
former occasion, and with as little pain.

15th. Injection seems to have entirely relieved the pain
in the cord, and he expresses himself as feeling better in
every particular.

19th. Continues comfortable. Some pain and heat at
the point of puncture, wdiere there is an exceedingly hard
and prominent tumor. Tumor is close to the cnord, and
seems in some measure to involve it. Seminal emissions
occur at long intervals now. Cold water dressings.

26th. Clot decreasing in size> but still very hard. Xo
appearance of ulcerating, as on former use of the persul-
phate.

March 1st. Tumor has steadily decreased in size ; but
little hardness remains. Veins completely obliterated when
injected, as well as all others which were enlarged.

Case 5. Varicose Veins of Ley Injection of Pers<'h>h"i<

922 Persulphate of Iron. [December,

of Iron Cared. Carl do Buke, admitted December 22d,
1859, with paronychia of left thumb. Varicose veins in
left [eg, which he lias had for many year-. Veins very
much distended at one point. Owing to the size of the

veins it was thought necessary to insert a larger quantity of
the solution than usual.
Feb. 11th. Ten drops of a solution of the strength of

one part persulphate to three of water, was used.

12th. A clot has formed, and obstructed the vein, though
it docs not appear to he so firm as in previous cases.

14th. Complains of pain at point of puncture, where
there is a considerable swelling and redness. Apply cold
lotion.

16th. Inflammation and pain subsiding. Continue lo-
tion. Xo constitutional disturbance at any time.

22d. Tumor lessening in size, and redness disappearing.

March 10th. All inflammatory symptoms have subsided,
and the vein is obliterated at point of operation.

Case G. Varicose Veins of Leg Injectior< \of Per- >'Jj>L"/c of
Iron Cured. James Flemming was admitted Dec. 29th,
1859, with secondary syphilis, and ulcers on right leg ; has
varicose veins of the same leg, which are increasing in size,
and he expresses a wish to be operated on for their relief.

Feb. 11th. Injected as usual, three drops of a solution
of the persulphate of iron, one part to four of water. A
second puncture was made below the first.

13th. Coagulum formed, but not so marked as in other
cases. Xo inflammation about punctures.

19th. Ulcer on leg has improved rapidly since operation.

27th. Old ulcer cicatrized, and he desires to leave the
hospital. Discharged cured.

It may be desirable to state briefly, the mode of pro
dure in the injection of varicose veins. A Pravat's syrii
as modified by Mr. Tiemann, is the instrument used. This
is a very small syringe of vulcanized rubber, having a small
(almost capillary) canula screwed to its lower vnd. Thia
canula is cut obliquely at its extremity somewhat alter the
manner of a pen, ending in a sharp point, The piston rod
is graduated to drops, to admit of the use of any quantity
no matter how small.

The canula being screwed on, the quantity of the solution
desired to be used is drawn in through the canula, which is
then plunged into the vein, the patient standing erect. The
finger of an assistant is then placed upon the vein, a little

I\ / Im,,.

Xl:\

above and below the point of puncture, and firm pressure
made ; the piston is then forced down and the fluid injected.
It is important that the pressure on the cardiac Bide of the
puncture, should be sufficient to complete the upward

current, as otherwise portions of the clot might be carried
into the circulation. The pressure aeed be kept up for a
minute or two only.

This completes the operation. [The patient is placed in
the recumbent posture, and cold water dressings applied,
with directions not to rise for Borne days. The above mode
of treatment of varicose veins, would scciu to promise a
sate, prompt, and painless cure, o\' a most uncomfortable,
painful, and sometimes perilous complaint, for which, here-
tofore, there have been only uncertain and dangerous expe-
dients.

The persulphate of iron as far as heretofore used, seems
10 excite adhesive inflammation alone, thus avoiding that
formidable affection, pyaemia ; and I feel confident in re-
commending it to the profession, as a safe, simple, and al-
most certain remedy for varicose veins, and with some quali-
fications for small aneurisms. American Medical I'iuies.

On Monsel 's Persulphate of Iron, By George S. Dickey,
Jr., of San Francisco, Cal. I give you my formula, the re-
sult of numerous experiments when I first undertook its
manufacture.

R-. Aquae destilla; glxxx.

Acid. Sulph. Coin. f.^ix.Xfoiii.
Ferri Sulph. Purse, 5c troy.
Acid, Nitric. " f.^viii. or q. &
Mix the water and sulph. acid, and dissolve in the mix-
ture one-half of the sulphate of iron with the aid of heat.
Bring up the mixture to a brisk boil, and add the nitric acid
little at a time until effervescence ceases, and while still
boiling add the remainder of the sulphate of iron little by
little, and boil until effervescence ceases. Filter the solu-
tion, evaporate to a syrupy consistence and spread on plates
of glass to dry. It requires considerable heat to dry per-
fectly, but is quickly dehydrated by a too long continued
heat. When dry. it is accessary to detach it from the
plates with a ch-
ine article has attained great celebrity here, principally
as a haemostatic and as a local application to venereal ulcers.
I have manufactured and sold more than two thousand
(^,000) ounces during the last year and a half and its sale
still continues, in fact, incre;,

924 Partdy [December,

I have never yet met an instance of its failure to stop
bleeding when properly applied, and it is only necessary

that the dry salt should be sprinkled on the wound.

I have been much surprised that it has been so Long get-
ting into use in your section, as I sent two or three samples
to different parties near a year since.

Very truly your.-.

Geo. S. 1)ickey, Je.*

*The specimens of the salt received from Mr. Dickey tvere the finest we have
seen ; perfectly dry, in very thin scales, translucent and of a light reddish brown
color, very soluble and astringent. Ed. Am. J. Ph.

A Case of Paralysis Agitans removed b>j the continuous gat
wmic current. By J. Russell Reynolds, M. D., F. Ii. O

P., Assistant Physician to the Westminster Hospital.

Case. W. F , male, ret. 51 ; married at the age of
twenty, and the father of twelve children; height, 5 ft. 10-J
in.; weight, under 11 st, Xo anatomical deformity; no
hereditary predisposition to disease ; has had good health ;
has lived well and temperately. His occupation is that of
a, carpenter ; he has resided in a healthy locality, and has
never, until the commencement of his present illness, suf-
fered from anything of a similar kind.

For the last live years he has had anxiety with regard to
his children, and distress at parting from them, but he can-
not definitely refer his malady to this cause. During the
last two years he has noticed occasional tremor of the right
arm and leg, the latter being affected less frequently and
less severely than the former. The tremor has occurred if
he (1) has been "put out about anything;" (2) has attempt-
ed to lift anything very heavy ; (3) has "taken cold ;" (4)
has lifted liquid in a cup to the mouth; or (5) has fully ex-
tended the arm and forearm, and pressed anything firmly
with the palm of the hand. But under all these circum-
stances the tremor has ceased when the "exciting cause"
has been removed, and it has never been so severe as to
prevent him from following his occupation, which is one
requiring much exertion and accurate direction of move-
ments.

For the last six or eight months he has suffered occasion-
al vertigo i. c. a "feeling as if he should tall, or pitch on
his head ; and as if the head were tied up in tight band-
ages." At the same time there has been darting pain
through the head.

I860.] Vtorafy 925

On September 20th, he was al work as usual was alter-
nately Btooping down and Lifting over his head when he
suddenly fell vertigo, aching in knee-joints, and general
disturbance ; and al die same time violent shaking occurred
in the right upper1 extremity. The agitation 01 the righl
arm continued throughout the day, but Btopped at night.
Ir returned on the following morning as soon as he moved*

On October 5th, he waa seen by myself, and on this day
(the fifteenth from its commencement) the agitation was
extreme. Nevertheless, it had always ceased during the
night, and on two occasions, for about an hour, and without
assignable cause, during the day. Ee thinks it is arrested
at night by pressing the anterior surface of the forearm
against the crest of the ilium. With the exception above
mentioned, the movements of the arm have been much the
same as now seen ; being occasionally aggravated, but not
much, by emotional disturbances, or by the attempt at vol-
untary movement of the extremity.

The whole of the right upper limb is involved i. e., the
hand moves on the forearm, the forearm on the arm, the
arm on the shoulder; but the most constant and most ex-
tensive movement is that at the elbow-joint; the least con-
stant and least extensive is that at the shoulder. Almost
every direction of movement possible in the upper extremi-
ty is performed ; from 22 to 24 double movements occur in
rive seconds, and the range of movement at the hand, when,
for example, the jerking is principally that of flexion and
extension of the forearm, varies from nine to ten inches.
The movement, therefore, amounts to about eight feet per
second.

To the patient himself the right arm feels hotter than the
left, and a difference of temperature is very obvious to the
hand of the observer. Temperature over left biceps, 87
Pahr.; over right, 91.

The involuntary movement of the arm can be arrested by
his lying on the sofa, and pressing the forearm against the
ilium ; but any attempt to move the limb voluntarily at
once reproduces the shaking,- although he remains in the
recumbent posture. The movement is, moreover, instantly
arrested by my firmly grasping either the forearm in any
part of its upper two-thirds, or the arm in its lower third.
This is not a mere mechanical arrest of the movements, for
it cannot be effected by holding the wrist; and the jerking
recommences if, while the extremity is grasped in the man-

926 Paralysis. [December,

ncr described, the patient makes any attempt at a voluntary
movement. The pressure is not painful, nor is it so direct-
ed as to arrest the circulation.

The mental condition of the patient, and his general
health, appear unaffected.

Sensibility is unchanged in the right upper extremity;
there is no deviation of the tongue, nor distortion of the
features, lie can walk well, and without dragging either
leg; there is only occasionally slight tremor of the right leg.

A continuous galvanic current (direct) was applied to the
arm and forearm, the movements of the latter being at the
time arrested by pressure. At the end of live minutes he
could execute voluntary movements without the least tre-
mor, and emotional excitement failed to reproduce the jerk-
ing. The temperature of the two arms, examined after the
current had been passing for half an hour, was equal. The
involuntary movements did not return until three hours
after the current was discontinued ; they then reappeared,
and continued throughout the evening ; stopped at night,
but returned on the following morning.

October 6th. The current was applied while the arm
was in violent movement, but in two minutes it became
perfectly still. Application continued for an hour.

7th. Last evening there was no jerking nor tremor for
live hours after the current was discontinued ; then it com-
menced, but stopped spontaneously in about half an hour,
and during the remainder of the evening there was nothing
more than very trifling tremor. The jerking has returned
this morning, but is much less than on the first day of ob-
servation. There are but twenty alternations in fifteen
seconds, and the range of movement is from three to four
inches. The movement, therefore, is only 86 foot per
second less than one-eight of what it was three days ago.

The current was applied on the 7th, on the 8th and 10th,
and after the 10th i. e., after five applications the spon-
taneous jactitation completely ceased. When any weight
is held in the hand, and it is lifted towards the mouth, there
is tremor; but this is slight, is not more than has occurred
for the last two years, and it immediately ceases when the
effort is discontinued. The arm and hand are weak; every
movement can be executed by them voluntarily, but such
movements are feeble.

28th. Has written me a letter in s*ood and legible hand.

The current was applied about every other day, for an

I860,] Cm 927

hour, until November 10th, and during this time there was
steady increase in the power of the limb, and the jactitation
did not return. No medicine of any kind was given.

November 12th. Quinine and iron were ordered.

L5th. W. F is in perfecl general health; there
.jactitation, and only the Blight tremor already described,
when the hand, wit! : in it, is raised towards the

mouth.

The current employed in this cae i was derived from a
Pulvermacher's chain battery of !-' Links.

The above case requires, I think, no comment. It is
more important that a fact of this character should be
placed on record than that any speculation should be ad-
vanced in regard to the pathology of "paralysis agitans," or
the modi of the continuous galvanic current. The

term which I have employed to denote the case involves no
theory; it is but the name of a prominent symptom a
symptom which, in this instance, constituted almost the
whole of the affection, and which, after a fortnight's dura-
tion without the slightest tendency to improvement, was
quickly, but progressively and effectually, removed by a
special form of treatment.

That this result of the contineous current is not to be at-
tributed to mere accidental coincidence is, I think, evident
from the history of the case. Moreover, a similar result
appears to have been obtained by Remak. In Schmidt's
Jahrbilcher, Jahrg., 1857, bd. 94, p. 102, there is the fol-
lowing entry : "Paralysis agitans, bei einem 60 jahr. man-
no in 15 sitzg. beseitight." Lancet, Dec. 3, 1859.

Palliative Treatment of Cancer. By Mr. Thomas Hunt.

Mr. Hunt's remarks apply only to those cases of true
scirrhus in the breast in which there is a hard and movable
tumor, not yet advanced to the stage of ulceration.

One indication in this condition of things is as far as pos-
sible to prevent the occurrence of ulceration. The author
regards this process as chiefly the result of the pressure sus-
tained by the skin and cellular membrane, from one hard
substance within (the stony tumor), and another hard sub-
stance without (the patient's corset). This pressure is gen-
erally sufficiently severe not only to give rise to pain, but to
effect, first, a congestion of the healthy vessels, and second-
ly, an absorption of the healthy structure, without being

928 Cancer. [December,

sufficient to absorb (as lias been proposed by higher pres-
sure) the cancerous tumor itself. A second indication is to
support the tumor, without undue pressure ; and a third, to
relieve the pain.

All these purposes are easily accomplished, in most cag
by the following expedients : The whole breast should be
allowed to rest on a thick broad compress of cotton wad-
ding. AVhen the breast is very pendulous, an old silk hand-
kerchief may be passed, as a sling, between the mamma
and the wadding, and tied over the opposite shoulder, one
tail of the handkerchief being passed over the clavicle, the
other tail over the scapula and spine ; and all should be in-
cluded in a capacious corset, which will then become a com-
fortable support, instead of acting as a tormenting vice*
When the pain has been very severe, the author has applied
to the skin a belladonna plaster, spread thinly on soft thin
leather. This, by encompassing not only the whole breast,
but an inch or two of skin beyond it in all directions, will
materially assist in giving comfortable support, and also in
allaying the irritability of the nerves. By this local treat-
ment the author has often succeeded in relieving the patient
of all pain for months together, and also in preserving the
isolation of the tumor, and in many cases diminishin_
size.

Together with this local treatment, great attention shouh
always be paid to the bodily health and mental tranquility
of the patient. She should be encouraged to hope that her
pains may be much relieved, if not entirely removed ; that
the disease may probably be checked, or even so far sub-
dued as to become for a very considerable period compara-
tively harmless and benign. The health shoulc be sustain-
ed by a generous but regulated diet ; by engaging the pa-
tient as much as possible in cheerful society ; and last, not
least, by moderate but frequent exercise in the open air, in
a locality where the atmosphere is pure and mild. This
will be far, very far, better than confinement in the h< i
and infinitely better than confinement in the wards of a
hospital containing patients with open wounds. If the
health is feeble, much good will be derived from the fol-
lowing formula :

R. Tinct. ferri sesquichloridi, 5'nj J
Liquor arsenici, 5v.
Aquse destHlatse, 5viij.
M. Capiat minima xl ter in die ex aqua post cibum.

.-

I860.] 92fl

The dose of both the iron and the arsenic musl be regu-
lated by their respective eflG be iron is generally use-
ful and necessary, the arsenic always; for, although tne au-
thor had rarely found a cancerous tumor entirely dissipated
by arsenic, he has as rarely known the mineral fail to check
its onward course, [t most assuredly exerts, when discret-
ly administered, a certain amount <>l' specific influence over
the disease, lie wishes he could say more than this iii fa-
vor of arsenical treatment; bu1 truth requires thai he
should stop here, That there is no medicine which is so
uniform ami potent in its controling power over this disease
is, however, most evident; and in this opinion he is sup-
ported by many high authorities in surgery.

As illustrative of the good effects of the proposed treat-
ment, trie two following cases are given :

Task 1. A female servant, jet. "40, single, consulted me
in the autumn of 1858, on account of a tumor in the left
mamma, which had been observed to exist upwards of a
year, and which was becoming painful, and was beginning
seriously to affect her health.

September 16th, 1858. The tumor was about the size of
a nutmeg, irregular, movable, and of petrous hardness,
having little sensibility, and little apparent connection with
the surrounding parts. It occupied a space a little below
the nipple, which was not contracted, nor was the skin
puckered or discolored. The absorbent glands were unaf-
fected ; but the complexion was sallow and dusky; the ap-
petite nearly gone, the nights were disturbed ; and she com-
plained of feeling "very weak and sinking." The alvine
and uterine secretions were normal. A soft cushion of cot-
ton wadding was placed under the whole breast, resting on
a corset of ample size. She was directed to live well ; to
take every opportunity of exercise out of doors ; and the
chloride ot arsenic and iron was exhibited thrice a day, in
doses of twelve minims and a half of the solution of chlo-
ride of arsenic, and seven minims and a half of the tinc-
ture of sesquichloride of iron.

November 1st. The pain was much relieved, and she
had better nights; the appetite was improving, and the pa-
tient felt and looked better. The tumor was diminished in
size. The treatment was continued.

January 25th, 1859. She had no pain whatever. The
tumor was still wasting. The health was improving. The
bowels being inactive, a compound rhubarb pill was direct-

59

930 Cancer. [December,

ed to be taken every night, and the arsenic and iron persis-
ted in.

July 22d. She had persevered most regularly in the
treatment up to this time, and had had no pain whatever
for several months. She looked well and plump, and had
a good appetite. She considered herself quite well ; but I
advised her to persevere for at least another month, and to
take especial care to use the cotton wadding as before.

This patient had been advised to have the tumor remov-
ed; but she strongly objected to the operation, and had re-
signed herself to despair. When I last saw her, her spirits
were so good that I suppose no one could have convinced
her that the tumor was malignant.

Case 2. Miss , set. 24, residing on a healthy eninence
in the country, had observed for several months a tumor on
the right mamma, below and to the right of the nipple.
She wTas a fine, handsome girl ; and nothing but the ex-
treme hardness of the tumor, coupled with failing health,
could have convinced me that she was the subject of can-
cer.

The tumor was of the size of a bantam's egg, of oval
figure, but irregular surface, very hard. The mamma was
swollen and tender, the axillary glands were not sensibly
enlarged, but very tender, and somewhat painful. The
pain in the tumor was often intense and lancinating. The
nipple was normal, the skin was slightly puckered over the
tumor, which, although buried in a highly developed mam-
ma, was in some degree adherent to the integuments. The
health was considerably impaired. The bowels were very
much constipated, and the catamenia very irregular, some-
times profuse and sometimes scanty. There was also se-
vere leucorrhcea, with pelvic pains and general uterine dis-
tress ; as well as a failing appetite and a coated tongue.
The pulse was rapid and feeble. The patient had wasted
considerably during the last three months, and her spirits
were "wretched."

March 12th, 1858. The breast was enveloped in a bella-
donna plaster, supported by cotton wadding and a sling.
She was directed to regulate the bowels by pills of colo-
cynth, aloes, and rhubarb ; and to take the chlorides of
iron and arsenic, as in the former case. She was ordered a
full diet, with stout or porter ; directed to take exercise in
the open air, and encouraged to hope for a speedy amend-
ment. In this she was not disappointed, for in less than a
fortnight her health had considerably improved.

I860.] (Jam 981

May 5th. She was much more free from pain, and bet-
ter every way in health and spirits. The leucorrhcea dis-
charge was much reduced, khe catamenia had become regu-
lar and normal. The tumor felt more loose and movable,
and Less irregular on its surface; and the puckering of the
skin was loss obvious. The pain and tenderness in the
axilla were quite gone. She complained, however, of head-
ache, and though.1 the iron did not agree with her. The
arsenic and aperient pills were continued, without the iron1 ;
and the local treatment as before. Fowler's solution, in
doses of four minims, was afterwards substituted for the
chloride, which began to nauseate a little.

duly 19th. She was better every way, appetite good,
was gaining flesh, and was in high spirits* The tumor was
decidedly reduced in size, and almost free from pain. The
Treatment was continued.

From this period I saw nothing of the patient for live
months ; and, as I had never revealed to her the malignant
character of the tumor, she expected she was recovering
altogether. Accordingly, she visited some friends at a dis-
tance, neglecting her medicine, and took no need to the
support of the breast.

December 12th. The tumor was larger and more pain-
ful, the catamenia were too frequent, leucorrhcea was con-
stant, and there had been a discharge of blood from the
bowels, which were constipated. The appetite was fickle
and capricious, the patient looked haggard and dejected.
The arsenic, iron, and purgatives wrere ordered to be re-
sumed.

I have not seen the patient since the last date, but the
relapse of all the bad symptoms, on her neglecting the
treatment, is quite as instructive as the benefit previously
derived from it.

I am quite aware that it has been suggested by a micro-
scopic pathologist of repute, whose name I forget, that in-
asmuch as a cancer is a parasitic growTth, the application of
warm coverings is objectionable, as tending to more rapid
development and growth of the parasite ; but few such facts
as the above surely afford a sufficient refutation of this
theory. Variations of temperature are great hindrances to
healthy action in local disease of every kind; and besides
that the cotton wadding serves as a soft cushion, it proba-
bly exercises a salulary influence by regulating the temper-
ature of the parts.

982 Leucorrhcea [December.

On the Uterine Lcurorrhrra of Old Women. Ry Dr. J. Mat-
thews Duncan.

The object of the present paper is to aid in advancing
our knowledge of leucorrhcea, by the description of a true
uterine form of it, occurring in women who have for a more
or less considerable period ceased to menstruate. This de-
scription is based on the observation of some cases that
have occurred in Dr. Duncan's practice, and which have
fortunately been so distinct in their characters, and so free
from complications with disease of neighboring parts, as to
afford almost typical examples of the affection.

The uterine leucorrhcea is, in the cases referred to, not
symptomatic of any of the organic diseases of the uterus,
such as fibrous tumor, or a complication of them ; but, like
the other primary leucorrhce, is a disease of the genital
mucous membrane ; and, in this case, of that part of it lin-
ing the cavity of the womb.

This disease is not peculiar to women who have passed
the childbearing period of life. Uterine leucorrhcea occurs
in young women in various forms; but in old Avomen it has
appeared to the author to have more characteristic, and,
perhaps, peculiar symptoms. Its treatment has also pecu-
liarities ; but above all, its diagnosis is important for two
great reasons first, that it may be appropriately treated ;
and, second, that the alarm sometimes excited in the pa-
tient, and sometimes in the practitioner, by the great simi-
larity of the symptoms to those of cancer, the bane of wo-
men of* mature years, may be subdued.

Discharge per vaginam of muco-purulent matter i
symptom of the disease. The discharge varies in charac-
ter, being sometimes like mucus, and thin, sometimes pur-
ulent, and more or less viscid. It is occasionally mixed
with blood, or only tinged with it. In some cases this san-
guinolence is produced only by the head of the bed, or by
anything coming in contact with the cervix uteri, especially
if its mucous membrane happens to be abraded. If the
discharge is retained in uteri, even for only several hours,
it acquires a putrid odor. Its retention is apt to occur from
the progressive atrophy of the neck of the womb leading
to contraction of its canal. It may also, in some cases, be
the result of flexion of the uterus ; the influence of gravi-
tation being then occasionally superaded to the dimension-
al contraction of the cervical canal at the seat of the flex-
ion.

10.] Lew

When the discharge doea nol flow freely, bu1 accumu-
lates in and distends the cavity of the uterus, it gives i
to a peculiar pain around the loins or pelvis, of a girding
nature, as if a tight, hard cord partially or entirely encir-
cled the person, a pain having probably some remote
aiogy to the corresponding symptom produced when labor
is obstructed by the distended hydrocephalic head i
on the cervix uteri. Other pains may be present in the
region of the uterus, orthere may be irritation and pain of
the vulva, from the constantly passing discharge; but ti
are not characteristic symptoms.

The only other notable symptom is disorder of the
stomach and vomiting. When it occurs, it is evidently the
resull oi' what is called symptathy with, or the reflected ac-
tion of, the uterine nerves irritated by a replete and tense
uterine cavity.

The exact seat and nature of the disease requires for its
diagnosis a careful physical examination. The more or less
atrophied and tent-shaped fornix of the vagina is first felt,
and at its apex the more or less atrophied crevix, with a
patulous mouth. The body of the uterus generally stands
high, and may he felt to be enlarged, generally, though not
always, inconsiderably. A probe, passed into the patulous
external os, soon finds that the internal os uteri is not in a
similar condition. But having permeated it, the uterine
cavity is found to be wide and capacious, the point of the
probe moving preternaturally freely in it. When the probe
passes without force, it causes almost no pain. It should
be urged and handled with great care and gentleness; for,
should the uterine walls have their toughness and elasticity
destroyed by disease, whether simple or malignant, a probe
may easily accidentally wound, or even transpierce them ;
and, while such a wound may be harmless in the case of
healthy walls, its gaping condition, when made in an une-
lastic wall, will render it at least dangerous, and probably
fatal.

If a small plug of sponge-tent be passed into the cervical
canal, to dilate it for the free passage of the discharge, the
latter will be restrained completely for the time, and the
girding pain will be much increased. On the removal of
thesponge, the discharge will come away fetid in a gush,
and the girding pain will be completely relieved. Much
care is necessary in using the sponge; for, if too large? it
may lacerate the rigid atrophied cervix by its rapid expau-

934 Leucorrhasa. [December,

sion ; or, by too long obstruction of the discharge, the over-
distended uterus may burst, especially if its walls are de-
generated and unelastic; or, b}^ the same cause, the noxious
fluid may be forced through the tubes into the peritoneal
cavity. These risks are over-above those rare evils which
occasionally occur from the use of sponge-tents in cases
that appear to be in every way proper for their application.

Examination with a speculum, adapted in size to the con-
dition of the parts, may not be necessary. By its means
an abraded condition of the cervix uteri may be remarked ;
and probably the process of the examination will cause
bloocl to ooze from these parts.

The general aspect of cases of uterine leucorrhcea in old
women appears to differ considerably from that of the
young, although there is no single feature to distinguish
them if the atrophy of age be omitted. This last condition
implies a smooth vagina contracting in dimensions in its
upper part, an elevated uterus, a small cervix, states which
are, of course, never observed in the young. But it will
be found that in the old the disease is more chronic than in
the young ; that there is less pain and tenderness in the old
than in the young ; that in the old, thickened uterine walls
and flexions or versions are rarer than in the young ; that
sanguinolence of the discharge is also rarer in the old than
in the young ; while fetor of it is more common, from a cir-
cumstance already mentioned, which leads to its more pro-
longed retention in utero. All these differences may not
exist in any two cases that may come under a practioner's
care ; and even if they did, they would not be sufficient to
establish any essential difference in the diseases ; but they
are of considerable importance nevertheless.

The treatment which has proved most successful in the
hands of the author is one which is certainly not generally
applicable to cases occurring in young Women. It is the
regular use of cauterization by nitrate of silver, applied
every third or fourth day to the interior of the uterus, in
Lallemand's port caustic. After each application the dis-
charge is altered in character for a day, and subsequently
diminished in quantity till it gradually disappears. Anoth-
er remedy appeared to be of marked service, namely irri-
gation of the cervix uteri and vagina with water consid
bly below the temperature of the body. This is easily
fected by a Iligginson's syringe, a syphon, or some other
suitable apparatus.

18()0.] Antidote to Strychnine.

As the cure progresses, the dimensions of the cavity of
the uterus are perceived, on introduction of the port cans-
tic, to be gradually lessening, the atrophy of tne cervix
rapidly increases the external os uteri Looses its potency,
and at last the discharge entirely ceases to low.

The disease being in itself not a fatal one, opportunities
-mortem Investigation can rarelyoccur. l>r. Duncan
refers to the appearances observed in one aggravated and
uncured rase, where the patient died of dysentery, and
where only a hurried autopsy was allowed. The uterine
cavity was dilated, SO that it might contain little less than
half an ounce. The walls of the uterus were abnormally
thin and soft, and the mucous membrane of the uterine
eavitv had an irregular and almost ragged surface, the de-
pressiona being apparently seats of ulceration.

Tannin as Antidote to Strychnine, By Professor Kurzac, of

Vienna.

From want of a reliable antidote, the treatment in eases
of poisoning by Btrychnine hitherto consisted principally in
endeavoring to evacuate the poison, to combat the frightful
spasmodic symptoms by narcotics, and to re-establish respi-
ration, when it finally ceased, by artificial means. Donne
proposed iodine, chlorine, and bromine, as antidotes to
strychnine ; Garrod, Rand, Morson, and Falck recommend-
ed prepared animal charcoal ; but the efficacy of these sub-
stances has been neither tested sufficiently by experiment
nor proved by experience. The same is true in regard to
tannin, and the astringent vegetables containing it, their in-
fusion, decoctions, etc. Although they recommended them-
selves by the fact that tannin forms chemical compounds,
insoluble in water, with strychnine and other poisonous al-
kaloids, it seems very probable that these products might
be re-dissolved in the stomach and intestines, and thus be
rendered capable of absorption; the virtue of tannin as an-
tidote to Btrychnine was, therefore, considered very doubt-
ful.

With a view to subject this matter to a thorough examin-
ation, and to ascertain the efficacy of tannin in preventing
and allaying the symptoms of poisoning by strychnine,
Professor Kurzac made a series of experiments on rabbits
and dogs. At the end of his interesting and highly impor-

936 Antidote io Slrycitnine. [December,

tant memoir, he states that the results of his own investiga-
tion permit him to draw the following conclusions :

1. Tannin, if administered in time, is an excellent chemi-
cal antidote to strychnine.

2. The doubt, whether the precipitate formed by tannin
in a solution of strychnine, although insoluble in water,
would not be redissolved by the gastric and intestinal juice,
and the strychnine thus reobtains its poisonous properties,
is solved by these experiments on rabbits and dogs in :>
complete and highly gratifying manner.

3. The successful results in dog9 and rabbits justify the
expectation that tannin would suspend the poisonous action
of strychnine also in man, even in cases where the evacua-
tion of the tannate of strychnine, formed in the stomach,
could not be accomplished.

4. These experiments show that twenty to twenty-five
times the quantity of tannin is required in order to suspend
the poisonous action of the strychnine. In cases of pois-
oning it will be, however, advisable to administer a relative-
ly larger proportion, as a part of the antidote will be ab-
sorbed by the usual contents of the stomach, particularly
by gelatin.

5. As tannin has proved to be an antidote to nitrate of
strychnia, which is much more soluble in water, there is so
much greater reason to hope that it will be successful in
poisoning by pure strychnia which dissolves in water with
much difficulty.

6. The same successful result is to be expected from its
administration in poisoning by the hard and tough mix
vomica, which imparts the poison to acqueous fluids, but
gradually and not very rapidly.

7. Tannin is a so much more valuable antidote in poison-
ing by strychnine, as galls in which it is contained can be
readily procured, and thus be administered without much
loss of time. They are easily reduced to a powder, which
is given, mixed with water. Another advantage is obtain-
ed by the vomiting which it is liable to produce. In the
mean time an infusion or decoction of powdered galls may
be prepared.

On an average, Turkish galls contain fifty, and the Ilivriaii
galls twenty per cent, of tannin. At least one drachm of
the former and two drachms and a half of the latter, arc
therefore required to neutralize one grain of strychnine in-
troduced into the stomach, but in general, especially if there

>.] Antidote to Slrychm

\< vomiting, a much larger quantity should be administered.

8. Another readily obtained Bubstance containing tannin
is Chinese tea, the efficacy of which in poisoning by strych-
nine, is confirmed by our experiments. Hut these experi-
ments (7 and 8) have also shown that, in a decoction of

. -e cannot count upon the whole amount of tannin

contained in them. Inpoisoningbj a Larger dose, it would

e l>c necessary to administer bo large an amount of

green tea that the antidote itself might produce poisonous

cts. One decigramme (j grain) of nitrate of strychnine

requires, as our experiments prove, ten drachms (600 grain-.

aspoonfuls) of green tea, which, according to Polig
analysis, contain about fifteen grains of caffein. Tea is,
therefore, applicable only in poisoning by smaller doses,
but may otherwise be useful as adjuvant.

i'. The efficacy of roasted coffee as chemical antidote to
strychnine seemed to be much inferior. The amount of
caffeo-tannic acid contained in coffee is, according to Payen,
3.5 to 5.0 per cent But our experiments (9, 10, and 11)
show that the decoction evidently contains a much smaller
quantity of undecomposed tannic acid than tins per centage
would justify us in assuming. The decoction of 180 grains
of toasted Cuba coffee (being adequate to 200 grains of the
raw coffee, which should contain at least six grains of tan-
nic acid) produced, according to the ninth experiment,
merely a delay and diminution of the poisonous effect of
0.13 grains of nitrate of strychnine. In the tenth and
eleventh experiments, 300 grains of raw coffee, which
weighed, after roasting. 2G7 and 264 grains, and should
have contained at least nine grains of tannic acid, had fur-
nished a decoction which, as antidote to 0.13 grains of
strychnine, was nearly inert, only delaying the appearanc
of the symptoms for a little while.

L0. From unroasted coffee, so inconsiderable an amount
of tannin is extracted, by boiling, that the employment of
its decoction for our purpose is out of question.

11. Oak bark (of Quercus robur and Q. pedunculata)
contains, according to Gerbcr, 8.."> per cent, of tannic acid,
and imparts it readily to aqueous fluids. It deserves atten-
tion in poisoning by strychnine bo much the more, as it can
be procured without much delay, especially in the country.
What has been said about the administration of gal!>
equally applies to the use of the powder and decoction of
this bark.

r

038 Pulmonary Hemorrhage. [December,

12. On account of their frequent occurrence and the large
amount of tannin they contain, Ave have to mention in this
connection : acorns (from Quercus robur and Q. peduncula-
te) with 9 per cent ; the bark of the horse-chesnut, with 8
per cent; willow bark, with 5-J per cent; and the green hull
of walnuts. The radix tormentilloe, with 17 per cent.; rad.
caryopbyllatre, with 31 per cent ; and rad. bistortrc, are still
richer in tannin, but can rarely be procured without much
loss of time.

13. The solubility of the precipitate, produced by tannin
in a solution of strychnine, by acetic, citric, and tartrric
acid, (vide experiments with the same,) show the necessity
of avoiding vegetable acids during the treatment of poison-
ing by strychnine with tannic acid.

14. The same applies to the internal use of alcohol and
alcoholic remedies.

15. The reported experiments on rabbits have sufficient-
ly proved that more active voluntary movements excite the
spasms usually produced by strychnia, even when they oth-
erwise would not have made their appearance. In treating
cases of poisoning by strychnine, it is therefore highly im-
portant to prohibit, as much as possible, all voluntary move-
ments, and to avoid violent excitement of any other kind. Zcit-
schrift der K. K. Gesellschaft der Aerzte zu Wien, March 12,
1860.

On the Use of Larch Bark in Pulmonary Hemorrhage. I3y
Dr. Owen Daly, Physician to the Hull General Infirmary.
The experience of Dr. Daly agrees with that of Dr. Fre-
zill (who recently introduced the medicine to the notice of
the profession), Dr. Moore, Dr. Hardy, Dr. Kennedy, Dr.
Carmichael, and some other Dublin physicians. "I be-
lieve," says Dr. Daly, "the tincture of larch will be found
to be a most valuable agent in arresting and restraining
pulmonary hemorrhage. It possesses powerful astringent
properties, combined with the styptic and slightly stimula-
ting qualities of a terebinthinate a rare combination, and
one which appears to me to present all the requisites for a
perfect styptic. By virtue of these properties, it acts as a
mild tonic, improving and strengthening the digestive or-
gans, while it does not interfere with the healthy and na-
tural action of the bowels. Further, it is a palatable and
pleasant medicine, having an agreeable balsamic lpi

ISiJO.] Pulmonary Hemorrhage. 989

flavpr, which is no slighl recommendation in medicines oi
this class, especially when their continued exhibition must
bo persevered in for a Lengthened period."

Or. Hardy has given larch bark in fifteen cases of pul-
monary hemorrhage, some passive and some active, in one
case i)i' severe epistaxis, and in one case of chronic cystitis,
and in all eases with positive advantage, except in the last.

Case 1. On the 3a of August, I was asked to visit an
unmarried lady, set. 25, who had been Buffering for several
days from passive pulmonary hemorrhage ; she had hurried
respiration and frequent COUgh, attended with expectoration
of blood. She had had haemoptysis on two previous occa-
sions ; both lungs wTere diseased, the left extensively, the
disease having advanced to the formation of pulmonary ex-
cavations. The finger-ends were much clubbed. Lead
and opium were first prescribed, afterwards sulphuric acid;
finding, however, after persevering in the use of each for
several days, that the lnemoptysis still continued without
any abatement, and that she wras becoming wreaker, the
tincture of larch wTas substituted for the acid, and was given
in half-drachm doses every third hour. Two days after,
the hemoptysis had almost ceased, the sputa being only oc-
casionally tinged with blood. The tincture was omitted for
a few days on two occasions, and on each the expectoration
became slightly tinged with blood; which, on the medicine
being resumed, soon subsided. Latterly she has taken the
tincture along with the infusion of chinchona.

Case 2. The following case I saw in consultation with
my friend Mr. Dix on the 31st of July. The patient was a
married man, set. 28 ; active hemorrhage had existed for a
week. The blood coughed up was pure and unmixed.
The haemoptysis occurring every day or every other day,
sometimes twice in the day, and on one occasion three
times, but never lasting for more than a few minutes at a
time; on one occasion at least four ounces of pure blood
were coughed up. The constitutional disturbance was xwy
slight, the pulse rarely exceeding eighty ; the cough was
very trifling more to use his own expression a "pining"
than a cough. The hemorrhage was always superseded by
a "spongy feeling" referred to a particular spot in the right
side of the chest, wdience the effusion evidently proceded.
In this case an excellent opportunity was afforded for test-
ing the virtues of the tincture of larch as a styptic, inas-
much as, previous to its employment, lead and opium, gal-

940

Pathology of Tubercle,

[December.

lie acid, the mineral acids and turpentine, had all been ad-
ministered, and each persevered in for two or three days
without giving any relief. On the 4th of August, the tinc-
ture of larch was prescribed in drachm doses qvqvy two or
three hours, given in water. The result was most satk
tory. The hemorrhage, after the administration of a few
doses, was completely arrested, and although nearly four
months have elapsed, no return of the bleeding has taken
place. The dose was gradually diminished, and after a
time quinine was added to the prescription.

Case 3. The last case I propose relating is one of severe
epistaxis occurring in a girl, set. 19. She stated that for
several weeks past she had suffered from profuse bleeding
from the nose, generally commencing in the evening, and
on more than one occasion she had become quite faint from
loss of blood. The bleeding was not vicarious, as she had
menstruated quite regularly ; her appearance was anaemic
and indicative of great loss of blood. Steel and quinine
in combination with sulphuric acid were prescribed and
taken for a fortnight without the least benefit. The tinc-
ture of larch was therefore substituted in half-drahm doses
every fourth hour. The bleeding was completely arrested
at the end of a week ; she, however, continued to take the
tincture in infusion of cinchona for some weeks longer ;
and when last seen, on the 10th September, was very much
improved in her general health. It would be not only te-
dious, but unnecessaiw, to take up more time by a relation
of further cases ; the refrain in each would be the same, an
immediate and striking improvement in the patient's con-
dition, the haemoptysis in evory instance yielding to the
medicine, in some eases after a few doses, in others after a
more prolonged exhibition. Medical Times and Gazette.

Pathology of Tubercle,

By 0. C. Gibbs, M. I)., Frewsburg,
Xew York.

In the American ,1 our no I of Medical Science, for April, \)v.
C. Ellis, of Boston, has an essay upon Tubercle. Thees
received the Boylston prize, and though the opinions of the
author are none of them novel, yet the essay is not without
its merit. We shall make a quotation or two, which will
embody the most important ideas. Of tubercle he says ; tkIt
is not a specific exudation. It does not exist as such in the

I860.] Pathology . 1 >le. 941

blood. The yellow variety is always the result of metamor-
phosis of degeneration." It Is altogether probable that it
is owing to a "degraded condition of the nutritive mate-
rial," which differs from that furnished under ordinary cir-
circumstances, "not in kind, but in degree of vitality or ca-
pacity for organization."

In regard to its connection with inflammation, lie says:
"Tubercle makes its app letimes with, sometimes

without inflammation, and, certainly, the recent granula-
tions, in most eases, show no signs of an inflammatory ori-
gin : tin* tissue in this neighborhood is remarkably healthy.
If, there lore, they generally or often exist without apparent
inflammation, the presence of the latter should rather be re-
garded as a consequence and not a cause." AVe quote the
ve opinions with pleasure, as they conform with our own
idea, expressed several years since.

Those of our readers who have been in receipt of the
Monthly for the last five years, may remember some re-
marks of ours in the January issue of this journal for 1856.
Speaking of meningeal tuberculosis, we held the following
language : k* Many have supposed that meningeal inflam-
mation commenced anterior to the deposition of meningeal
tubercle. Such suppose the granular deposition to be noth-
ing more or less than the prodnct of inflammation, and,
consequently, tuberculosis the sequence of an inflammatory
cause. Some of the first names in the profession, in the full
light of our present pathology, have maintained this opin-
ion, of whom may be mentioned Broussais, Alison, Andral,
Rainhart, Eokitansky, Gross, kc. Williams, too, claims
that tubercles are frequently the product of inflammation.
The subject is of the first importance, and I propose here a
few arguments in disproof of the opinion of the above men-
tioned pathologists. Perhaps there is no fact better estab-
lished in pathology than that tubercles exist in numberless
cases without any evidence of inflammation, either by
symptoms, or as shown by anatomical examination. If this
be so, then inflammation is not necessary to the production
of tubercle ; and when it exists in connection with such de-
posits, it is probable that it is a superinduced consequence,
and not a pre-existing cause. It is admitted that tubercles
may occur in an organ simultaneous with, or subsequent to,
inflammation in the same organ ; but even then there is no
evidence that there is an existing relation of cause and ef-
fect : but it is probable that their coexistence is accidental,

942 Pathology of 7 ubcrcle. [December,

or, rather, the subjoined tubercles are an independent coin-
cidence. It is possible that, in persons of a scrofulous dia-
thesis, inflammation may hasten the deposition of tubercles ;
but this is far from justifying the conclusion that such de-
posits are the products of inflammation."

Bearing upon some other points of Dr. Ellis' paper, we
should be happy to quote similar ideas from our paper re-
ferred to, but our space will not justify great extension.
"We will, however, make one other quotation. Dr. Ellis
states his conclusions in regard to tubercle thus: < "It is al-
together probable that owing to a 'degraded condition of the
nutritive material,' which differs from that furnished under
ordinary circumstances, not in kind, but in degree of vital-
ity, or capacity for organization." ' (The double quoted are
his.) This is the prominent idea of Dr. Ellis' prize essay,
and now let us see if the idea is altogether new. In our pa-
per previously referred to, and published in 1856, we made
the following remark: "It is probable that fibrin, or a
substance that is fibrin-like, may result from a retrograde
condition of albumen. And it is my opinion, though that
opinion may be hastily formed, that this fibrin-like sub-
stance, resulting from defective albumen, that has failed in
its object in the process of nutrition, is the pabulum of tu-
berculosis. In other words, "the albuminous material which
in the process of nutrition is to form the elements of growth
and repair, through some defect in its formative process, is,
to a limited extent, incapable of cellular development ; and
this non-developmental albuminous product becomes the
dead, fibrin-like concretion which is denominated tuber-
cle." We fail to perceive the difference between the prize
essay opinions of Dr. Ellis, and those expressed by ourself,
in an unpretending article, nearly five years ago.

While upon the subject of tubercle, we wish to pay a pas-
sing notice to articles in the Medical and Surgical Reporter.
In the issue of that Journal for April 21st, under the head
of "A Xew Theory of Phthisis, "reference is made to a work
just issued in London by Dr. Goodwin Tims, and to his opin-
ion that tubercle is the product of "destructive assimila-
tion," retained in the system because of imperfect excretion.
In the Reporter for May 12th, Dr. E. J. Fountain, of Daven-
port, Iowa, complains that credit is erroneously given, and
affirms that he first enunciated this opinion, in the July issue
of the N. Y. Journal of Medicine. That Dr. Fountain be-
lieves his statement true, we will not doubt, but it is, never-

I860.] tiu Pat) 948

theless, slightly incorrect Several pathologists, and am
them we think we may mention Andral and < tavarret, have
considered tuhercle only modified fibrin. Because so
ridered, Simon called it fJbriniform. Though fibrin was once
considered the material from which textures were chiefly
nourished, yet, for several years back, several eminent phy-
siologists have regarded fibrin only an excrementitious pro-
duct Both the above ideas were fully brought out in our
article, to which reference has previously been made, and
they do not differ from those advanced by Drs. Tims and
Fountain.

On the Pythology of Lead-Colic. By Willouchby P. Wade,
M. B., Physician to the Queen's Hospital and to the
General Dispensary ; Professor of the Practice of Physic
in the Queen's College, Birmingham.
The received opinion that this painful disorder depends
upon some perverted action of the colon, as its name im-
plies, has already had its antagonists. When we come to
inquire a little more closely what the perverted action is,
we find that no satisfactory answer can be given. Some
contend for an empty and contracted condition of the gut,
others for a distension by gas or feces.

Dr. Copeland says that in his cases distension was as fre-
quent as retraction, owing evidently to inflation and faecal
engorgement of the colon, the course of which could be
distinctly traced under the abdominal parietes. De Haen
and Merat found contraction of the colon and cpecum in all
the cases they examined. But, as Dr. Watson judiciously
remarks, "with regard to the contraction of the large intes-
tine in these cases, we must not be two ready to attribute
it to spasm, for the bowel, when empty, is apt to be con-
tracted." Andral details six cases in which no such con-
tractions were found. Indeed, Andral, Louis, and Sir
George Baker, concur in describing the intestines as being
normal throughout their whole extent. I doubt very much
whether an unopposed contraction of a hollow muscular
canal can be attended with pain. It is the vain endeavor
to shorten the muscular tissue, and the resistence offered
by an incompressible material, that causes the pain in bil-
iary calculus and ordinary crapulous or flatulent colic. An
empty intestine might, I think, go on contracting till its
calibre was obliterated before it produced pain, The after-

944 On the Pathology of Lead- Colic. [December,

pains of labor do not offer any necessary objection to this
view ; for the contraction of one layer of fibres can be well
resisted by the large mass of inactive ones. Besides, they
often depend on the presence of clots. On the other haid,
did the pain of lead-colic depend upon the presence of
flatus, I cannot conceive how it is that this should not, in
such cases, be readily removed, for a time at least, by opiates
and carminatives, as happens in ordinary flatulence. If,
again, it depended upon retained faeces, the removal of them
should remove the pain. But the operation of the bowels
is by no means necessarily followed by this relief. It is,
indeed, true that the two often coincide, but this is quite as
easily explicable in another way, as we shall see directly.
The retraction of the abdominal parietes, so constantly no-
ticed in this form of the complaint, is by no means so con-
stantly observed in other varieties of colic.

The pathology of lead-colic is then, I submit, unsatisfac-
tory and vague as at present taught.

Various pathologists of distinction have been disposed to
refer the symptoms to cramp of the external abdominal
muscles, instead of the intestines at all. Giacomini first
broached this notion and M. Briquet ot la Charite has more
lately revived this view, which he supports with skill and
vigor. The existence of cramp in these muscles has been
recognized by those who are entirely committed to the gen-
erally accepted pathology. Thus Dr. Copeland says, "the
voluntary muscles often become so sore that they cannot
bear the slightest pressure ; and the pain frequently alter-
nates between the stomach and bowels and the external
muscles." Besides the spamodic contraction of the ab-
dominal muscles, which he has observed more particularly
in the severe cases, Grisolie says that three-fourths of these
patients suffer from cramps, or a feeling of numbness, or
from lancinating and tearing pain in the muscles of the
lower extremities; half of them have similar affections of
the muscles of the upper extremities, and a third in the
lumbar muscles.

The fact that in most severe cases the abdomen was found
to be retracted is important; for therewasevidently aspasm
of all the abdominal muscle. Hence, on Briquet's theory,
the acuteness of the pain ; whereas in the slighter cases
there would be only a moderate spasm or perhaps affection
of one or two muscles only, which would not produce re-
traction and which might be readily overlooked unless at-
tention were specially directed to it.

I860.] On the Pathology of Lead-Colic. 9 15

There can be no question that this condition is more than
sufficient to produce any amounl of pain even the excru-
ciating agony of lead-colic. T<> any one who lias Buffered
from cramp in the leg or any other part of the body, furth-
er proof 01 this point is quite BUperfluOUS. That such 18

the actual cause of the suffering M. Briquet shows by the
following arguments :

Muscles which are thus affected may be excited to more
energetic action by rubbing them with the point of the
finger or with any rigid, bluntly pointed instrument, such
for example, as a penholder. They can also he re-excited
if they have previously become quiescent. AVc can thus
reproduce or exacerbate the pains of lead-colic, and this
artificial excitement cannot be distinguished by the patient
from the natural exacerbations so common m this com-
plaint.

Some little time ago I had an opportunity of proving the
truth of M. Briquet's assertions.

A boy, aged 13, who was engaged in polishing black
glass brooches with a powder containing lead, and whose
gums were marked with the blue line, was brought in great
suffering to the Dispensary, in October, 1858. The pain
was constant, with paroxysmal exacerbations; it was refer-
red to the upper part of the abdomen ; the bowels had been
open two days before, but for a week had been very costive.
The pain, also, was of a week's duration. The upper half
of each rectus abdominis wTas tonically contracted and the
spasm evidently increased during each exacerbation. The
spasm might be artificially excited by manipulation with
the finger, as described by Briquet. This produced just as
much pain as occurred during the inartificial exacerbations,
and this pain was just of the same character as that which
came on spontaneously. In this case the bowels were
moved, not before, but after the pain had ceased. In an-
other less severe case, in a girl, the pain ceased twenty-four
hours before the bowels were opened.

There can be, I think, no difficulty in understanding that
the pains of lead-colic, and the retraction of the abdomen,
may be completely explained by the existence of tonic and
clonic spasm of the abdominal muscular parietes. The
question then which remains to be answered is, whether it
is possible for the constipation to depend upon this spasm.
It appears to me that this question may be safely answered
in the affirmative.
GO

946

On the Pathology of Lead-Colic. [December,

In ordinary defecations these muscles take an active part.
"The act of defecation (as of urination)," says Dr. Carpen-
ter, "chiefly depends upon the combined contraction of the
abdominal muscles, similar to that which is concerned in
the expiratory movement; but the glottis being closed,
so as to prevent the upward motion of the diaphragm their
force acts only on the contents of the abdominal cavity ;
and so long as the sphincter of the cardia remains closed,
it must press downwards upon the walls of the rectum and
bladder, the contents of the one or the other of the cavities,
or of both, being expelled according to the condition of
their respective sphincters ; these actions beihg doubtless
assisted by the contraction of the walls of the rectum and
bladder themselves."

The muscles, then, of the abdomen being already firmly
contracted without closure of the glottis, the diaphragm is
unable to descend, and pressure upon the rectum becomes
impossible. This, combined with the hardened state of the
faeces and the contraction of the sphincter ani, both of
which are, according to the best authorities, common occur-
rences in lead-colic, are undoubtedly sufficient to explain
the constipation which characterizes this disorder. The
bladder requiring a less sustained voluntary effect is emp-
tied ; this applies also to the stomach. This theory explains
also why micturition is sometimes painful; and the connec-
tions of the cremaster account for its spasmodic contraction
and the consequent painful retraction of the testis. And
we can also comprehend why the action of the bowels, and
cessation of the pain, should be so commonly contempora-
neous, and why, as in these cases I have cited, the pain
should cease before the bowels are moved.

It now remains to consider in what relation the lead-
poisoning stands to this spasm ; and what relation there is
between this latter and the disorder of the abdominal or-
gans, which is certainly a common feature of the complaint,
such as the slight icterus, the hardened iseces, the vomiting,
loss of appetite, and so on.

I presume that the members of the Association are ac-
quainted with the papers which have been published from
time to time in our Journal, by our ingenious confrere, Dr.
Inman, of Liverpool. In these and in a volume which he
has published separately, Dr. Inman has contended that
the symptoms which have been grouped together under the
title of "Spinal Irritation," arises from the irregular con-

I860.] On the Pathology of Uad-CoUd. 047

traction of muscles which have been enfeebled from any
cause; as for instance over-exertion or malnutrition, II-'
points out, too, that the term over-exertion, is a relative one;
that whereas one person might walk fifty miles or lilt enor-
mous weights, others might evidently be overtasked did
they accomplish a tenth part of such labors, Me
effected present, generally perhaps in a minor d< hose

appearances and phenomena which are found in the abdom-
inal muscles of patients with Lead-colic.
Now, we know, t'mm examination, that muscles impreg-
nated with lead Loose their colors and Income enfeebled in
various degrees, even to the extent of actual paralysis.
The malnutrition, it' extreme, ends in fatty degeneration so
complete that all the proper functions of the muscles are
rendered impossible. It is especially, if not exclusively,
the voluntary muscles upon which lead exerts its morbid in-
fluence. I can assert that the abdominal muscles are im-
pregnated with lead in these eases, because sufficient time
has not elapsed since attention has been directed to this
view to permit of the necessary investigations being com-
pleted. But if this be made an objection, I answer that it
applies to the intestinal involuntary muscles, which have
not been shown to suffer disorganization, but which on the
contrary, have been stated by independent observers to be
apparently healthy. Besides the frequency with which
spasm does attack the external muscles has been admitted
by the same observers.

Whether the absorption or ingestion of lead produces
any direct effect upon the abdominal viscera, I am also un-
able to state ; if not, we must attribute their disorder to
general causes, such for instance, as intemperance in men,
a vice to which painters are much addicted, and which we
have the authority of Dr. Copland for stating, aggravates
and reproduces the effects of lead upon the system. Indu-
ration of the fajees has a direct influence upon the produc-
tion of parietal spasms, by necessary unwonted activity of
the muscles during the act of defecation. The occupation
of many of these people involves considerable exertion.

In a case of so-called spinal irritation, with costiveness.
in a young girl, not a lead-worker, the act of defecation was
always attended with pain in the abdominal muscles and a
subsequent soreness in the upper portions of the recti ab-
dominis. This ceased in a great degree when the bowels
were rendered more soluble by medicine, and this long be-

948 Urticaria. [December,

fore there was any or much amelioration of the other mus-
cles which were liable to these painful contractions.

Congestion of the liver, irritability of the stomach, and
irritation of the colon, from scybala, may tend in another
way to produce this spasmodic affection. It is not uncom-
mon to find the muscles contracted where they overlie an
internal organ which is in an abormal state; indeed, Dr.
Copland explains this contraction by supposing that it is
involuntarily instituted for the purpose of compressing the
distended colon.

In conclusion, let me ask why should we seek to offer an
explanation on lead-colic which cannot be substantiated,
when we can find another one which is not only supported
by admitted facts, but which is capable of adequately ex-
plaining not merely the colicky pain and the constipation,
but also of embracing those, as they have been held minor
and accidental features, the existence of which must on the
old theory, have been explained in the very way whj^i I
now seek to extend, so as to embrace and harmonize almhe
phenomena of the disorder. Whether lead-colic, using the
term in its strict acceptation, ever exists is, I think, ex-
tremely doubtful ; but that many cases reputed to be such
are to be referred to a totally different category, rests upon
evidence which cannot, 1 think, be controverted. It there-
fore behooves those who are prepared to admit as, I think
all must, the occasional simulation of lead-colic (in the
strict sense) by a spasm of the external muscles ; it behoves
them, I say, to distinguish carefully in each case its exact
nature, both with the view of ascertaining the real patholo-
gy of these two disorders, of regulating their treatment by
this, and not merely by the name under which they have
been hitherto confounded. Brit. Med. Jour.

Urticaria as a Symptom of Irritation of the Female Sexual Or-
gans. By Prof. Scanzoni.

Professor Scanzoni observes that although it has long been
known that chronic affections of the female sexual organs
are not infrequently accompanied by skin diseases (as urti-
caria, eczema, acne, psoriasis, chloasma, etc.,) the influence
of a more sudden irritation of these organs upon the cuta-
neous surface is by no means so well established. lie has
been enabled to find no very definite statements upon the

I860.] Urticaria. 949

lubject, and this leads him to communicate some cases tend-
ing to establish such a consensufl.

A lady, aged 35. had been under his care for sometime
with slight retroflexion of the uterus and chronic metritis,
when he ordered lour leeches to be applied to the vaginal
portion of the cervix uteri. This little operation had been
already performed once before without any ill effect, but
upon the presenl occasion, ten mirfutesafter the application
had boon made, the patient was seized with violent febrile
action, and slight delirium. In half an hour she was s<
by the author, who found her skin, and especially thai of
the face and upper part of the body, almost of a scarlel red.
The temperature of the Bur&ce was considerably raised,
and her pulse beat 136. She continued much the Bame
during the night, and when seen next day, the face, neck,
chest, arms and thighs exhibited with the intense redness,
innumerable urticaria elevations. In a day or two the ex-
anthem had entirely disappeared, a distinct desquamation,
however, taking* place on the face and neck. As this was
the first ease the author had ever seen in which these symp-
toms followed the application of the leeches to the crevix,
lie did not believe in their dependence upon this, and again
ordered them to be employed. Four times this was done
without any unpleasant occurrence, but on the fifth occasion
the whole series of symptoms above described were repro-
duced, and that so rapidly after the biting of the leeches
that any doubt as to cause and effect could no longer be en-
tertained.

In a second case, a woman, aged 28, was admitted into
the "Wiirzburg Midwiferv Institution on account of chronic
uterine infarctus, and five leeches were ordered to be ap-
plied to the cervix. Scarcely had they taken hold, when
she complained of the most violent labor-like pains in the
abdomen, and although these soon moderated in force, they
were accompanied with such intense febrile action that the
entire body glowed with heat, the pulse rose to 140, the
carotids pulsated visibly, and the face, neck and chest ex-
hibited an intensely red color, "to which wTere added in a
very short time a large eruption of urticaria elevations of a
palish color. The eruption was accompanied by great head-
ache, inclination to vomit, and excessive lassitude, symp-
toms which continued to the following day, although the
exanthem with the accompanying fever disappeared entire-
ly after three hours' continuance. This patient often had

950 Arsenic. [December,

suffered from urticaria at the menstrual periods, without,
however, its being accompanied by such violent symptoms.

The third case occurred in the person of a young lady,
aged 26, who, on account of long-continued chronic oopho-
ritis and metritis, required blood-letting. In the course of
sixteen months four or five leeches had been applied eight
times. On the ninth occasion, an intense redness covered
the skin, and the patient complained of the most violent
pain in the head. The temperature of the surface was
much raised, and it was almost entirely covered with innu-
merable, minute, prominent, white elevations. In the
course of an hour these appearances gradually subsided,
the headache continuing for twenty-four hours longer. The
author is aware of a fourth case of the same kind, but is
unable to furnish the particulars.

Professor Scanzoni believes that these cases deserve the
attention of those occupied with the diseases of women, as
well as of dermatologists. They admit of no other explan-
ation than the irritation of the uterine nerves, caused by
the bite of the leeches, induced an entirely unusual, and in
its mode of origin inexplicable, disturbance of the vascular
system, which again, in a mode which is to us equally un-
intelligible, gave rise to the production of the eruption of
urticaria. In proof that these appearances were not pro-
duced as a consequence of any poison being conveyed
through the medium of the bite of the leech, it is to be ob-
served that similar symptoms never result from the applica-
tion of leeches to other regions of the body, while it is to
be observed that even very slight irritation of the sexual
organs, as that produced by examination with the finger or
speculum, or by the application of caustic, will in many
sensitive women give rise to erythema of the face, neck,
breast, etc., which disappears as rapidly as it comes on.
Wurzburg Mediein. ZeUschrifts, band i. pp. 90 95.

Arsenic Poisoning and Arsenic Eating. Arenic appears
to be fast becoming an ubiquitous poison. Little children
swallow it in their delecate green bon-bons ; women encircle
themselves with robes tinted with its beautiful hues, and watt
danger around their lovely persons, hilling their admirers
literally as well as metaphysically ; painters spread it^ over
their canvas; paper-hangers captivate their customers with its
charming colors. We can hardly turn without meeting this
poison in some form or other.

I860.] An 951

When it was first announced that paper hangings colored
green by arenite <>t* copper were dangerous to health, the pa-
per hangers took the alarm at the prospective damage to their

trade, and secured the services 01 eminent chemists to look
into the question of danger to life and health. These scienti-
fic gentlemen put green paper into test tubes, with and with-
out currents of air, and found that no moderate heat, not even
that of boiling water, was capable of volatilizing the arsenite
of copper. Thev also looted into the question of putrefying
paste, and found that its emanations passing through the pa-
per did not give rise to the formation of arseniuretted dydro-
gen. Thev therefore concluded that as in none of these ways
arsenic could he volatilized, it was perfectly fixed, could not
mix with the air ot the apartment, and therefore, that the
green paper was entirely innocuous.

range to say, in all their speculations, these learned gen-
tlemen entirely overlooked the humble but potent agency of
Bridget. When that high domestic functionary, intent upon
clenliness and the extermination of spiders, enters an apart-
ment armed with her irresistable brush, she sweeps from the
surface of the paper the imperfectly adherent green powder,
which from its extreme fineness floats in the atmosphere of the
room, and when it does settle on book, and chair, and carpet,
is so easily raised that it may be considered to be constantly
present in the air when any one is moving about the room.
in this way it gets access to the lungs and other air-passages,
and even through the saliva to the digestive organs. Thus a
slow poisoning is set up, which manifests itself by the usual
symptoms. The fact that such poisoning does take place has
been established by a great mass of concurrent testimony so
pointed and direct that it is impossible to doubt it,

Shortly before public attention had been drawn to this mat-
ter of the paper hangings, some curious statements had been
made relative to the innocuousness of this very poison in con-
stitutions accustomed to its use. In all these cases the poison
was eaten habitually. So remarkable a statement gained ex-
tensive currency and was alternately doubted and believed.
At last a counter statement was made, the whole story was
ridiculed, and it was settled that Styrians could no more eat
arsenic with impunity than other people. The matter was
believed by many to be finally ret at rest, and Styrian arsenic
eating was credited to the general account of traveler's tales.

Eecently, however, Mr. Charles Tleisch. lecturer on chem-
istry at the Middlesex Hospital, has published in the Phar-
maceutical Journal a paper on this subject, which we copy.

f52 Poisoning by Strychnia. [December,

believes the original statement
about the arsenic eating, and cites authorities to prove it.
Among other interesting points in the article, we call attention
to the greater danger of inhalation over the introduction of
the poison into the stomach.

Poisoning by Strychnia Analysis of the Viscera. By Hen-
ry Osborn, M. R. C. P. London, Physician to the South-
ampton Dispensary.

Prior to the discovery of Marshe's test for the detection of
minute quantities of arsenic in organic mixtures, many cases
of arsenical poisoning, probably, occurred which were never
brought to light; but whether cases of poisoning by strychnia
have been overlooked for want of a delicate process for its ex-
traction, or whether errors in diagnosis occurred, I cannot
venture to assert. It is possible, however, that there was a
greater difficulty in procuring strychnia by the public former-
ly than now.

A few months since a case of poisoning by strychnia oc-
curred in this town, and Mr. Lawrence, who was called in,
made a correct diagnosis of the case, as it ultimately proved
to be by the result of the analysis which I was requested by
that gentleman to undertake.

Mr. Lawrence kindly invited me to the post-mortem exam-
ination which he performed, and we placed in three jars, the
stomach with its contents, a portion of the small intestines,
including the duodenum, and a portion of the liver. By
keeping the parts separate from each other we prevented the
possibility of transferring any portion of the poison from one
part to another. On opening the stomach about eight ounces
of fluid, mixed with a quantity of partly digested food, was
present. The mucous membrane of the stomach presented
no appearance of congestion, as is usually observed when
death takes place after a full meal, but it exhibited a pale
color, except at the pylorus, which was congested.

In conducting the analysis I was kindly assisted by Mr.
Lawrence, and proceeded at once to search for strychnia (a).
One half of the contents of the stomach and the organ itself
were submitted to the chloroform process, as recommended
by Messrs. Rogers and Girdwood, using sulphuric acid for the
solvent. The duodenum and its contents were submitted to
the same process, using hydrochloric acid for the solvent; but

(a.) A mi. all bottle (without a label) was found after death, containing strychnia.

18H0.] Sarsaparillain Syphilitic Diseases,

so touch coloring matin- was taken np by the acids, that a fur-
ther process was necessary ere the Btrychnia could be obtain-
ed sufficiently pure for the application of the color t
Owing to the difficulty and time occupied in getting rid of the
organic matter, [used acetic acid for the solvent tor the other
half of the stomach and its contents ; also for the liver, substi-
tuting ether and potash lor ammonia, as recommended by Dr.
Letheby, when the Btrychnia was obtained at once in a state
of purity tor the application o( the color I

After washing the potash solution witli ether i! was treated
with chloroform, and the strychnia obtained equally pure by
that solvent, thus showing the superiority of acetic acid
the two former acids, at least in the case under consideration ;
and I trust the observation affords a sufficient excuse for pub-
lishing the process which 1 found to be the most direct for
obtaining a satisfactory result.

It may be necessary to state that in the alcoholic stage of
the process we were surprised to find the extract only slightly
bitter to the taste (a small quantity only being applied to the
tongue), and in order to prove whether the strychnia was
taken up by the sulphuric and hydrochloric acids, we resolved
upon trying its effects upon animals For this purpose a kit-
ten was procured, and a small quantity of the fluid extract
(deprived oi' spirit) administered. The first symptom observ-
ed was that the hair of the animal stood on end, and within
the space of about an hour it died, with all the symptoms of
poisoning by strychnia. It may be remembered that Dr.
Marshall Hall suggested a physiological test for the detection
jtrychnia, and although Mr. Lawrence expressed his satis-
faction at the result of the colour tests, he suggested the ad-
visability of trying the strychnia, which Iliad extracted in a
pure stare, on a frog ; a small quantity being administered,
well marked tetanic symptoms were produced.

On the Use of Sarsaparilla in Sujjhil'dle Diseases. By Pro-
fessor Sigm iiud, of Vienna (Zeitchrift der Gesellschaft der
Aerztezii Wten, January 2d, 18G0.)

Professor Sigmund proposed to himself to examine the pro-
perties oi sarsaparilla when used alone, and for this purpose
he selected the best sarsaparilla root, and administered a por-
tion of a freshly-made and strong decoction to the patients
every day, their diet at the same time being carefully regula-
ted. The only remarkable effect of the drug was a moderate

954 Sarsaparilla in Syphilitic Diseases. [December,

excitement of diuresis, and occasionally a Blight discharge
from the bowels (which might perhaps be attributed to other
causes), but no other disturbance of any organ or function
could be discovered. The patients were from eighteen to
forty years of age, were kept quiet in bed, at a uniform tem-
perature, and were free from scrofulous or other wasting
ease. The sarsaparilla was administered both in the primary
and secondary forms of syphilitic disease, and the following
is an abstract of the results; 1. In simple recent gonorrhoea :
seven cases exhibited a cure in no case, nor was any of them
made worse ; but the symptoms diminished as they would
have done under any ordinary expectant treatment. 2. In
chronic gleet, induced by swelling of the prostrate gland and
consecutive catarrh of the bladder : four cases exhibited no
result whatever. 3. In simple primary syphilitic sores : nine
cases were observed. The local treatment consisted in daily
clensing the sores, cauterization with nitrate of silver, or sul-
phate of copper, or corrosive sublimate, and dressings with
weak solutions of the latter salt. The disappearance of the
discharge, and the formation of a clean suppurating surface
and gradual cicatrization, followed in six cases in precisely
the same manner and at the same period as they would have
done in the absence of all internal treatment. 4. In in dura
ted sores, the existence of which had not dated beyond five
weeks: there were 14 cases, and the local treatment consisted
of daily clensing, and dressings containing white or red pre-
cipitate, or iodine with iodide of potassium. There was a
slow formation of scars, like flat, hard nodes, while the glands
in the vicinity, as well as those at a greater distance, became
hard and swoolen, and in nine cases the treatment spots de-
veloped themselves on the skin. 5. In papular syphilitic
eruptions, scattered over the skin: four cases, which had been
subjected to no medical treatment, were now treated continu-
ously for thirty days, during which the original papules con-
tinued, and others more numerous were produced ; here and
there one of them shrivelled up and formed little scales upon
cuticle, and larger ones followed after. 6. In papular syphil-
itic eruptions, grouped in circles or discs: four cases had been
previously treated with idoide of potassium for five or six
weeks, and they were now treated for thirty days without any
result. 7 In secondary ulcers of the skin and in periostitis,
the use of sarsaparilla appeared to produce no effect in addi-
tion to that which might be attributed to local treatment with
mercury or iodiue.

Thus it seemed established that sarsaparilla, used by itself,

I860,] iritta in Syphilitic Di i

(Joea not the slightest perceptible influence on the

course and termination oi syphilitic . and Dr. Sig-

mund therefore coasts entirely to employ it alone in any form

of syphilis.

Oases treated with German drinks, in which Barsaparilla is
made to enter as an essential constituent, gave the following
results, in the hands of Dr. Sigmund. The preparation em-
ployed was Zittmann's decocti in, prepared according to the
Prussian pharmacopoeia.

1. In secondary syphilis, the cases which had not been
treated at all previously, exhibited no deviation from the or-
dinary course as long as the decoction alone was employed;
upwards of a hundred such cases were observed. More than
half of the patients here the purgative effects very badly,
and Buffered from constant sleeplessness and obstinate dis-
charge from the intestines, while some actually became ema-
ciated.

2. In secondary syphilis, which had been previously treat-
ed by mercury or iodine, or both combined, but without suc-
cess, and in which the cases presented relapses, papular or

alar eruptions, squamous affections, ulcers of the skin and
mucous membrane, disease of bones, &c; in such cases, the
use of the decoction alone generally diminished the symp-
toms, and its continued administration in certain instances
effected a cure. In all such cases, copious discharges from
the intestines and bladder and abundant prespiration were the
immediate results of the treatment, and whenever these re-
sults failed to ensue, the cure was not effected. Since sarsa-
parilla, employed alone, does not produce the effects just de
scribed, the inference is, that the results must be attributed to
the other ingredients present in the decoction, and therefore
the sarsaparilla was omitted and a decoction prepared from
the other constituents, and this latter afforded the same result,
under the same circumstances, even when the sarsaparilla was
quite pure, and not mixed, as is often the case, with bardana,
astragalus, inula, &c. The decoction of Zittmann is well
known to contain a considerable quantity of antimony and
mercury, and the operation of this preparation is accounted
for by the presence of these minerals.

The conclusion to be drawn from the above cases is, that
the use of sarsaparilla alone in ganorrhoeal discharges, and in
primary and secondary forms of syphilis, effects no material
change, and that the activity of the decoctions which contain
sarsaparilla cannot be referred to that root as one of their es-
sential constituents.

056 On the Use of Haw Meat. [December,

On the Use of Raw Meat as a Remedy. By F. P. Leverett,
M. D. (Charlestown Medical Journal and Review, March,

18G0.)

The use of raw meat as a remedy, first recommended by
Wiesse, of St. Petersburg, lias been followed by remarkable
success in American practice. In 1855, Dr. Caspar Morris
introduced the use of raw beef into the chileren's ward of the
Philadelphia Hospital; and the patients soon took it with
readiness, if not avidity, and with great benefit. The mode
of administration was to take a fillet of beef, as free from fat
as possible, and scraped with a knife, being thus reduced to a
pulp ; this was generally seasoned with salt, and sometimes
with sugar. A teaspoonful of the pulp was first given three
or four times a day, and then gradually augmented as the
child's fondness for it increased. Hie first cases in which the
raw meat was given were those of two little children who had
been much reduced by a long-neglected intermittant fever,
followed by obstinate diarrhoea. Under the use of the raw
meat they soon began to improve, and in less than a fortnight
they were convalescent. Another case was that of a child,
two years old, suffering from hereditary syphilis, and reduced
to the most emaciated condition. Paw beef and brandy were
administered, and in a week there was a change for the bet-
ter, so that it was possible to administer idoide of porassium
for the constitutional affection ; and in two or three months
the patient had quite recovered. Paw meat was given not
only to children, but also to adults with great benefit. One
was the case of a man suffering from chronic diarrhoea, who
took the raw meat, and in less than two months he was cured.
In 1856 Dr. Leverett administered the raw beef in a number
of cases at a hospital in Philadelphia, and often met with
marked success. He found that it could be rendered palata-
ble to adults, if sprinkled with salt and allspice, and spread
on a thin slice of bread, or between two slices as a sandwich.
In one case of chronic dyspepsia, with great irritability of the
stomach, it was retained when almost everything else was re-
jected; and in the latter stages of typhoid fever it proved a
valuable article of diet. Dr. Leverett thinks that the value
of raw meat as a remedy lies in its being highly nutricious,
easily digested and assimilated, and capable of being effica-
ciously administered in a small dose, one or two mouthfuls
being enough for a meal.

I860.] Miscellaneous. 957

EDITORIAL AND MISCELLANEOUS.

End of the Sixteenth Volume of the Southern Medical and

Surgical Journal.

A year of indefatigable labor brings us to the end of another volume.
We have endeavored to make each number a fair representative of the
current literature of the profession, and to crowd its pages to the full,
with the most practical and useful matter for the benefit of our readers.
A low matters of medical news have escaped us, much medical gossip
we have omitted, while all which savored of medical scandal we have
purposely excluded. We have endeavored to keep the work as purely
scientific as possible, and during the coming volume we hope still to
pursue the same, as we regard it, becoming course. To both, readers
and correspondents, we return our sincere thanks for their assistance
and encouragement during the present year, and earnestly ask that they
will continue to cheer us with their helping approval during the toil and
labor of another volume.

What they think of American Diplomas Abroad. An American
medical contemporary states that the ease with which charters are now
obtained from State Legislatures, for every nondescript association of
men, whether for proper or improper purposes, has effectually broken
down all safeguards to respectability, and thrown the field of medicine
widely open to every species of adventurer. Charters are granted by
State Legislatures to any and every body of men, for any and every
conceivable purpose, without discretion or reserve. At nearly every
session a batch of medical institutions are chartered, embracing every
shade of quackery : and these, equally with the respectable and legiti-
mate schools of medicine, are entitled to confer the degrees of M D.,
and to represent themselves abroad as universities. It is difficult to
imagine a more deplorable state of- confusion than such reckless State
patronage of ignorance and quackery must produce. Already it threat-
ens to disorganize the educational system of the profession in America ;
for adventurers are thus freely enabled to purchase that academical
status which only education can confer in other countries. The inevitable
result must be, that since we have no means of distinguishing here,
amongst the multitude of American colleges, those which apply the
necessary tests to their members from those which admit the most un-
worthy persons, American diplomas will fall into discredit, and will be
regarded as one of no value. Dublin Medical Press.

958

Miscellaneous.

[December,

On the Employment of Pantonine in Amaurosis By M. Mar-
tini. (Comtes Rendus, No. xi, March, i860.) M. Martini, in 1858,
communicated a paper to the Academic des Sciences on the effects
which santonine exerts upon the coloration of the vision and the urine.
In the present communication, containing additional observations upon
the same subject by himself and others, he gives an account of the results
of his employment of santonine in ocular neuroses. Only three cases are
referred to, the most meagre details being given : 1. A woman, seventy
years of age, had suffered for some time with defective vision of the left
eye, when M. Martini saw her in March, 1859. The pupil was bat
slightly sensible to light, and was larger than that of the right eye. A
slight white cloud was perceived in the aqueous humor, and the patient
could scarcely distinguish light. On March 10th, the santonine was
commenced, with from four to six grains being given, (how often is not
stated,) and on the 15th the patient perceived, several times in the day,
objects of a greenish-yellow color, and that even with the bad eye. On
the 18th eight- grains were given, and the patient began to be able to
recognize the countenances of the bystanders. By the 22d objects were
observed to be colored yellow, and had become still more plainly distin-
guishable. The employment of the santonine having been now discon-
tinued, the improvement remained stationary. 2. The pantonine having
been administered from March 20th to 22d, to a patient amaurotic in
both eyes, the retina became much more sensible to the action of light.
3. To a man who suffered from amaurosis of the left eye, being already
deprived of the right one, ten grains of santonine per diem were given.
In a week's time he was enabled to read some large letters written on a
wall. Philadelphia Med. Sf Surg. Reporter.

Ventilation of Rooms at Night. A a extraordinary fallacy is the
dread of night air. What air can we breathe at night but night air ?
The choice is between pure night air from without and foul night air
from within. Most people prefer the latter. An unaccountable choice.
What will they say if it is proved to be true, that fully one-half of all
the diseases we suffer from, is occasioned by people sleeping with their
windows shut ? An open window most nights in the year can never
hurt any one. In great cities night air is often the best and purest air
to be had in the twenty-four hours. I could better understand in town
shutting the windows during the day than during the night, for the sake
of the sick. The absence of smoke, the quiet, all tend to making night
the best time for airing patients. One of our highest medical authori-
ties on consumption and climate has told me that the air of London is
never so good as after ten o'clock at night. Florence Nightingale.

Chloride of Zinc Moulded into Sticks for the purpose of Caute-
rization. Soften gutta-percha in boiling alcohol, and incorporate it
with finely pulverized chloride of lime in a warm porcelain mortar,
taking equal parts of each. Then roll rapidly on a porphyry slab, to
the diameter of a quill, and divide in fragments, each of which shall be
pointed at one end. Keep these in a wide-mouthed bottle in powdered

I860.] M

lime. These sticks remain perfectly hard, arc easily handled, cauterise
with peat regularity, and act bg b sponge through which the chloride
will slowly exude, becoming liquid by the action of the air and the

skin. Lancet.

Iodide of Propylamine, According to M. Benjamin J. Crew, in
the American Journal of Pharmacy, for September, propylamine com-
bines readily with the aid of a gentle heal with iodine, and forms a
colorless solution in which the characteristic odor of these twosubstai

can be perceived. It may be prepared by adding iodine to a conve-
nient quantity of propylamine in a glass flask over a sand bath as loDg
as the iodine is taken up ; a deep red solution is first formed, which, as
the combination is effected, becomes gradually colorless ; in case of an
excess of iodine, a small addition of propylamine will speedily take it up.
M. Crew that the iodide of propylamine might be found to

answer better in certain cases than the chloride. He proposes the fol-
lowing formula: R. Iodide of propylamine, 25 drops; peppermint
water, 6 f. oz.; sugar, 2 drams. Dose A table-spoonful every two
hours. In this form the patient would receive the 1-lGtli grain of iodine
at a d

Treatment of Gleet. Every one knows how tiresome and difficult
to cure a gleet may become, and how weary of each other both patient
and surgeon occasionally grow in consequence. A little " dodge."
which may not yet have crossed the Channel, and which I have seen
succeed here, when the whole armament of balsamics, injections, and
derivatives had failed, is the following : Take a moderate-sized wTax
bougie (the common yellow wax ones are the best,) warm it slightly, and
then roll it for a few seconds in well-powdered alum ; when thoroughly
whitened with the salt, roll it between the hands so as to press the alum
well into the wax, and the instrument is ready for use. Make the
patient micturate previously, and then pass your bougie, without the
ance of oil or cerate, as far as may be deemed advisable, cutting it
off to within an inch of the orifice of the meatus, where it may be tied
or not, and left for one hour each day. In this way a tiresome and re-
fractory old gleet may be cured in ten days. Lancet, July 8, 1860.

Chloroform in Scabies. Professor Bock, in Schmidt's Jahrsbucli,
for August, states that the external application of chloroform is useful in
some cases of itch. This substance appears to kill the insect, and
moreover, by producing anaesthesia, it relieves the irritability of the
skin. M. Bock has never observed any inconvenience to arise from the
use of chloroform ; and the sensation of burning, which it produces for a
short time, is quite trifling in comparison with the intolerable itching
caused by the disease. Chemist and Druggist.

Lotion for Mentagra. M. Richard has recently called attention to
the good effects which he has seen from the application, in patients
affected with mentagra, of a lotion composed of sulphate of zinc and

960 Miscellaneous.

sulphate of copper in distilled water. After the employment of ordinary
remedies, and when the affected part is cleansed from the crusts which
cover it, the lotion is applied frequently ; and under this treatment it
has been found that the disease disappears in a comparatively short
period. Br. Am. Jour.

British and Foreign Medico-Chirurgical Review. We learn
that Dr. Sieveking, who has for several years very ably conducted this
iournal, is about to retire form the editorship.

Iodohydrate of Ammonia in Constitutional Syjihilis. Prof.
Gamberini deduces the following conclusions from fourteen cases: 1.
Iodide of ammonia and the iodohydrate of ammonia are indicated in the
same cases of syphilitic diseases as the iodide of potas. 2. The treat-
ment from the employment of this remedy in increasing doses from 10
to 80 centigrammes daily, in from 100 to 180 grammes of some liquid,
has lasted from 14 to 35 days, averaging 21 days. 3 A sensation of
burning or heat in the throat and stomach of some patients forced us to
suspend temporarily the iodide, as well as to lessen the dose. 4. A lin-
iment, composed of the same remedy, with olive oil, 15 centigrammes of
the former, and 30 centigrammes of the latter, has assisted in curing the
osteocopic pains, 5. Syphilitic accidents cured by iodide of ammonia
have been cases of arthralgia, rheumatic neuralgia, periostosis, ganglionic
enlargements of the groins and neck, and a papulo-vesicular eruption of
the back. The process of making this medicine is very simple. It is
that of Buspini, consisting in precipitating a solution of the iodide of
iron by carbonate of ammonia, filtering the solution, which is then to be
evaporated promptly, until a pellicle is formed, and then crystallize.
This salt crystallizes in cubes, and is very soluble in water. Its taste is not
very disagreeable, being a little more bitter than iodide of potas. Bol-
letino delle Scie?tza Medica : ' Union Medicale de la Gironde.

PJtthisis in Hysterical Subjects M. Beau, in a clinical lecfure,
given on the 4th of August, at La Charite, spoke of the rare occurrence
of phthisis in hysterical subjects. The cases which suggested his re-
marks were those of two females of middle age, at the present moment
under treatment in his wards, both presenting the symptoms of the sup-
purative stage of consumption, and both having within a very recent
period manifested unequivacal indications of hysteria. The coincidence
of the two affections, he said, was rare so rare, indeed, as to have led
to the belief that the presence of the latter exercised a protective influ-
ence in the constitution antagonistic to the development of turbercle.
The same immunity from phthisis had been observed in persons suffer-
ing from asthma and emphysema of the lungs. But this also, was a
general and not an invariable rule ; and M. Beau expressed himself as
onfident that neither of these morbid conditions could be considered as
compatible with the tubercular diathesis ; their coexistence was the ex-
ception, and not the rule, but quite sufficed to prove that hysteria pos-
sessed no power in preserving the patient from phthisis. Lancet,

INDEX TO VOLUME XVI.

PAGE.

Aii Essay on the Adaptation of
Climate to the Consumptive
for a permanent residence, em-
bracing an examination of the
climate of certain localil '
frequent resort ; and also an
Investigation of the degr<
Adaptedness of the Pacific
Climates of the United State_s.
By William Henry Doughty,
M. D., of Augusta, Georgia,

81, 161, 234

A New -Mode of Dressing in the
Wound- of Amputation. By
M. Laugier 136

American Contributions to Med-
ic;!] Science. By Prof. L. A.
Dugas 154

A Clinical Lecture, delivered at
the Augusta Hospital upon
the subject of Homeopathy.
Prof. L. A. Dugas... . .'. 242

A Case of Threatened Abortion,
apparently caused by Malaria.
By M. 0. Davidson, M. !>..
\'an Buren, Arkansas 290

Another Sovereign Remedy for
Ascarides 480

A Case of Dyspepsia cured with
Strychnia. By (). C. Gi
M. lb. o\' Frew-bur- X. Y. . 298

A Revolution in An. . 304

A Practical Treatise on the Di-
I
ment of Diseasesof the Heart 312

A Few Particulars respect';;
Woorara 870

Atropia in Incontinence of
Trine 392

American Medical Society of
Paris * 399

American Contributions to Med-
ical Knowledge 473

Animal Oils in Fever 473

An I Hood-letting. By

A. fcf. M.

1)., of Augusta, (hi

A Series of Lectures on Pick-

518,

Action of Chloride of Zinc as a

Caustic 540

Abortive Treatment of Paron-

chia 480

American Medical Association,

A Successful Operation of Sta-

phyloraphy. By Prof. L. A.

Dugas... .'....

A Clinical Lecture at the Royal
Free Hospital, London .

Delirum Tremens 703

Anaesthesia and Amesthetics. . . 758
Advantages of the Use of Gly-
cerine in Surgery 7^2

An Air-Plug- for the Speculum
Uteri. By Henry P. Camp-
hell M. D "

i c P o i s oning and Eating. . V 5 0

Blood-letting in 1 >is< a 014

Bronchitis and Pneumonia. . .

Buttermilk and Longevity 319

Blood-letting in Pregnancy. . . . 352
British and Foreign Med. Chir.

Review " 960

Comparative Pesearches on Ole-
um Morrhuse, Bajae and

Squali 04

ract in Progs produced by

gar 7i'

Cauterization of Tumors 144

Caustic 159

,Cancer: 159

Case of Poisoning by Atropine,
Coli< onum Treatment

;tt La ChaVite

Chloroform Vapor in Far Ach
Contributions to the Bistory of
Nervous Diseases of Syphili-
tic oriuin 000

062

INDEX.

PAGE.

Caffeine as an Antidote in the
Poisonous Narcotism of Opi-
um. By H.F. Campbell.... 321
Crania] Deficiency in a Foetus

at full term ' 388

Carbonate of Lithia in (lout.. 382
Croup and its Treatment with
Anteperiodic Doses of Qui-
nine. ByH. F.Campbell. .. 393
Cold Affusion in Narcotic Pois-
oning 461

Case of Ovarian Disease, com-
plicated with Pregnancy and
immense secretion of Liquor
Amnii. Delivery of Twins
at five and a half months
Recovery. ByE. M. Pendle-
ton, M. D.... 481

Correlation of Forces 598

Clot of Blood in the Pons Varo-
lii 622

Chlorodyne History 626

Caffeine in Opium Coma. By

H. F. Campbell 628

Clinical Lectures on Diseases of

the Eye 671

Case of Inflammation ofOs and
Cervix Uteri cured by the
Cautery. By P. W. Doug-
lass, M. D 833

Chloride of Zinc as a Caustic. . 958

Chloroform in Scabies 959

Diuretic Action of Iodide of

Potassium 48

Diabetic Cataract ' 208

Dr. X. Bozeman 235

Digitaline in Puerperal Fevers. 239
Double Amputation for Gan-
grene of the Feet 251

Death from Obstruction of a
small portion of the Alimenta-
ry Canal in a new born infant 252
Dressing of Scalp Wounds with
Silver Sutures and tying the

Hair 343

Do Pad Smells cause Disease. . 447

Diphtheritis 836

Death of Chariot W. West 554

Epethelial Cancer of the Lips.. 286
Effect of Caffeine on the Mus-
cular System. By Henry F.

Campbell 397

Electricity in the Treatment of
the Diseases of the Ear 444

PAGE.

External Application of Bella-
donna in Scarlet Fever 548

End of Sixteenth Volume of
Southern Medical and Surgi-
cal Journal 95 7

;Fever and Ague 45

Fever the Duality of its Source P4

Formation of Clots During Life 1 ! 1

Fluid Extract of Camomile 398

I Poetic Sweating of the Feet. . . 560

First Report to the Cotton Plan-
ters' Convention of Georgia,
on the Shell Limestones and
Maries of Georgia. Bv Jos-
eph Jones. M. D. . . .721, 801, 881

Fifty Years Ago 795

General View of the Therapeu-
tic Application of Electricity.
By Joseph Jones, M. D . . . . . 9

General Council of Medical Ed-
ucation and Registration of
Great Britain 79

Grave Pneumonia speedily re-
lieved by Ergotine 147

Glucosuria in Marsh Fevers. . . . 238
Do in Paludal do .... 477

Hospital Statistics 77

llydrocynate of Iron in Epelip-
sy. ion

Hygienic Treatment of Diabetes
Mellitus, or Glencosuria. from
the French of Bourchardat. . 20-1

Habits of Phvsicians in 1670. . 480
;Holopathy.. 08-1

Hypophosphites in some condi-
ditions of Disease in Young
Children S85

Humboldt's Library 400

.Iodide of Ammonia in Syphilis 398

Improved Xeedles for Vesico-
vaginal Fistula 811

Induction of Premature Labor. 545

Importance of the Functions of
the Skin in the Pathology
and Treatment of Tubercular
Consumption 634

lodohydrate of Ammonia in
Constitutional Syphilis 71 7

Incontinence of Urine

Idolized Glycerine in Skin Dis-
eases 864

Iodide of Propylamine

lodohydrate of Ammonia '-"i'1

[NDEX.

968

PAGE.

JacksonStreel Hospital Reports,
By Robt. 0. Carroll, M. D. . . 882

Leuoooythflsmia 872

Lectures on the Diseases of In-
fancy and Childhood 56 I

Ligature of the Common Caro-
tid for Hemorrhage from the

Tonsil 291

Larch Bark in Pulmonary Hem-
orrhage 988

Lotion for Mentagra 969

Maisouneuve's Operation for Re-
moval of Naso-Pharyngeal Fi-
brous Polyps 88

Markoe on Subcutaneous Per-
foration of Bone in Ununited

Fracture 306

.Method of Applying Chloride

of Zinc 400

Metalie Ligatures 43G

Memorial to John Hunter 478

Medical Colleges and Medical

Students 558

Mal-Practic'e 675

Medical College of Georgia, Tl
Mammary Abcess Occurring

During Lactation 700

Median Lithotomy 267

Needles in the Stomach 223

Normal Hypertrophy of the

Heart During Pregnancy . . . . 228
Nux Noniica as a Febrifuge. . . 318

New Needle for Sutures 795

Necrosed Hone 472

()n some of the Difficulties at-
tending upon the Treatment
of Stricture of the Uthera. . 83
Osseous and Cartilaginous Sys-
tem 42

On Apparent Equivocal Gener-
ation 4G

i >n the Employment of Veratria
in Acute Diseases of the Chest 50

( )n the Spiral Chord 52

On the Treatment of Epithetial
Cancer by Application of Ac-
tual Cautery 53

On the Action of Fatty Bodies
in the Absorption and Assimi-
lation of the Metalie Oxides, 55
On the Production of Cataract
in Frogs by the Administra-
tion of Sugar 57

On Glycerine 69

( >n Inflammation of the Thora-
cic Duct

On the Nature. Seal and Rela-
tions of Neuralgia

On the Efficacy of Cold Affu-
sion to the Head in Narcotism

On the Existence of Febrinous
ClotS in the Heart in Borne
cases of Croup

On a Case of Acute Chorea trea-
ted successfully with Arsenic

On the Employment of Tonics
in the Treatment of Typhoid
Fever

On the Cicatrix-like streaks on
the Skin of the Abdomen,
Breasts and Thighs of Wo-
men that are Pregnant, or

have Children

I On Cerebral Symptoms Inde-
pendent of Cerebral Disease

On Discharges from the Uretha,
not of a specific Gonorrheal
character

On the Physiological position of
Fibrin

On the Mode of Employing the
Hypodermic Treatment

On the Treatment of Corns on
the Sole of the Foot

On the Curability and Treat-
ment of Pulmonary Phthisis
and Tubercle

Occlusion of the Vagina

Osteo-Plastic Operations

iOur List of Payments

On Opiated Colchicum Wine in
Rheumatism

On the Treatment of Rheuma-
tic Affections

jOn Iritis as it Occurs in Syphil-
itic Infants

|On the Use of Sarsaparilla in
Syphilitic Diseases

Proposition of an Abortive
Treatment of Typhus Fever.

PirogofTs Osteoplastic Prolon-
gation of the Bones of the
Leg, with Exarticnlation on
the Tibio-Tarsal Articulation.

Persulphate of Iron as a Hoe-
mostatic

Preparations of Larch Hark in
Pulmonary Hemorrhage. . . .

\(.r.

126
180

210

220
226

22 'J

232

254

279
289

2!'2
468

465
469
506

552

698
865

-74
953

411

138
236

2:.7

%4

rXDEX.

T'.V TAGE.

Permanent Exutories in Chron- Santonine in Amaurosis

ic Plegmasice 302 The Pathology and Treatment

Private Instructions in Chemis- of Cardiac Disease 17

trv

Preparation of Caffein

Pathology of the Pituitary Body
Pathological and Practical Ob-
servations on Diseases of the
Alimentary Canal, Aesdpha-
gns, Stomach. Ccecum and In-

311 The Chemistry of Caustic!

310 The Sixteenth Volume of the
344 Southern Medical Journal. . .

Transaction of the American
Medical Association, Volume

12

The causes of Pulmonary Con-

testines 553 sumption 12

Physiology of Digestion 615 Transplantation of the Dura

Pathology and Therapeutic- of
Typhus Fever

Proceedings of the American
Medical Association 631,

Phosphornecrosis

Perchloride of Iron in Epitaxis,
etc

Practical Clinical Remarks on
Diseases of the Bursa Patel-
la!

Mater as a means of deter-

623 mining its Periosteal charac-
ter 1

720 Treatment of the Nausea and

Vomiting of Pregnancy 150

Treatment of Whooping Cough

59

273

by Diluted Nitric Acid 153

The Relations of Belladonna and
Opium, and on Poisoning by
Belladonna 197

Persulphate of Iron 918 Treatment of Blehnorhagia by

Paralysis Agitans removed by

continuous Galvanic Current

Palliative Treatment of Cancer

Vinum Colchici and Tincture

024- of Opium 227

027 Treatment of Indolent Ulcers

Poisoning by Strychnine 952 j by Vapor of Iodine 2Sq

Pathology of Tubercle 940 Treatment of Gout and Rheu-

Pathology of Lead Colic 943 matism 2 I

Phthisis in Hysterical Subjects, 960 To Avoid Sutures and Shavii
Report of the Proceedings of the Head in Wounds of the

the Medical Association of Scalp

Georgia for 1860 4-15 The Influence of Cohabitation

Raw Meat in Chronic Dvsente- in the Transmission of Phth>-

ry * 791 is

Raw Meat as a Remedy 950 The Microscopist's Companion. 815

Stomatitis Materna 1 The Georgia Medical Associa-

Strychnine as a Remedial Agent 5 tion ill 1

Syphilitic Pneumonia 109 The Binding of the Fifteenth

Sickness of Pregnancy 160 j Volume

Substitute for Anaesthesia 218 The Diseases of the Par. Na-

Sugar in Urine 219 tore, Diagnosis and Treat-
Southern Students Leaving the ment *7fi

Medical Schools of Philadel- The Antiseptic Properties of Io-

phia 236 dine 47'.'

matitis Materna :>s4 The Croup Process

Strychnine in Ileus 471 The Diagnostic Tube, and the

Spontaneous Cure of Cancer of Diseases of the Middle Cham-

the Breast 547 ber of the Ear

Subcutaneous Injection ot Mor- Treatment of Obesity 400

phia in a case <>f Puerperal The Endermii

Convulsions 697 ; Fat in Typhoid Fever 401

Synthesis of Cataract 701 The Annual Address, delivered

Sunstroke 863 1 before the Georgia Medical

PAQI.

\ <> liation, at their Meeting,
lield at Rome, Georgia, April,
I860 ,

Treatment of I \\ epepsia 451

rreatment of Ascaridea

Treatment of Epidemio Whoop-
ingOonghby Vaeoination... -IT"

tnptoma, Diagnosis, and
Treatment of [ntnssnsception,
\\ ith oases

Tongue Removed by the Ecra-

r 548

Topical Applications for Tomo
of the Breast 549

The Arsenic Eaters of Styria. . 556

Adulteration of Tea 618

of Tracheotomy, for
Removal of a For
Body from the Trachea 618

The Humoral and Vital Pathol-

641

menl of Deaf Mutes 652

The Theory of Tertiary Syphil-
is ., 633

The Effects od Children of Mer-
curial Treatment ot" Syphilis
in their Parents '. 680

Treatment of Mammary Abscess 682

Technical Chemistry Disinfec-
tants 687

Therapeutic Effects of Ammo- .
nia as a Dermic Agent in the
Treatment of Disease 706

Treatment of Lupus 713

Treatment of Prolapsus of the
Funis 716

The Value of some New Reme-
dies lately introduced in the
Treatment of Phthisis 716

The London Medical Review. . 719

pjLOE.

The Lan ogoscope. .

The 29th Session of the Medical

Coll ' orgia 7'.' 1

The Year Book of American
licine

The Number oi' Children a \\ 0

man can Beai

Tannin as Ami lote to Strj oh-

' nine

Treatmenl of Gleet 959

Treatment of Varicose Veins of

the Leg and Varicocele 918

Union of Strands of the Hair

i8s the [noisiou in wounds

Of the Scalp 630

Urethritis and Vaginitis 225

Unaccountable Antipathies. . . . 816

(Jngnentnm Glycerine 659

Urticaria as a Symptom of Irri-
tation of the Female Sexual

Organs 948

Valerinate of Strychnia 456

Venereal Diseases 7is

Vegetable Parasites of the Hu-
man Skin 458

Vesico Vaginal Fistula 551

Veratmm Viride in Nervous

Affections 7

IVentillationof Rooms at Night 958
What they think of American

Diplomas Abroad 957

J Whooping Cough 859

jWoorara in Tetanus '. 712

I White Lead Paint in Cutaneous

Diseases 714

White Paint in Severe Burns. . 297
Year Book of American Contri-
butions to Medical Science
and Literature 796

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