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. / 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 exeeut 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'' >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 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 If rt -2 .2 3S 0 p '0 T T CO CO CO e oTP : COCO O O O O 0 o tj< co e CN o o o o_ o o 'O e CO 02 CO 35 t- -< o o o o o o - -r -r f 1(5 CO CO CO CO - O CO CO =3 -T CN CO G* 0 0 O O 0 o co m n <- -- :. : r. cd i- cc CO >-0 T t- CO CO o o o o r> o t- cc t- C "O 35 CO "3 CO t- 1- t- f- CN CO CO C N . C- CO O O 0_ 0 0 O tC in f CO OS 00 V CO CM CD CO 35 o o o o o o CC "3 t- C Th a it; cn -0 CO OC0COO35CN 0 o o o o o to n us t- c t- <-,2P88S O O O 0 o o OHO"* O CC CD CC CO CO - - !__ 3c it; <- -r- CO CO O t- co to O CVO O O 0 >Q :o JB X i- t- CO OC -J CN CN t- uo , in t> co o o o o^o o CO UQ L.Q CO P t^ CO 35 CO CO CD x j;n o o o o o o CO [- CC :c 35 35 CO OCCf-C" 1- l- co cc -r - s -i 65 co eo w O O 0 O 0 o CO 3 CO LO 35 "3 CC p- p- CO r- T CC CO = 35 3 c a a 3 o t- 'J' CC CN CO CN ,~ t ._ ._ , 0) i in co t- CD CD CO O i 3 3c a 3 3 ; - : - - -- -! -N CO '0 S5 C- p- P- 'a ^2 - 2* -,2 . S3 E Jg 1 o 3 o.2 S 1 ct : = ; 3 >. co a s * a 5 a * * - c/> x j. o9 cf. P 03 I a 33 C3 r-< bC P .P " ~ '"P P P qn h a) ;- r; - *^ fl* -M *_i #- ** r-^ CC 43 ^ P o ^o P-T P ^ o o / o p C3 rti P be P c8 P C o H P ' P a bo 03 rP O -/, P 'o !S pv. * P cc M r-J S 03 a O o .. be be -e g Ph be^: rP p -*r o .3 P h P r-' 5 r^ .IP P T! t-* *--* fcj ^ P p ^ tH O -+^> ^^ p XI o L-i 33 -r O ^2 cc C -Q cq c-j Ph |L| P P |> ^ P P u o p te P o CN r-P O o be o -J o ^ S -^ ^ --i HM EH ^ -14 o bO' J-. a c -/. "-- S3 Ph ^P DD 03 - 33 U be O 03 P ^h QD -O -( - i +J CO cc <3 O o Ph P P g 1 a "S ^ +3 o _P r <+-< -+f o c3 P CC Cj .r-i r O co P d ^ p s -*-0 rp P f O > P o 2 2 rP CO o S3 a 73 pj ^ -+- o" P 5 5 o -t- o p p rP co be ,2 .2 rP P^ P - I ro CQ .Jh r| S 2 o 2 ^ TJ =- -_P O ^ r^ P r CO O P* c3 O s 'H-f o 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-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 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 over <*'g,S>& 2:8=3, !2&35 a- X * 4-5 ^ ->r ~ o o o o ;S; :SS: J b o o o ci o r t- t> r: l- ! I _ , iC ir r> tt lO T TCTt"f,C t~ <= t- f- co eo &2.&g. 2.8, >0 "5 <> tO !S CD { , - 3-. OS cc t- .e . |tc ex co ec co 6j o o o o o o x 5 CO -T < ? c^ co ec e >o te o c r- o e o 8, 8, 2. & ft 8. >-r s i.: c>. f c is 0 O Q O O O H* i sc ce cn * ec o ^ C C h O ;S O ' il^ IC o to c C ' -r 45 b o ^^ g 'So .2 o o ?- - g O o n 0 o 43 & -s **- 2. &^ | I S c3 o CJ I S o o ^1 c 4H o S 8 ffl g a o % >. .o c Eg Q 03 Ph P rli 0D o a "z S ^ +3 o 3 ^ co ^ O goo O CD ao ci c3 *fl r^ 13 3 g ph 45 O J o CO 45 CD ^ co ph 03 4s -- CO ^5 03 ^ 33 c+h a "S r-. CO 03 00 P bJD P 03 00 5 a h - 03 9 a o3 CO 45 r-. 42 9 > o o 3 & c3 a e 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 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!^ 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 thld 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-sf 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-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 anften 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< 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< ref 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 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 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 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\ 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 \\ 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>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 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 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\' 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. 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 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 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 {' the sterling good Bense of Wat- son and BiHing, o\' London; ^{' Graves and Stokes, of the eminently practical Dublin School of Medicine: \' 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 . 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 ]>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. Buf 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. 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>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. \Vixty 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 <- 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. 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'>>. 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, "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 ! 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 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 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. 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 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 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 . 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 )]]. 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 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 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 /. 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 :<> 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 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 Tj*e s ~ ~r ^:ih^ o i- o ST a ei S o C 2 - - B 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 :.> 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 o a o ' a z o o - 'en H 00 P< OQ o ._ s o O -d ,G w M R "en fcfl fl h w T3 cS < W ft fe O 0 - 69 QQ o CO 13 C^ ^ w o fi o 1 C tc o t- o >. -^ o r3 GO o k; j -_ - O o Xfl o3 >T3 DQ "go a. N ' '/. F hJ +s o3 ^ ,03 o fr C w -o ^d ** 3 fS o" o 5 r? o OJ OT o : --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. 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) "* 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 6A 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 ' 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 ^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 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< 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 :

-^ :.'; 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 ,".", 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 (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 .*; 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 ~- ~ c~. o OJ 0? c* _, ~. "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 > 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 -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 > ' ~. 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- ~ 3, r" /. < 25 < I Ton of 2000 pounds contain, oo 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$3g8 SSSSfSi* tioNOKv: c: \c cr. c 1 1.- ci V crj ~ * id r. i / - -iik^. 3 t p-i si .-. o35e ~ Water, ^223S=j SSSSSSS 352?=?5 = ?!??3S?2 H -t--jo -f 1- +&.* & eocg> X 00 I- te ' r- c> C l So53q L- o o t- c> ICC-* o ci-*xo CC I- f I- *J Sulphuric Acid, 'hlorine, '51 ia e o c .- o C; .-_ l- 9 1; c; CI -T t> 3r. ' -7 Magnesia, r-$ 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 : 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 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< <*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- -: . - (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 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-! 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 : : ' "}- cifcacco 001 Sand and Silica ~ ncootcj nKici-ooi!' iioa-cTiO nn-ci--/) rtr.sccxj 1 a a #oc 1 - - - r - n T-< 1 I- "i CI ; ^j i 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 : : : : & : : - 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 -l CO >C l~ CO o "858888 i :--f ci- -to co -r -. i . : i - 1 - 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 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 o I CM O rt G? O w r/j O s i-; _^ 4> rM1 r/; o o r5 5 3 M pq o t* o cS ^r -M 0 GU 0 O H a o O r_, cs o 1 1 a 0) rG o G> rC bC o 0Q Organic Matter. Water as Moist. 'J' CO i-i O NPSN^HOOWO r-iCNrHTOifiCt~-* 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 o *-c a w "ft W to 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 OMriOfTfCNH OHMCOijiCOOOOHHWNO 1-1 Sulphuric Acid. . CI CM i CM co -f o '''' i-i ' ^ ' ' ::';:::: Sulphate Lime. o . cC . CM if CM rf O CO to SO tO 31 CM U3 co OOOOHWH rH rH O CM rH CM TO Tf iO rH Caib. Magnesia I- 1- CM ^ > CI "tf IG id QC C R i i tf rr 0"*X-*X!NOhw N "* H x h o 1 CO XCiCCOJ-lrlH-eOt-iOTOOXt- CM to rH CM TO nf CO rH CM TO CO - i 1 1> O t- * * C i i CM i i JITOi* t- t- * n CO i(5 r~ m< *- r~ -*f iCr-iCM'* t- i iiuspuunc .rixiu . , e M o o a ai a o x * cr. a * oo n t- i-< * i ( CO i i CO "O O CO i< CM i-Cl CM iO CO i-i i 1 CM O rH r 1 CM CO rl cs o c x n o o c c o i.c o o o co to co te as cm us o **CO CltOTO cow Phnwn'fp nf I.imptc 3i-tf3i- 0 co 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 - 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 - 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 - 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 .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 -.o 10 cm co oi i.o --H rfi cm -* . -# at x ^ ic tO CM rHrH C5>CtOrHt^-rJ4 -*I.CMC5tOeO .t-rH*~Hj 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/ 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* 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 -; 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* <6(6<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.0 d d * 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<-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 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 #' 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 - 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 . , . 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<-^* 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- . . . - >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 , * 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, 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 =? 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 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 ^ * - *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 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 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 >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 -" : 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- c \ egetable Matter, ^.^r^^'Txi:-; '-.::. "'."".--" ~. ~! '-. ~-~. '-.': ". t~ r-i -9- CC O :I" 50 "2 2* 1 : ;*y . ,,c( aSf% 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 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 / 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, 1artly 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 Wf }l yd , M Wmti Warn WM Wmm X&Jmjfflf/fi